Just a few weeks ago, I was having my morning (black coffee) and saw big headlines at NPR and other news outlets about this new drug “Wegovy” – with bold claims about weight loss.
I was pretty excited about this for my weight management patients – its not common to get new medications for obesity.
We had Qysmia in 2012 and Contrave in 2014, both excellent options – good safety profiles and are both effective. Here in my clinic in Portland, we use Qysmia or Contrave along with intermittent fasting or slow carb / carb restricted diets, we can typically reach about 15% and sometimes 20% weight loss in 6 months or so.
Wegovy’s data is showing that it might be 3-4x as effective as both these other drugs though – which is very impressive.
Let’s take a closer look.
What is Wegovy?
Wegovy is a new formulation of a previous medication, semaglutide. Its given as an injection under the skin (at home) once a week. It comes in an easy-to-use pre-filled pen.
Semaglutide belongs to a drug class called GLP-1 agonists and has been around since 2012, under the name Ozempic and Rybelsus. It was initially developed to treat type 2 diabetes and, in contrast with insulin – which causes weight GAIN, semaglutide and the GLP-1 class actually caused weight LOSS.
Novo-Nordisk (the company behind Wegovy) ran studies (details below) to see if a higher dose of semaglutide could, for patients without diabetes, help with weight loss.
The answer was yes and the FDA (June 2021) gave the green light for this high-dose semaglutide to officially be used for treatment of obesity.
What did the study show?
The double-blinded study enrolled 1961 patients with obesity (BMI >30 or BMI >30 plus a weight-related condition). Note that none of these patients had diabetes. Some of the patients got semaglutide once a week, the other got a placebo. Both groups received a life-style intervention program to help with weight loss. These patients were tracked for more than a year (68 weeks total).
At the end, the patients that got the semaglutide ended up averaging about 15% weight loss from initial body weight compared to the placebo group only had about 2.4% weight loss.
Looking at it from another angle, the rates of successful weight loss also was much higher with semaglutide.
For somebody that is, say ~250lbs to start off, if this person takes semaglutide over a year – they would have about 86% chance of reducing their weight by 13lbs, 69% chance of losing 25lbs, and a 50% chance of losing 38lbs. The placebo & lifestyle intervention group achieved 32%, 12%, and 5% respectively – still not bad!
In this study, the main side-effects from semaglutide were nausea, GI upset – occurring in about 86% of patients. Interestingly, the 63% of the placebo group also complained about GI upset.
How does Wegovy (and these GLP-1 agonists) work?
GLP-1 is a natural messenger peptide (small strip of protein) produced in the GI tract (small intestines). As you eat a meal and food comes in, the GI tract senses this and produces GLP-1. It travels the body and communicates with the pancreas, the stomach, the brain, among other organs of the body.
GLP-1 tells the body to produce more insulin and less glucagon in response to food – basically helping normalize how the body handles the glucose (sugar) from the meal.
GLP-1 also tells the stomach to slow down digestion and tells the brain when it has enough to eat – preventing over-eating and excessive calories.
Semaglutide and the other medications in this class, basically acts like GLP-1 peptides in the body – helping the body respond better to carbs and sugars in meals and reduce appetite and food intake.
What are the side-effects and risks of Wegovy?
Just like the rest of the GLP-1 drug class, there are a number of possible side effects. The most common issues is nausea, vomiting, diarrhea – occurring in about 7-10% of patients. We can usually avoid these effects by starting low dose and letting the body get used to the medication.
Much less common but more serious risks include possibly pancreatitis (irritation of the pancreas), gallbladder problems, and renal insufficiency.
In animal studies – there was an increase in thyroid tumors, but it is not known whether this is also true for humans. We avoid any GLP-1 agonists for patients with history of thyroid tumors (specifically medullary thyroid carcinoma) or family / personal history multiple-endocrine neoplasia syndromes (MEN2).
Bottom-line : Will Wegovy work for you?
If it is paired up with lifestyle (i.e. dietary!) changes, I think there’s a great chance it would work.
I treat many diabetic patients and patients w/ obesity. Using the lower dose semaglutide, we’ve been able to get quite a number of patients off of insulin and other oral medications while getting better control of sugars AND achieving significant weight loss. I’ve had some patients with nausea and had to some the medication, but not many.
I think trying the higher dose Wegovy is worthwhile for most patients battling obesity with or without diabetes.
The bigger question now is if insurance is going to cover it! We will see.
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Ref: https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
Ref: https://jamanetwork.com/journals/jama/article-abstract/2777025
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