Could a New Diabetes Drug Help You Lose Weight?
Maintaining a healthy weight is not just about the size you wear or the reflection in the mirror – it’s also about keeping your body healthy. Statistically, as a nation, we have a problem with maintaining a healthy weight. Two-thirds of the U.S. population is overweight, with 36.5% suffering from obesity, defined as a BMI over 30. Obesity means having too much body fat, which can lead to heart disease, diabetes, stroke, and more. For many, weight is a constant struggle, but a new medication on the market may help.
In June, the Federal Drug Administration approved Wegovy (semaglutide), a drug that has proven effective in helping reduce weight. Shore Physicians Group Ambulatory Pharmacist Dr. David Totton said Wegovy was approved for weight loss for patients with a BMI of 27 or greater who also have type 2 diabetes, high cholesterol, or high blood pressure. Patients with a BMI over 30 do not need a second contributing health problem for approval. In both cases, the patient must also adopt a lower calorie diet and increase exercise, with the potential to lose up to 20% of their body weight.
How Wegovy Aids Weight Loss
Wegovy belongs to a class of medications called GLP-1 agonists. According to Dr. Totton, these medications mimic the action of glucagon-like peptide, a hormone produced in the intestine that helps regulate appetite and control blood sugar. Another form of the same medication, Ozempic (semaglutide), was originally created for diabetics, but many of these patients also lost weight. That prompted an investigation into its potential to aid in weight loss for non-diabetic patients. Researchers found that GLP-1 agonists are also able to slow the movement of food through your digestive tract and suppress appetite centers in the brain, decreasing food cravings and helping patients (diabetic or not) reach their weight-loss goals.
Wegovy is not the first medication in this class to be approved for weight loss, in fact. The medication Saxenda (liraglutide) has been used for weight loss for years, however, it only provides a minor benefit, around a 5% reduction in weight compared to Wegovy, which can result in a 15-20% weight reduction in some patients.
BMI is an Important Number
Dr. Totton explained a patient is considered overweight when their body mass index (BMI) is 25-30 and obese when their BMI is >30. If you are unsure of your BMI, you can quickly find out by inputting your height and current weight in the CDC’s online BMI calculator.
“Being overweight or obese greatly increases your risk of heart disease, stroke, and a host of other related conditions, including hypertension, high cholesterol, and diabetes. In addition, holding onto so much weight can cause joint pain and make it even harder to lose weight, especially as you get older. Interestingly, for obese patients with Covid-19, they are five times more likely to require ICU admission and two times more likely to experience respiratory failure than those who are not obese.”
When you have a combination of obesity, high blood pressure, high cholesterol, or type 2 diabetes, this is known as “metabolic syndrome”, according to Dr. Totton. “The concern is that each of these comorbid conditions can contribute to vascular damage, inflammation, and greatly increase the risk of heart attack, stroke, disability, and untimely death. The reason that weight loss is so important is that obesity can contribute to, and worsen, all of these conditions, further compounding the negative effects.”
Research Found the Dual Purpose
Originally Ozempic was solely a drug for treating type 2 diabetes effectively. After examining the findings, the FDA has given the green light to treating obesity with the medication, rebranded for weight loss as Wegovy. Dr. Totton said finding another use for a medication is proof that continuing research may yield many useful results.
“This is how we discover uses for many different medications. For one condition, a side effect may have a beneficial impact on a different condition. This is just really smart use of an existing medication.”
Is It Worth The Side Effects?
Novo Nordisk, the Wegovy manufacturer, has a lengthy list of possible side effects. Dr. Totton weighed in on whether the ultimate goal of losing up to 20% of body weight is worth the possible side effects. Dr. Totton said, “The most common adverse side effects from Wegovy are gastrointestinal and include abdominal discomfort, nausea, vomiting, constipation, and diarrhea. Most of these side effects are rare or self-limiting, meaning the longer a patient remains on the medication, the less severe the side effects should become and, for the majority of patients, will completely resolve.”
Because Ozempic/Wegovy was originally designed for diabetes to reduce blood sugar, the risk of hypoglycemia was also carefully analyzed. According to Dr. Totton, “It was found that the effects of the medication are highly dependent on the presence of food, meaning that there is little risk of low blood sugar in the general population.” Dr. Totton added, “There are some rare instances where I would caution a patient against taking Wegovy. These include patients with a personal or family history of medullary thyroid cancer, those with multiple endocrine neoplasia syndrome type 2, and anyone with a history of pancreatitis. If you have any of these conditions, an alternate weight-loss medication may be a better option for you.”
Wegovy is a once-a-week injection, given in increasing amounts as a means of limiting side effects. Dr. Totton explained that slowly increasing a medication dose is a tried and true method for reducing adverse effects when starting medication.
“We administer the dose in increasing amounts over a period of time as tolerated until we reach the desired effect. This is essential so we don’t shock the system by introducing large amounts of an unfamiliar substance.” Dr. Totton said this strategy was well tolerated in the clinical trials leading to the medication’s approval and thus is the current recommendation when starting Wegovy.
Do Not Mix With Any Other Weight Loss Products
The manufacturer stresses Wegovy patients should not take any other weight loss product, including over-the-counter or herbal supplements.
“The concern with taking multiple weight-loss medications at once is that most of these are not studied together and it is unknown whether the combination will be safe or effective,” said Dr. Totton. “In addition, most of the over-the-counter or herbal weight loss supplements are not regulated by the FDA and are not required to prove their effectiveness in clinical trials.”
Dr. Totton said, in his opinion, these products are often ineffective and a waste of money. “I recommend you discuss any medications or supplements that you are considering with your primary care physician.”
Long-term Use and How to Access Wegovy
“Looking at the trials that led to the approval of Wegovy for weight loss, we can see that patients who came off the medication eventually gained a majority of the weight back. This tells us that patients must stay consistent to see sustained weight loss. This is of course in addition to maintaining proper diet and exercise habits.” Dr. Totton added that if patients decide to discontinue, they do not need to wean off Wegovy.
To determine if you are a candidate for Wegovy for weight loss, speak with your primary care physician. Dr. Totton shared that the company is offering a discount card to all patients on commercial insurance that guarantees a maximum of $25 co-pay per week for the first six months of therapy. Another important tip from Dr. Totton is that when using an injectable medication such as Wegovy it is important to remember to rotate the injection sites to ensure proper drug absorption. Appropriate injection sites include the abdomen, thigh or upper arm and should be injected under the skin.
David Totton, PharmD, is the ambulatory care pharmacist on staff with Shore Physicians Group. He consults with physicians regularly about medication management, conducts Medicare annual wellness visits, provides comprehensive medication reviews, and more. Dr. Totton sees patients in Marmora, Ocean City, Somers Point, Margate and Northfield. Click here to learn more about how an Ambulatory Care Pharmacist can help you. To find an SPG primary care provider, click here.