This week is Obesity Care Week (OCW). At FORM, this week–and every week—we are dedicated to supporting people with obesity and to providing the best care to treat it. We share OCW21’s vision for a society that understands, respects, and accepts the complexities of obesity and values science and clinically-based care.
Obesity Prevention and Treatment is the theme for the second day of Obesity Care Week and I thought this would be a great opportunity to share promising results of new research on the weight effects of a medication called semaglutide. As a physician, I am dedicated to helping my patients prevent and treat medical complications related to excess weight. I strongly believe that changing one’s lifestyle by eating healthier food, limiting portions, and staying physically is essential for weight loss. But I also know that how much we weigh is a matter of biology, not willpower. The reality that excess weight has biological drivers is highlighted by my patients who, despite putting incredible effort to eat healthfully and increase exercise, are unable to achieve or sustain weight loss. This affects their health and leaves them feeling frustrated and defeated. And this is why weight loss medications -which modify our weight biology- play a key role in the treatment of obesity. Weight loss medications work by changing the chemical signals in our brain that regulate hunger and cravings.
Options for weight loss prescriptions for people with obesity (defined as a body mass index [BMI] above 30) have increased a lot over the last decade, with the approval of several medications. But we still desperately need more treatments, because the available drugs are either not accessible (due to cost and lack of insurance coverage) or not appropriate for so many individuals. The average weight loss with medications on the market is in the range of 5-10% in 6 months, so we would also of course love to see new medications that work more effectively, and help people lose even more weight.
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New research published in February in the New England Journal of Medicine studied how well a drug called semaglutide works to help people achieve weight loss. First, let’s review the basics. Remember high school biology? No? That’s ok, this wasn’t covered anyways. Here’s a refresher.
Our bodies naturally produce a hormone called GLP-1 when we eat. When GLP-1 interacts with signal receptors in the gut, it increases insulin secretion and lowers blood sugar levels. When the hormone interacts with signal receptors in the brain, it suppresses appetite. Semaglutide is in a class of drugs called glucagon-like peptide 1 receptor agonists (GLP-1 RA). GLP-1 RA drugs are synthetic versions of the GLP-1 hormone, so they help improve blood sugar levels and decrease appetite, which leads to weight loss. Because they increase the secretion of insulin, GLP-1 RA medications (including semaglutide) are approved for the treatment of type 2 diabetes. One drug in this class, liraglutide (Saxenda) is approved for weight loss in people without diabetes (I prescribe it all the time). What is exciting about semaglutide is that it is a more potent drug, so it is better at both glucose and weight reduction. And, while liraglutide has to be delivered as a daily injection, semaglutide is long-lasting and only has to be injected once per week.
The recent study of semaglutide for weight loss was a randomized, double-blind, placebo-controlled trial, with about 2000 participants, so it was a high-quality study. Semaglutide was used at a higher dose than is used for diabetes (2.4 mg per day for weight loss, 1.0 mg per day maximum dose for diabetes). In the study group that followed a diet and exercise plan plus injected semaglutide, the average weight loss was about 15%, compared to only 2.4% for the control group, at the end of 68 weeks. This is among the highest weight loss seen with any medication. More than a third of those in the study drug group lost 5% or more of their initial weight.
However, this medication does cause significant side effects, most commonly gastrointestinal. Nausea was reported among 44% in the group that got the drug, and others reported vomiting, diarrhea, constipation, and abdominal pain. Right now semaglutide is not approved or available for weight loss. Only the lower dose mentioned above is approved and available for people with type 2 diabetes. To be approved at this higher dose for weight loss, it will first have to go through a rigorous Food and Drug Administration (FDA) review. I am optimistic that this will be available in the near future as a new (and very effective!) medical treatment for obesity. But as with any new medication, there are unknowns at this time about how the approval process will go, how much it would cost, insurance coverage, etc. I am also thrilled to see that the scientific community continues to work to understand obesity as a medical condition and develop novel medical strategies to help people lose weight. And heartened to see efforts like Obesity Care Week devoted to promoting improved access to medical treatments, and respect and compassion for people with obesity.
Thanks to everyone who joins us today—and every day—in working toward obesity prevention and treatment, towards focusing on science while eradicating weight bias!
