Weight loss drug Wegovy: The pros and cons, explained
Semaglutide originally arrived on the market in the US in 2017 as a diabetes medication, but has quickly been tied to extreme weight loss.
Wegovy can be prescribed to people over the age of 12, but many of the 65% of New Zealanders who are overweight or obese will have trouble affording it, with an estimated price of $500 a month.
The drug has transformed our ability to manage obesity and type 2 diabetes, and has shown potential for a wide range of conditions such as Alzheimer's, addiction and depression.
But there are clouds to go along with the silver linings — such as potential vision loss.
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"This condition, it occurs when there's insufficient blood flow to the nerves connecting the eye to the brain, and this leads to damage," US-based health reporter for New Scientist, Grace Wade, told RNZ's Sunday Morning. The specific condition was non-arteritic anterior ischemic optic neuropathy.
"That can cause this sudden and permanent vision loss, usually in just one eye. Now, I should be clear this isn't total vision loss, at least usually - it's more like cloudiness, stuff like that."
People using semaglutides to treat diabetes were 4.3 times more likely to develop this condition, and those using it for weight loss 7.6 times, as people using other types of diabetes medications, a 2024 study found (Wade wrote about it in New Scientist here).
Novo Nordisk, the maker of Wegovy, said in a statement, patient safety was the top priority and all reports of adverse events were taken seriously.
"Semaglutide has been studied in robust clinical development programs with more than 52,000 semaglutide exposed patients and exposure from post-marketing use of over 33 million patient years."
It said it was recommended to update patient leaflets for Wegovy and Ozempic on June 6 to include the condition under its special warnings and precautions for use and as an adverse drug reaction with a frequency of "very rare, meaning it may effect up to 1 in 10,000 people taking semaglutide".
It said based on the totality of evidence it concluded the data did not suggest a reasonable possibility of a casual relationship between the condition and semaglutide and "the benefit-risk profile of semaglutide remains favourable".
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"We work closely with authorities and regulatory bodies worldwide to continuously monitor the safety profile of our products."
Researchers looked at semaglutide, a prescription drug that decreases appetite and is sold under the brand names Wegovy and Ozempic. (Source: 1News)
The drug worked by suppressing appetite, which typically leads to weight loss as people consume fewer calories. But the weight lost was not always beneficial, Wade said.
"It leads the body to break down fat, muscle and actually even bone for nutrients, and that's why… some research has found that upwards of 40% of the weight loss seen with these medications is due to loss of muscle mass… that makes it really important that people prioritise exercise when taking these drugs because if you don't use your muscle, you're more likely to lose it."
Getting into the exercise habit was also important since one day, most people on Wegovy will stop taking it - putting themselves at risk of putting the weight back on if they were not regularly moving.
What about 'Ozempic face?'
Then there is 'Ozempic face'.
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"I don't think this is a clinical term yet, but it's something that's popped up a lot in social media," Wade said.
"People who are taking these medications start developing... a sunken or hollowed out appearance, which can exacerbate fine lines and wrinkles, make their skin look a little more saggy.
"It isn't clear exactly how common this is… but it probably has to do with just weight loss, right? If you're losing weight, as much as some people would want to target their weight loss to certain areas of their body, we can't really do that. So, you know, any sort of overall weight loss is also gonna cause a loss of fat in your face."
There were also side effects for some, including constantly needing to go to the toilet, feeling bloated, belching, constipation, heartburn, fever, upset stomach - the list, collected here by the Mayo Clinic, goes on.
And nearly half of people who try it make it through a three-month course, one study found.
Wade also mentioned a lot of people taking semaglutide for diabetes or Alzheimer's prevention might be older and "frail", so not able to lose weight.
"Drug developers are actually working to develop new drugs that have similar effects as these weight loss medications, but without the weight loss."
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The good news
One unexpected benefit of semaglutide was its apparent effect on not just calorie consumption, but use of addictive substances, such as alcohol and nicotine.
"We aren't exactly sure why that is, but it appears to be with how these medications affect brain activity.
"So these drugs curb cravings for alcohol similar to how they curb cravings for food, right? And that probably has to do with their impact on brain regions involved in reward processing and craving…
"A study of more than half-a-million people with a history of opioid use disorders showed that those who took Ozempic or similar [medications] had significantly lower rates of opioid overdose than those who didn't.
"Other studies have shown similar effects in people with cannabis use disorder, cigarette smokers and alcoholism."
Scientists did not expect this effect, calling it an "unintended consequence".
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Approval for the popular medication said to be a "game changer" for many New Zealanders. (Source: 1News)
The drugs have also shown promise in reducing heart attacks and strokes, improving fertility, treating pain, improving mental health, lower the risk of kidney failure and slowing cognitive decline.
"I've never encountered a group of drugs like this," Wade said. "That's what makes these drugs so remarkable, because most medications can only treat one or two conditions, right?"
She said it was likely that weight loss was playing a role - as it frequently does in health - but "it doesn't seem to be the only [reason]".
But there is still a lot of research to be done, she said, before we all start taking it.
"Let's unravel how they can treat all of these conditions before we jump the gun and start suggesting we, you know, maybe put it in everyone's water or something."
