Due to the recent popularity of anti-obesity medications such as Semaglutide (Wegovy/Ozempic®), there has been an increase in news coverage and social media commentary on these medications. Some of this coverage has caused concern among patients.

Before covering some common questions/concerns regarding these medications, it is important to note that these medications have been on the market for a significant period of time resulting in a large amount of data.

The discovery of GLP-1, which led to the development of medications such as Semaglutide (Wegovy/Ozempic®) and Liraglutide (Saxenda®) known as GLP-1receptor agonists – is now over 40 years old! GLP-1 was originally discovered in the lab of Dr. Joel Habener, Harvard Medical School Professor of Medicine and director of the Laboratory of Molecular Endocrinology at Massachusetts General. Significant experience with this medication class has provided us with substantial trial results and post-marketing data, since Exenatide was FDA approved in April of 2005.

GLP-1is a natural substance produced by the gut. We all have GLP-1!

Regarding the substantial media attention recently…

As we all know, news outlets and social media can have a tendency to sensationalize stories and create fear around even extraordinarily rare issues– rather than basing worries on well-conducted science.

Every single day we all do things that carry some degree of risk, whether we drive to work or walk across the street (sometimes even ignoring the walk sign). Many of these daily decisions require weighing the risks and benefits before making a logical decision.

In that same spirit, here are some things that we know about this medication class through well-conducted studies and quite substantial post marketing data:

-FDA approved medications such as Semaglutide (Wegovy/Ozempic®) and Liraglutide (Saxenda®) allow patients that have been struggling with their weight to obtain improved control of their dietary habits and achieve substantial overall weight loss. This is particularly true with Semaglutide (as Wegovy®) as it is highly active and effective.  

-The average weight loss with Semaglutide (Wegovy®) is 15%, and 39% of patients in the STEP trials of the medication achieved weight loss of 20% or more. To date, we have never had a medication for weight loss achieve this amount of success.

-These medications can also result in reduction of hemoglobin A1C, improvements in nonalcoholic fatty (metabolic) liver disease, and a lowering of cardiovascular risk. Please see this post with news from a recent trial showing a substantial lowering of cardiovascular risk in patients with known coronary disease taking Semaglutide (Wegovy®).

-Lifestyle intervention is paramount when using any medication for weight loss as success is greater with a healthy lifestyle. In addition, there are many benefits of a healthy lifestyle that go far beyond weight loss alone!

Some additional things we know about potential benefits:

-For some patients, excess weight may be associated with worsening metabolic health as well as issues such as sleep apnea and osteoarthritis. 

-A 5% reduction in weight results in metabolic benefit to patients and can improve your overall health with reductions in hypertension, hemoglobin A1c, hyperlipidemia.

-A 10% reduction in weight tends to reduce issues such as sleep apnea.

-A 10 to 15% reduction in weight can make a significant impact in the reduction/remission of non-alcoholic fatty liver disease and diabetes.

GLP-1RA and other weight loss medications can have substantial benefits for patients who have struggled to see improvements from other methods, including many who have attempted years of lifestyle intervention strategies.

We cannot simply perpetuate the calories in, calories out mantra and ignore the biology and genetics of weight management.

Below please find my thoughts on specific items recently raised in the news regarding Semaglutide (Wegovy/Ozempic®):

Gastroparesis: Recently, the news has covered a few rare of events labeled as “permanent paralysis of the stomach”. In medicine, this would be diagnosed as severe gastroparesis.  In clinical practice, I have yet to see this occur with the use of GLP-1 RA medications in our practice. It is important to recognize that part of Semaglutide’s efficacy and action is related to providing satiation due to slowing transit of food from the stomach into the small intestine. This can provoke common side effects noted with this class such as nausea and constipation (generally mild and transient). That said, if you have known gastroparesis, then these medications may not be the best choice for you. It is imperative that you share your full medical history with your physician, who can discuss other options. In our experience, as well as post-marketing data, the benefits have far outweighed the rare risk of severe gastroparesis inpatients without known gastroparesis. It is also important to recognize that, although the half-life of the weekly injectables is longer, discontinuation of the medications generally results in the disappearance of side effects as the medication is eliminated from your body.

Aspiration when under anesthesia: The slowing of gastrointestinal transit does create some potential risk when undergoing operative intervention as food may remain in the stomach; when under anesthesia, this can create an aspiration event with food entering the lungs. Anesthesiologists are increasingly aware of this risk. Historically anesthesiologists have screened patients and told them to hold certain medications perioperatively.

The anesthesiology team should ALWAYS be aware that you are on this medication. You should never withhold that data for any reason. This is extremely important, as they then can advise you properly with regard to when to hold and restart medications you may be on, including the GLP-1 RA’s.

Ozempic Face: This is the name you may have seen on social media referencing a change in facial appearance in users of Semaglutide (Ozempic®). As we all know, changes in weight can cause changes in our appearance. This is, of course, independent of how we achieved weight loss!  With significant weight loss the patient can have excess skin, as well as changes in skin pliability and hydration resulting in a different appearance. It is not the medication directly, so much as the degree of weight loss seen.  In clinical practice, this honestly has not been a common concern raised by patients I have treated with this class of medications.

Hair loss: This is also an effect of weight loss itself as some patients with significant reductions in weight (independent of how this was achieved) can develop something called telogen effluvium. This does not result in full baldness, but rather a slight thinning of hair. This potential issue tends to be temporary with the process ceasing within 6 months for 95% of patients. Adequate protein in the diet, healthy plant-based fats, reasonable caloric consumption and perhaps a multivitamin may help reduce this transient process.

Medullary thyroid cancer: These medications all have a black box warning for medullary thyroid cancer. To date, this risk has been entirely in animal models(rats). No well-conducted human trials have shown an increase in medullary thyroid cancer since Exenatide hit the market in 2005. However, out of an abundance of caution and heeding the current black box warning. If you have a family or personal history of medullary thyroid cancer/multiple endocrine neoplasia type II, we do not recommend GLP-1 RA medication. Patients do to NOT need to have screening/surveillance for these cancers while on the medication per any evidence-based guidelines.

Weight Regain: When you take medications such as these you are creating ametabolic advantage you do not currently have. Recent studies accurately show that with cessation of Semaglutide (Wegovy®), patients tend to revert towards their baseline weight. A longitudinal, comprehensive approach that incorporates all of the elements of a healthy lifestyle (healthy nutrition and adequate physical activity, sleep and stress reduction) is essential for long-term health!

Ihope this helps to dispel some of the concerns and fears regarding these medications. Finding the right medication for you should always involve transparent conversations regarding the risks and benefits of medications with your trusted healthcare professional. Above all else, you as a patient deserve to be known well.