Weight-loss injections: miracle drugs or new risks in a bottle?
Weight-loss injections are rising in popularity and show potential in the management of obesity. But uncertainty remains over long-term risks to health, and there are also concerns regarding the use of the injections for aesthetic weight loss in unintended (ie, not obese, not overweight) populations.
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A new generation of semaglutide and other GLP-1 incretin mimicking compound weight-loss drugs are gaining popularity. Influencers and celebrities publicise the merits of these drugs for rapid weight loss. Some estimates see global sales of said medications at USD 150 billion by 2031, not far off the size of today’s cancer treatment market.1 Beyond the use for aesthetics by those who can afford it, semaglutide injections are being hyped as a miracle cure for the obesity pandemic. “Hype”, however, may well prove the defining term: the drugs also raise concerns regarding uncertain health risks.
Why the hype?
Originally developed to treat diabetes, the drugs have been found to also reduce body weight and in the US, have recently been Federal Drug Adminstration-approved for such usage in overweight individuals.2 In clinical trials, semaglutide injections led to average weight loss of about 15%.3 The medication mimics the action of human incretin glucagon-like peptide 1 (GLP-1), a hormone produced naturally by the lining of the stomach after ingestion of food. The drugs increase insulin secretion and improve blood sugar disposal, and hence glycaemic control. They also slow the emptying of the stomach, creating a feeling of fullness that reduces appetite and food intake, in turn resulting in weight loss.
Benefits are not without side effects
For overweight and obese individuals, the weight loss benefits of semaglutide injections might outweigh the health risks, some known, some uncertain. The drugs come with side effects: nausea, vomiting, diarrhoea, abdominal pain and constipation are among those that have been reported. There are also concerns regarding the potentially serious ramifications of the artificial creation of the feeling of satiation. The long-term effects of the consistent presence of a molecule that signals satiation, which, when produced naturally by the stomach, is present for just a few minutes after food ingestion, remain unknown. Possible suspected negative effects are (mal)functioning of the thyroid gland (eg, thyroid cancer) and the pancreas (pancreatitis).4
Also, the weight-loss benefits are not always permanent. In clinical trials, many patients who stopped taking the drug regained a large proportion of their lost weight soon after. Without complementary lifestyle and nutrition changes such as reducing carbohydrate intake and cutting calories, patients can mistakenly believe they have been cured of obesity, rather than it just being in remission. The efficacy of the drug is thus reduced, which can become a recurring issue, and more so in jurisdictions like the UK where reimbursement schemes are restricted to 2 years.5
Concerns over non-medical use
Another important concern is the growing non-medical use of semaglutide injections. With celebrities endorsing the drug for rapid weight loss, there has been a rise in cases where the injections are prescribed as a lifestyle drug, even to patients with normal BMIs.6 As part of the hype, in these cases the health risks may be downplayed, which could potentially trigger claims in medical malpractice and other professional negligence covers. Given the popularity of semaglutide drugs, there is also a risk of black markets developing, with illegal sales of secondary and counterfeit products and potential for overdoses.
The novelty, combined with uncertainty over the longterm effects of semaglutide drugs and potential for misuse, opens up the possibility for liability claims and class actions, should the drugs be found to have serious adverse health effects. Beyond the drug manufacturers, many agents in the value chain, from distributors to retailers and pharmacies, could be implicated.
All medical interventions entail benefits and risks. Semaglutide injections may bring health benefits to obese individuals, giving them the opportunity for more mobile and healthier lives. However, in mildly overweight individuals or those who use the drugs for aesthetic purposes, uncertainty around the long-term risks might outweigh the benefits. In addition, their price tag (around USD 1 000 per month in the US152 7) raises questions as to their cost-effectiveness in managing weight loss over time. To date, lifestyle changes and nutrition strategies that include fasting, reduced carbohydrate and calorie intake remain the safest and most cost-effective interventions for sustained weight loss and reduction of long-term mortality and morbidity risks.
References
References
1 ”New drugs could spell an end to the world’s obesity epidemic”, The Economist, 2 March 2023.
2 ”FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014”, FDA, 4 June 2021.
3 Bergmann et al., ”Semaglutide for the treatment of overweight and obesity: A review.” Diabetes, Obesity and Metabolism, January 2023.
4 ”Summary of risk management plan for Ozempic”, EMA, 23 February 2022; “Summary of risk management plan for Wegovy”, EMA, 10 March 2022.
5 ”NICE recommends new drug for people living with obesity”, NICE, 8 February 2022.
6 ”What Is Ozempic and Why Is It Getting So Much Attention?”, The New York Times, 8 March 2023.
7 ”Find out the cost for Ozempic®”, NovoCare.