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Wegovy Drug Not Miracle Obesity Cure, Warns Weight-Loss Doctor
A weight-loss doctor is warning patients not to rely on Wegovy as a cure for obesity, saying the newly available medication could be more harmful than helpful. Waikato bariatric surgeon Dr Rowan French said Wegovy was a welcome tool in the battle against obesity, but it needed to be used in conjunction with psychological, exercise and nutritional support. As with bariatric surgery, he recommended patients address the reasons they overate and the types of food they ate to avoid regaining any weight lost. "People need to know that it's likely, particularly for someone who's living with severe obesity... their problem is a lifelong one and, while it can be controlled, there's a good chance they will never fully be cured of that. "Without substantial change in their lifestyle - this is not just the foods they eat, it's the reasons they eat as well - without external help to understand their drivers to eat and nutritional help to understand the sorts of foods that they should be eating, particularly in the first 18-24 months, then the medications could prove more harmful than good. "Particularly by causing some initial weight loss followed by substantial weight regain." How does Wegovy work? Wegovy contains semaglutide, an obesity medication that's a synthetic form of a hormone called GLP-1, which is made in the small intestine. Ozempic is also semaglutide and works in the same way, but is licenced for type 2 diabetes rather than obesity. GLP-1 plays several roles in the body, including triggering insulin release from the pancreas, and affecting areas of the brain that control hunger and satiety (feeling full). Gastric bypass surgery causes amplified release of GLP-1 (and other hormones) from the small bowel in response to meals, which switches off appetite. The release is cyclical, which means the hormone levels go up and down through the course of the day in response to eating, and goes directly into the gut circulation. By contrast, Wegovy is injected under the skin in a large weekly dose into the systemic circulation. "Here's the problem," French said. "We already know there is tachyphylaxis - the medical term for tolerance - that occurs with bariatric surgery as early as 18-24 months after surgery - there is a slowly waning effect. "We can be almost certain that the injection of synthetic GLP-1 given in large bolus will cause tolerance earlier and more profoundly than bariatric surgery. "In other words, as time goes on, the patient will get less and less benefit from the medication, so any suggestion some people should stay on it for life is unlikely to be sensible or beneficial." French said that was where psychological and nutritional support, as well as exercise to avoid muscle mass loss, was vital, but "infrequently available". "We know that weight regain is common several years after bariatric surgery, particularly if patients are not engaged in multidisciplinary follow-up. "We know that, when semaglutide is stopped, in most cases, weight is regained, but we can also predict, if a patient stays on it, they will develop tolerance, because this occurs with bariatric surgery, albeit later in the piece." 'Obesity is a lifelong disease' French said people with a weight problem almost certainly had a lifelong disease. "We are generally born with a likely predicted adult weight, which - in large part - is decided by our genetics... things that have happened to us in early life [trauma] and, to a certain extent, the environment. "We have far less control over our long-term weight than most people think we do." He said long-term weight control was subconscious - it happened in the "primitive brain". "We can temporarily go on diets. We can temporarily override our primitive brain, but almost always this innate set-point... that we are born with dictates what our adult weight is going to be and it will drag us back up to that adult weight, despite going on diets." The aim was to control obesity, not cure it, French said. "One of the things we see that raises that set-point is what we call 'cyclical dieting'." Also known as 'yo-yo dieting', this is when a person loses weight on a diet, but regains it after the diet ends. "Our primitive brain interprets that as starvation and it starts to fight back, and most people will regain the weight quite quickly. "They will go back to a weight that was slightly higher and it's nature's way of putting more in the bank in case it happens again." French said, when yo-yo dieting elevated a person's set-point to a new, higher level, the brain in turn defends that weight. "So every time someone goes on a yo-yo diet and gains more, their weight set-point rises, so by the time we see people with severe problems who need treatment such as bariatric surgery, they might have done 10-12 diets. "Each time their set-point has risen and it might have gone up 20, 25, 30, 35kg over a number of years." The role of ultra-processed food French, who works in public and private, is speaking out, because he's concerned Wegovy has been sensationalised by celebrities as a wonder-drug. While he said the new medications were the best New Zealand had ever had for weight loss, he stressed the need to address the causes of obesity. One factor, he said, was the type of food people ate. French said ultra-processed food (UPF) caused a spike in obesity rates in the mid-1980s and what he refers to as "pandemic obesity" in the western world. "Essentially, you've got now a dominant food that makes up about 50-60 percent of what we eat, which is purely manufactured and designed to make us eat as much as possible. "We know from the very robust data that it causes metabolic disease, it causes depression, it causes dementia, it causes cancer." UPFs included most food that wasn't a whole food. "Whole food being what your grandma would recognise as food," he said. "Very simply, if it's wrapped in plastic and it's got one ingredient that you wouldn't find in a home kitchen, that's an ultra-processed food." The food was attractive because it was convenient, quick to prepare and easy to cook, and often less expensive. French said it was often soft and easy to chew, low in fibre and didn't activate the hormone needed to make a person feel full, so people ate more. "It's the combination of salt, fat and sugar that's always engineered to make it the most moorish it can possibly be." French, who's private work is through Tailor Clinics in Hamilton, said his patients learn about eating whole foods at least 95 percent of the time.
