Ozempic: is the trendy anti-obesity drug really a revolution?

The Conversation

In the last year we have seen Ozempic gain enormous popularity for treating obesity around the world.

Promoted by actors and influencers Through social networks, its fame has generated high demand and even a shortage of supply in some countries.

Does the commotion that has arisen make sense? Who is it really indicated for?

Why do you lose weight?

Generic name semaglutide, this drug is an incretin marketed exclusively by the Danish laboratory Novo Nordisk under the trade names Ozempic, Rybelsus and Wegovy.

To explain how it works we have to go back to the research carried out in the first half of the 20th century. With them, it was demonstrated that the oral administration of glucose produced a greater release of insulin than if it were administered at an equivalent dose intravenously.

It was in the laboratory directed by Professor W. Creutzfeldt where the existence of certain peptides responsible for this effect was discovered in the seventies. They were given the rank of hormones under the name incretins.

Endogenous incretins, such as GLP-1 (glucagon-like peptide 1) and GIP (glucose-dependent insulinotropic peptide), are produced in intestinal L and K cells, respectively. These hormones are released in the intestine after eating food and act directly on their specific receptors.

Its main target is the pancreas, stimulating the release of insulin and inhibiting that of another hormone: glucagon. In this way they manage to regulate glucose levels in the blood, although they also act on other organs. This made incretins an important therapeutic resource in the treatment of type 2 diabetes and, subsequently, weight loss.

Specifically, Ozempic is a GLP-1 analogue that was originally developed, like others from the same group, to treat type 2 diabetes.

Now it has also become a valuable resource against obesity. In fact, the United States Food and Drug Administration (FDA), in 2021, and the European Medicines Agency (EMA), in 2022, authorized a new indication for this drug for adults with obesity, overweight or associated comorbidities.

This effect is due to the fact that it crosses the blood-brain barrier and acts on the central nervous networks that regulate food intake. This reduces appetite and slows down gastric emptying, which prolongs the feeling of satiety and reduces the desire to eat.

Additionally, Ozempic may improve insulin sensitivity. This helps those who have resistance to this hormone, a very common occurrence in obesity and type 2 diabetes. It is also worth remembering other favorable actions on blood pressure, inflammation and plasma lipids.

What risks does it have?

Like any other medication, Ozempic is not free of adverse effects. The information available to date describes the most common unwanted effects as those that occur at the gastrointestinal level. These include nausea, vomiting, diarrhea, flatulence, dyspepsia, and hypoglycemia.

Special caution should be taken when prescribing it in patients with diabetic retinopathy and informing about the potential risk of thyroid C cell tumors and pancreatitis.

Ozempic and Wegovy are administered subcutaneously once a week with very good bioavailability. That is, the amount of drug that reaches the blood unchanged is almost 90%. Novo Nordisk also makes semaglutide for oral administration (Rybelsus), but it offers reduced bioavailability.

Who would it be suitable for?

Currently, the number of obese people in the world is increasing, to the point of being considered a pandemic. This pathology is associated with other diseases, such as high blood pressure or type 2 diabetes. Therefore, losing between 5% and 10% of body weight is essential to reduce the risks of developing these comorbidities.

To this end, the FDA and EMA have approved the subcutaneous administration of semaglutide to reduce and maintain weight in adults who are obese or overweight or who suffer from at least one of the related pathologies, such as high blood pressure, type 2 diabetes or high cholesterol.

In any case, this treatment is always a complement to a low-calorie diet and increased physical activity. That is, it must be associated with changes in habits in these two areas of our lives.

Prescription only

Currently, therapeutic options to lose kilos are scarce, so the positive impact of Ozempic has aroused great interest in the medical community and among the general population. However, it is useless to try to fight obesity if the dietary habits or lack of physical activity that triggers it are not corrected.

According to experts, weight loss with Ozempic stops or stabilizes after 60-68 weeks. If the treatment is withdrawn, the patient can regain the lost kilos. This means that continued use would be required to keep this reduction stable, although we do not know if there are long-term adverse effects.

The “miracle drug” with which you can lose weight quickly and without any effort does not exist. In obesity, medical supervision is essential; Otherwise it turns out to be self-deception and a health risk.