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With obesity rising in the United States and worldwide, providers and patients seek novel ways to combat the diseases associated with excess weight. People use several methods to lose weight, from fad diets to surgical weight loss, but with almost 75% of the adult population overweight or obese, something needs to change. Our standard measures of healthy and unhealthy weights are based on a somewhat archaic formula known as the body mass index (BMI). Obesity is defined as patients with a BMI greater than 30, while those considered overweight are between 25 and 29.9. The BMI has several limitations discussed in one of our other blogs. However, it is the simplest and best formula we have today.
A relatively newer class of medications has reenergized providers and patients to combat diseases such as diabetes and obesity. Glucagon-like peptide-1 (GLP-1) receptor agonists like Ozempic, Rybelsus, and Mounjaro to treat diabetes and Wegovy to treat obesity have become exceptionally popular due to their stunning weight loss results and associated news coverage. These medications are available as injections. However, oral drugs are currently being studied for eventual FDA consideration. GLP-1 medications work by stimulating the body to produce more insulin.
According to the recent SELECT trial¹ by Novo Nordisk, the maker of Wegovy®, semaglutide has potential health benefits, including reducing the risk of cardiovascular disease (CVD). They chose a sample of over 17,000 participants in 41 countries over the age of 45. The participants had no previous history of diabetes and had a BMI ≥ 27.
Participants received once-weekly injections of semaglutide 2.4 mg. Overall, they showed a 20% reduction in the risk for first Major Adverse Cardiovascular Events or MACEs. This can be extrapolated to prevent 1.5 million cardiovascular events over ten years.
This research aligns with previous studies showing that semaglutides improve cardiovascular risk factors. However, it’s important to remember that these benefits are not maintained after discontinuing the injections unless patients have made significant changes to their lifestyle, including improved diet and exercise.²
Do These Medications Come with Risk?
As a weight loss treatment beyond appropriate diet and exercise, there are risks involved with taking GLP-1 receptor agonists. These risks will vary between patients but can include hypoglycemia or low blood sugar, pancreatitis, gastroparesis, which involves slowed movement of food through the stomach, and possible suicidal ideations, which UK and European authorities are currently investigating. Patients should also be aware of the significant cost associated with these medications. If not covered by insurance, they can be costly. Further, remember that these medications only work as long as they are being taken. Patients will likely regain some or all their weight if they have not made significant lifestyle changes, including improved diet and exercise.
The Bottom Line
Unhealthy diets can lead to many comorbidities, including diabetes and obesity. One of the most significant risk factors for heart disease is obesity. When a healthy diet and exercise are unsuccessful, patients may have a promising option in using GLP-1 receptor agonist medications like semaglutide. GLP1 medications can help with diabetes and obesity while lowering heart disease risk. However, they do come with financial and adverse effects considerations. These should be discussed with your doctor or weight loss specialist.
Resources:
- News details. Novo Nordisk. (n.d.). https://www.novonordisk.com/news-and-media/news-and-ir-materials/news-details.html?id=166301
- Kosiborod MN, Bhatta M, Davies M, Deanfield JE, Garvey WT, Khalid U, Kushner R, Rubino DM, Zeuthen N, Verma S. Semaglutide improves cardiometabolic risk factors in adults with overweight or obesity: STEP 1 and 4 exploratory analyses. Diabetes Obes Metab. 2023 Feb;25(2):468-478. doi: 10.1111/dom.14890. Epub 2022 Oct 28. PMID: 36200477; PMCID: PMC10092593.
