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What’s in this article:
Semaglutide for weight loss
You may have heard of some amazing weight loss injections and wanted to find out more about them. Ozempic is the brand name for the drug semaglutide which has shown amazing results for weight loss. The other brand name in the UK is Wygovy.
Ozempic vs Wegovy: What’s the difference
Ozempic was the original brand of semaglutide that was released for the treatment of type 2 diabetes.
Wegovy is the brand of semaglutide marketed for weight loss.
What’s the difference? In short, none. Both contain the same medication, semaglutide. The are also produced in the same doses 0.25mg, 0.5mg and 1mg. However, Wegovy also comes in higher doses of 1.7mg and 2.4mg to facilitate weight loss.
Revolutionary
Doctors have been prescribing semaglutide for diabetes since 2017, and since 2019 when it was introduced in the UK. The National Institute for Health and Clinical Excellence (NICE) approved it for weight loss in the UK in 2022. I am convinced that semaglutide injections will be game changers in obesity management. The reason is that I have already been using semaglutide off-label for my obesity patients with great success. In fact, there is a raft of similar medications which will be coming to the market over the next few years that will completely revolutionise the treatment of obesity.
That may sound strange coming from a doctor who likes to treat people by avoiding medication whenever possible and optimising their lifestyle. In fact, if you had asked me about weight loss injections a few years ago, then I would probably have rolled my eyes. However, the problem with changing lifestyle is that it only works if people manage to stick with it. The natural inclination is to think that this is entirely a matter of choice. As a result, society continues to stigmatise overweight people due to a perception that they lack willpower or self-control. The problem with this thinking is that it is completely untrue; unfairly so. In fact, I see numerous patients that have done their best to lose weight though diet and exercise and have got nowhere. It’s not just about calories.
Beyond calorie-counting
Hormonal and metabolic changes linked to weight gain cause people to feel hungry even when they have eaten enough food. Calorie-counting beyond a certain level just does not work. Their appetite off-switch does not work properly. Worse still, they crave unhealthy and high calorie foods because their brain tells them that they are still starving. Part of the hormonal change is insulin-resistance which makes weight loss more difficult.
How do semaglutide weight loss injections work?
Semaglutide is a Glucagon-Like Peptide-1 (GLP-1) analogue. As its name suggests, it mimics the hormone GLP-1 that our small intestines release and that we all naturally have in our bodies. The mechanism of action of GLP-1, and therefore, semaglutide, is to:
Delay gastric emptying and reduce small intestine motility
You feel full after eating for a longer period and consequently eat less.
Reduce appetite
GLP-1 directly reduces appetite by acting on various parts of the brain. You feel less hungry.
Release insulin from the pancreas
GLP-1 increases release of insulin from the pancreas in response to glucose and reduces the release of glucagon, a hormone which has the opposite effect. This means that you become more insulin sensitive. Overweight people tend to have insulin resistance which makes weight loss difficult so this is an important effect.
Evidence that semaglutide works for weight loss: the STEP 1 study
What was the study about?
The STEP 1 study aimed to compare weight loss between two groups of people: one group randomly selected to use semaglutide weight loss injections and another group that used a placebo injection.
Both groups:
-
- Received lifestyle advice
-
- Reduced their calorie intake by 500 kcal daily
-
- Exercised (walking) for 150 minutes per week; e.g. 30 minutes, 5 days per week
Who were the participants?
There were 1,961 participants who had a BMI of 30 or more, or 27+ with one or more health conditions.
Most participants were white (74.1%) and female (75.1%).
The average weight of the participants was 105.3 Kg (16 stone 8 lb), average BMI 37.9, and average waist circumference 114.7 cm (45 inches).
Both groups contained people of similar ages, starting weights and demographics.
How long did the study go on for?
68 weeks (16 months)
What was the final result?
Average weight loss was much greater in the semaglutide group than the lifestyle-only intervention group.
