Wegovy and other new weight-loss pills really work—so what’s next?

In recent years, few prescription drugs have burst into the public consciousness as suddenly as Ozempic and Wegovy. Novo Nordisk’s brand-name drugs have become as synonymous with weight loss as Viagra and Cialis are for erectile dysfunction. While 2023 has made it clear that these and similar drugs are indeed the future of obesity treatment, it’s also shown that that future looks messy — sometimes for reasons that have nothing to do with the drugs themselves.

Semaglutide: the real deal

Semaglutide is the active ingredient in Ozempic and Wegovy and is injected subcutaneously once a week. It is a synthetic and longer-lasting version of the hormone GLP-1, a hormone that regulates metabolic functions such as hunger and insulin production. Ozempic was approved by the Food and Drug Administration in 2017 to treat type 2 diabetes; in 2021, a higher dose of Wegovy was approved to treat obesity.

Wegovy achieved unprecedented success in clinical trials and was ultimately approved by the FDA, helping people lose an average of 15% of their baseline body weight.These results led many experts to predict A new era of obesity medicine.In data collected since then, semaglutide not only works as expected But it appears to offer benefits beyond weight loss, such as alleviating some addiction symptoms.

In November, researchers publish A series of cases in which people with alcohol use disorder began to desire to drink less alcohol after starting to take semaglutide to treat obesity. The drug is currently being tested by several teams to treat alcohol dependence and other disorders associated with compulsive behavior, such as bulimia.Elsewhere, scientists have begun investigating whether GLP-1 can reduce inflammation in the brain and slow the progression of diseases such as Alzheimer’s, some of which Promising early results.

There may be other health benefits.This summer, Novo Nordisk freed Results from the SELECT trial, which studied heart-related outcomes after taking high-dose semaglutide or placebo in obese or overweight patients with cardiovascular disease. Compared with placebo, patients taking the drug had a 20% lower risk of major (and potentially fatal) cardiovascular problems such as heart attack or stroke for up to 5 years. In October, the company Decide A similar trial of semaglutide in chronic kidney disease ended early after preliminary results found clear benefit.

This risk reduction may be largely due to weight loss, which is an important finding in itself. Many studies have shown that weight loss improves overall health in people with obesity, but it’s difficult to prove directly—in part because it’s often difficult for people to lose weight and keep it off long enough, apart from interventions like surgery to study them. Same.But some studies have suggestion These benefits go beyond weight loss and may be related to semaglutide’s other effects on the body.

Not all of these avenues of research are guaranteed to pay off. But even if only some people do, these drugs could improve and potentially save millions of lives, more than anyone initially foresees.

Competitors enter the ring: Tezepatide

Perhaps the most important development this year is the FDA’s Agree Eli Lilly launches Zepbound for obesity in November. The drug’s active ingredient is tezeparatide, which mimics GLP-1 and GIP, another hunger-related hormone, a combination that appears to be more effective than Wegovy in treating obesity. In clinical trials, people taking tezepatide lost an average of 20 to 25 percent of their body weight, a weight loss close to that seen with the most successful bariatric surgeries.

The arrival of Zepbound not only solidifies the fierce competition in the obesity drug market going forward, but also shows that these products are just the beginning.There are dozens now Other Obesity Drug Candidates Some of these drugs are in development and may help people lose more weight than semaglutide or tezepatide, or may offer other advantages, such as being easier to take go take medicine rather than as an injection.

No free lunch: Side effects of weight loss pills

Although these drugs may seem almost miraculous, few treatments are without risks. People who take them often experience gastrointestinal problems such as vomiting and diarrhea. These symptoms tend to go away over time and are usually not severe enough for most people to stop receiving treatment.But there have been some signs People can develop serious complications such as gastroparesis, pancreatitis, and even suicidal ideation. In September, FDA renew The labels for Wegovy and Ozempic warn that the products may cause ileus (intestinal obstruction) based on adverse event reporting data, but the agency has not identified this as a known risk.

Some of these questionable side effects, such as suicidal ideation, have less evidence Currently supported Links used by GLP-1 compared to others. In general, serious problems such as gastric paralysis and intestinal blockage appear to be rare. But doctors and patients must always be aware of these issues and evaluate whether the benefits are worth the risks.

Semaglutide off-label and black market products

Not all complications associated with these drugs are medical. Production issues and unexpected demand have led to ongoing shortages of Wegovy and Ozempic, as many doctors have begun prescribing the latter drugs off-label for weight loss.This in turn affects the care of people taking Ozempic as intended, including people with diabetes is switched Other medications that may be less effective.

The drugs’ low availability, high price tags (more than $1,000 per month without insurance) and often lack of insurance coverage also contribute to their emergence. Gray and black markets. People now buy customized and much cheaper versions of semaglutide from compounding pharmacies, but there is no guarantee of its safety or effectiveness. The increasing popularity of co-semaglutide may lead to an increase in overdoses.Earlier this month, the U.S. Poison Center report So far this year, poison control centers nationwide have received about 3,000 calls related to the drug, a 15-fold increase from 2019. In other countries, including Austria, pseudosemaglutide Rumors have begun circulating that some people have been hospitalized for taking falsely labeled products that actually contained insulin.

the road ahead

The latest clinical data shows that many people will regain some lost weight if they stop taking these medicines. This isn’t inherently a problem, as many chronic conditions require ongoing treatment, but it does complicate things. For example, will people be able to continue paying for these drugs, especially as insurance companies start to become more restrictive about coverage of these drugs?Weight cycling is often thought of as what happens to the health of people who lose and gain weight as a result of losing coverage. harmful?

Unless dangerous and relatively common side effects are discovered, these drugs are unlikely to become less popular anytime soon. But even in a world where these drugs are generally safe and effective, not everyone will like them.

some critics have debate These drugs do little to actually help most obese people and perpetuate harmful messages about obesity, such as the idea that people must be thin to be healthy. Conversely, you don’t have to scroll too far through social media posts about these drugs to find that people view them as a drug. Quick solution And says people should lose weight the “real way”, just through lifestyle changes – as if people didn’t spend any money billions of dollars per year Trying to do so in vain.

Others have made a more nuanced argument, arguing that these drugs do not address the drivers of obesity, such as barriers to accessing nutritious, fresh foods. But statins for cardiovascular disease or chemotherapy for colon cancer (treating other chronic diseases that have also been linked to an unhealthy diet or lack of exercise) don’t work either.

It’s true that drugs like semaglutide and tilsiparatide don’t solve the obesity problem by themselves (assuming you think that’s a problem to be solved). But they are and will continue to help some people lose weight and potentially become healthier—as long as you can afford the cost or find a safe supply in the first place. Predicting anything beyond this, including their impact on society as a whole, is not so easy.