GLP-1 agonists like semaglutide are making strides in improving type-2 diabetes management and weight-related health. Recent research has shown that they can lower the risk of heart attacks and strokes and also help quiet the food noise.
However, as demand for semaglutide rises, so do assertions that using it is cheating in weight loss or taking the easy way out.
Society doesn’t label people needing statins for high cholesterol or blood pressure medications as cheaters or taking shortcuts. So, why would one stigmatize those using semaglutide, a medication commonly prescribed for diabetes, pre-diabetics and obesity (the latter being an approved use of the medication in the US, but not yet in Australia)? Why would society choose to take a negative approach to medication with efficacy based on long-term use that deal with the risks associated with these conditions? Especially when its use is so often combined with lifestyle changes to effect a holistic improvement in lifestyles and health.
First, let’s look at how it works
Semaglutide is a GLP-1 receptor agonist (GLP-1RA), that enhances the action of the body’s GLP-1 hormone. GLP-1 is released by gut cells in response to increased nutrient levels after eating, stimulating insulin production to lower blood sugars.
GLP-1 slows gastric emptying, making you feel full and reducing hunger and post-meal reward sensations. GLP-1RA medications like Ozempic amplify and prolong the effects of GLP-1.
Some studies suggest that adults with obesity or type 2 diabetes release less GLP-1 after meals than those with normal glucose tolerance. This reduced GLP-1 level translates to less satiety and earlier hunger compared to individuals producing more. GLP-1 has a brief half-life, necessitating the design of GLP-1RA medications with a longer duration. Semaglutide is administered weekly due to its seven-day half-life.
What can users expect? What does the research say?
Higher semaglutide doses are used for obesity treatment compared to diabetes management.
Large scale trials consistently show that weekly 2.4 mg semaglutide injections result in greater weight loss (6-12%) compared to placebos or alternative interventions over 1.3-2 years.
Semaglutide-induced weight loss is accompanied by reduced blood pressure, triglyceride levels, and improved physical function. In adults with heart disease and obesity (without diabetes), semaglutide reduced specific cardiovascular event risks by 20% over three years.
Eligibility
Semaglutide (Ozempic) is approved for treating type 2 diabetes by the TGA. Currently, off-label use for obesity treatment is not recommended due to shortages and lack of Pharmaceutical Benefits Scheme subsidies.
The TGA has approved Wegovy to treat obesity but it’s not currently available in Australia.
When it’s available, doctors will be able to prescribe a semaglutide based medication to treat obesity in conjunction with lifestyle interventions (including diet, physical activity and psychological support) in adults with obesity (a BMI of 30 or above) or those with a BMI of 27 or above who also have weight-related medical complications.
During treatment, what else is required?
During treatment, participants in the STEP trials invested significant time and effort beyond medication intake. They attended brief lifestyle counseling sessions with dietitians or health professionals every four weeks, aiming to support them in consuming 2,000 kilojoules (500 calories) less than their energy needs daily and engaging in 150 minutes of moderate-to-vigorous physical activity per week, such as brisk walking, dancing, or gardening.
These trials varied in duration, ranging from 68 to 104 weeks, with the objective of demonstrating the medication’s impact when combined with lifestyle interventions.
Interestingly, studies on obesity medication trials have shown that individuals required less cognitive behavior training to maintain reduced energy intake with drug treatment. This suggests that medication may facilitate adherence by reducing hunger and environmental food cues, potentially lowering the need for intensive goal-setting, self-monitoring of food intake, and avoidance of triggers that promote eating.
What are the side effects?
Semaglutide can cause side effects such as nausea, diarrhea, vomiting, constipation, indigestion, and abdominal pain. In one study, these side effects led to discontinuation of medication in 6% of people, and interestingly, also in 3% of people taking placebos.
More severe side effects of semaglutide include gallbladder disease, acute pancreatitis, hypoglycemia, acute kidney disease, and injection site reactions. To minimize the risk or severity of these side effects, medication doses are increased gradually over several months under medical supervision. Once the full dose and response are achieved, research indicates that long-term treatment is necessary.
Considering the long-term commitment to medication adherence by those prescribed semaglutide, their focus on lifestyle improvement and their financial commitment to the medication regime, is semaglutide really ‘cheating’?
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