SHOULD YOU TRY A NEW DIABETES DRUG FOR QUICK-FIX WEIGHT LOSS?
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You’ve probably seen recent newspaper articles or TV reports about new type-2 diabetes-treatment drugs that can dramatically help people lose up to 20% of their body weight. The best-known of these drugs has the technical name semaglutide and goes by the brand name Ozempic. More people who don’t have diabetes are turning to this drug for a quick weight loss fix. However, one needs to pay for this ease; semaglutide is expensive—more than $1,000 per month. (Please also see my June 10, 2022 post about the drug tirzepatide: New Experimental Obesity Drug has Amazing Claims)
To get more info on these drugs in general, I found an online article in the March 2023 Harvard Heart Health Letter by Julie Corliss, Executive Editor—The new diabetes drugs: Your best shot for weight loss? Here are excerpts:
Injectable medications that mimic natural gut hormones may also lower heart-related risks. Here’s what you need to know about these revolutionary drugs.
A weekly injection that leads to dramatic weight loss without serious side effects almost sounds too good to be true. But several drugs originally developed to treat type 2 diabetes can help people shed as much as 20% of their body weight — far more than other anti-obesity drugs. Known as incretin mimetics, they also improve blood pressure and cholesterol levels.
Not surprisingly, these medications are in high demand, especially semaglutide. This has led to shortages of certain formulations. That’s just one of the issues faced by people hoping to take these drugs, which are costly — around $1,000 to $1,500 per month — and not covered by Medicare for obesity (although some private insurers cover them). Who’s a good candidate for these medications, and what else should people know about them?
Diabetes and anti-obesity drugs
Today there are effective anti-obesity injectable drugs including dulaglutide (Trulicity), liraglutide (Victoza), and semaglutide (Ozempic); the latter is also available as a pill called Rybelsus. Liraglutide and semaglutide are also approved for weight loss, in formulations marketed respectively as Saxenda and Wegovy.
The newest addition to this drug family is Tirzepatide (Mounjaro), which was approved for treating type 2 diabetes in May 2022 and tagged for accelerated review for approval to treat obesity, which is anticipated sometime in 2023.
Overlapping risks
Up to half of all new-onset diabetes cases in this country are linked to obesity, a disease that now affects more than 40% of Americans. Both conditions are closely linked to cardiovascular disease. “Many cardiologists now recognize that treating obesity is the best way to treat heart disease,” says Dr. Caroline Apovian, who co-directs the Center for Weight Management and Wellness at Harvard-affiliated Brigham and Women’s Hospital.
Other anti-obesity drugs help people lose only about 5% to 8% of their body weight. But the incretin mimics, which are similar to hormones made naturally by the gut and brain, have multiple effects. They prod the pancreas to release insulin when blood sugar rises too high, slow down the emptying of the stomach, and target brain receptors involved in reducing appetite.
The newest ones, tirzepatide and semaglutide, can lead to remarkable weight loss and also lower HbA1c levels (a three-month average measure of blood sugar) by as much as two percentage points. “Studies also show that semaglutide and liraglutide, an older drug, can lower the risk of serious cardiovascular problems, such as heart attack and stroke, in people with obesity and diabetes,” says Dr. Apovian. A large trial to see whether semaglutide lowers heart-related risks in people without diabetes who are overweight or obese is currently underway, she adds.
Who might consider these drugs?
People with diabetes who are carrying excess weight are good candidates for semaglutide or tirzepatide, especially those at high risk for heart disease, Dr. Apovian says. For people without diabetes, the official criteria for prescribing the drugs are the same as for all other anti-obesity drugs: a body mass index (BMI) of 30 or higher, or a BMI of 27 or higher, and at least one weight-related health problem, such as high blood pressure or high cholesterol
Taking these drugs involves injecting yourself in the abdomen or thigh using a pen like device with a tiny needle the size of a human hair. Side effects such as nausea, diarrhea, and constipation are common. But they rarely last longer than a week or so, especially if you start low and increase the dosage slowly while guided by an experienced physician, says Dr. Apovian.
If you stop taking the drug, you’ll likely regain weight. But that’s similar to what would happen if you were taking blood pressure medication and stopped — your blood pressure would rise. “Obesity is a disease, and we need to treat it like one,” says Dr. Apovian.