The semaglutide group lost on average 15.3 Kg (14.9%) or 2 stone 5.7 lb from their starting weight compared to just 2.6 Kg (2.4%) or 5 lb in the lifestyle-only group over the 16 month period.
The semaglutide group also had greater improvements in waist circumference, blood pressure, cholesterol, HbA1C (blood glucose control), a marker for inflammation CRP, and physical and mental wellbeing. In the semaglutide subpopulation that had their body composition measured, they lost significantly more total fat and visceral fat, and increased the proportion of lean muscle mass.
What are the side-effects of semaglutide?
Semaglutide has been on the market since 2017 and has been in use in the UK since 2019 for diabetes. We, therefore have a good idea about its side-effects, but not the long-term effects since it is a new medication.
The main semaglutide (Ozempic) side-effects in the study were equally common in both groups but gastrointestinal side-effects of nausea, diarrhoea, vomiting and constipation were more common in the semaglutide group (74.2%) than the placebo group (47.9%). Most gastrointestinal side-effects were transient, mild to moderate in severity and subsided with time.
The semaglutide group experienced more serious side-effects (9.8%) than the placebo group (6.4%). The difference was due to greater gastrointestinal and hepatobiliary side-effects (e.g. gallstones) in the semaglutide group. More people stopped treatment in the semaglutide group (7%) compared to the placebo group (3.1%). These were mostly due to gastrointestinal side-effects.
Three participants in the semaglutide group reported mild acute pancreatitis. One participant had a history of acute pancreatitis, and the other two participants had both gallstones and pancreatitis. All recovered during the trial period. There was no difference between groups in the incidence of benign and malignant tumours. Animal studies indicate a higher risk of thyroid cancer, but researchers have not observed this in humans.
So, is semaglutide safe? According to the data we have so far, it is very safe. Most of my patients suffer from a little nausea but it is very manageable and tends to reduce with time. What we do not know is the long-term safety profile of semaglutide because it has not been around long enough.
Ozempic Face
Ozempic face is the name given to the gaunt or hollowed-out appearance of the face of those who have lost a significant amount of weight. It happens when people lose a lot of fat from their face so that it becomes more angular. I have personally seen it only in one patient. Potentially it can be avoided if lifestyle changes are done alongside taking the medication.
Take home messages
Semaglutide weight loss injections are amazingly effective for weight loss when combined with lifestyle changes, much more than just lifestyle changes alone.
The weight loss is over a period of 16 months.
Three-quarters of the people in the study who took semaglutide had mild gastrointestinal side-effects. A small number of people had such severe side-effects that they had to stop taking it.
Unanswered questions
Will semaglutide be equally effective in people who are not like the study population who were mostly white and female; i.e. will it work in non-white races and in men?
The Step 6 trial partly answered this by demonstrating effective weight loss in East Asians.The Step Teens trial also showed that semaglutide was effective in the 12-17 age group.
What are the long-term side-effects?
We do not yet know enough about semaglutide to answer this question.
Who should consider treatment?
You should consider treatment if you have a:
BMI > 30 without any associated medical problems (We define obesity as a BMI greater than 30).
or
BMI > 27 and having an associated medical problem such as high blood pressure, high cholesterol, sleep apnoea or a heart problem.
Please note that risk factors for metabolic problems start at the lower BMI of 27 for South Asians, East Asians, and Afro-Caribbean. This would, therefore, be a suitable BMI to start weight loss treatment for these ethnic groups.
BMI CALCULATOR
The ideal BMI is between 18.5 and 24.9 for most people.
What happens when you stop semaglutide (Ozempic)?
We now know what happens when you stop treatment with semaglutide following the Step 1 Trial Extension. Researchers followed up with about 300 patients from the original study for 1 year after they stopped using semaglutide weight loss injections. On average, they regained two-thirds of the weight that they had lost, indicating that obesity is a persistent condition.
Although this sounds disappointing, these patients were taking 2.4mg semaglutide and were on a reduced calorie diet. Once they stopped semaglutide injections, they reverted to their previous pattern of eating.
Based on my experience over the past year, patients rarely need the large dose of semaglutide weight loss injections used in the original study to reach their target weight. Most of my patients are taking a maximum of 1mg each week. During the period that they are taking the weight loss injections, I make suggestions to modify their diet so that they are more easily able to maintain their weight loss when they stop the injections. So far, some of my patients are able to stop semaglutide completely, and some need to continue taking a reduced dose to maintain their weight loss.
How much does semaglutide (Ozempic) cost?
The cost of semaglutide injections bought privately can be anything from £120 – £250 per month for one pen depending on the dose. Each injection pen lasts 4 weeks. Unfortunately, I have seen some pharmacies that mark up prices unfairly. I work with a number of pharmacies that not only try and keep a sufficient supply of medication for my patients, but who also keep the price down to a minimum.
Where can you buy semaglutide injections? Many people have been buying the injections online and administering it themselves without support from a qualified clinician. I would discourage using semaglutide without proper supervision since it is still a relatively new medication. Like all medications, a doctor should start and monitor its use. You only have to see recent news articles to see how dangerous these medications can be when taken unsupervised. This is especially true if you have any medical problems or if you are taking any other medication.
I have a number of patients that I follow up regularly. The cost of treatment includes the cost of an appointments plus the cost of semaglutide injections. At the time of writing, the cost of semaglutide is around £120 per month when ordered through our partner pharmacies.
How about semaglutide tablets?
Semaglutide comes is a range of tablet doses, 3m, 7mg and 14mg under the brand name Rybelsus which is for diabetic patients. Unfortunately, there is not much effect on weight loss at these doses although some of my patients have found them helpful
A recent study revealed that 50mg semaglutide tablets produce a 15% weight loss, equivalent to the injections.No doubt a 50mg dose will be available in the future but no such dose exists at present.
Semaglutide injections supply issues
You may have heard in the news that semaglutide weight loss injections have been very difficult to get a hold of because of supply issues. Novo Nordisk, the company who makes it issued a statement that supply issues will continue until the end of 2024. The whole World seems to be taking it.
The problem is not with the supply of the medicine but with the plastic pen device that it comes in. They can apparently not make enough to keep up with demand. This issue might resolve when authorities approve the semaglutide 50mg tablet.
At my practice, there are times when patients cannot get the dose of semaglutide that they need. We deal with this in a number of ways which aim to maintain the weight loss that they have already achieved until the pharmacy is able to source more supply. This may involve taking a lower dose or taking tablets temporarily.
How can you start using semaglutide weight loss injections?
Please book a weight management appointment with me at Prime Health in Weybridge, Surrey. If you live elsewhere in the UK, then you can book a telephone or video appointment.
Appointments are monthly to begin with for the first few months and include an assessment of your medical history, lifestyle counselling and monitoring of your progress. During this phase, you will gradually increase the dose of semaglutide, and I will monitor your condition and any side-effects. The semaglutide (Ozempic) dosing for weight loss is generally 0.5mg or higher, although some patient do lose weight on the lowest 0.25mg dose.
Our partner pharmacies will deliver the semaglutide weight loss injections to your home. Patients make payment to the pharmacy for the injections directly.
Once you reach a stable dose of semaglutide, you can reduce the frequency of appointments for the duration of the treatment based on your progress, general health, and any medical conditions that might require monitoring.
How to use semaglutide injections
Semaglutide is a once-weekly injection into the fat around your belly and is straightforward to use. Each semaglutide (Ozempic) pen contains 4 doses, injected once per week and therefore also comes with 4 tiny needles. Watch this video to find out how. Please note that Ozempic is a brand of semaglutide.
Book a weight loss appointment in person or by video/telephone
Telephone: 01932 504999
E-mail: amer.sheikh@bedsidemanner.uk
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