Injectable Semaglutide Formulation Makes Compliance with Healthy Diet Easier
You’ve probably heard about semaglutide; it is branded as Ozempic and Rybelsus for diabetes management and Wegovy for weight loss. Information about these products is pervasive throughout the media, but the message is often skewed by the time it reaches the public. In an attempt to separate fact from fiction, Women’s Health Advisor spoke with Louis J. Aronne, MD, medical director of Weill Cornell Medicine’s Comprehensive Weight Control Center. He says, “These medicines are transforming the lives of people who have been untreatable in the past; people who were really suffering health problems because of their weight.” Dr. Aronne explained who might be candidates for this drug, how it works, what people can expect if they are prescribed semaglutide, and what other similar drugs are being studied and likely to be available in the near future.
The drugs Ozempic and Wegovy both contain semaglutide. Tell us about this.
Dr. Aronne: In simple terms, semaglutide works by mimicking hormones that are released when you eat food so you get full faster and feel full longer. These drugs are prescribed in different dosages for different purposes. Drugs like Ozempic have been used for more than 18 years to lower blood sugar levels in diabetes patients. For the past five years, in addition to using Ozempic for diabetes, in some cases specialists in the field of endocrinology and metabolism have been prescribing Ozempic for weight loss. Now, after being thoroughly studied in clinical trials, Wegovy has been approved by the U.S. Food & Drug Administration for weight loss. Using medicines like semaglutide diminishes cravings and hunger pangs and makes it easier to comply with a healthy diet and other behavioral recommendations.
Who are the appropriate candidates for this drug?
Dr. Aronne: Wegovy is for people who have obesity, as well as those who are overweight, with additional complications such as sleep apnea, high cholesterol, or type 2 diabetes. Generally speaking, this population includes patients who are 30 to 50 pounds or more overweight and have a BMI of 30 or above. Roughly 40% of the U.S. population has obesity and over 30% are overweight. The fact is, a sizeable portion of the population could benefit from weight loss. The biggest problem? Semaglutide is very expensive. The average monthly cost is $1,400 for Wegovy and $900 for Ozempic. Some—but not many— insurance carriers are covering the cost in the case of medical necessity. This drug is not indicated for cosmetic weight loss.
What can the average woman over 50 years of age who is an appropriate candidate for Wegovy expect from this medication?
Dr. Aronne: With the help of this drug, weight loss is not as difficult. That’s what people who have obesity deserve because this is a disease of hypothalamic signaling pathways and many other metabolic processes. It’s not anybody’s fault; it’s not because of an absence of willpower despite what people have been led to believe. People should expect weight loss to be easier, but not quicker. Instead of feeling deprivation and cravings, they will be satisfied with eating less. The average weight loss that can be achieved with Wegovy is 10% to 15% of a person’s body weight (over 12 months). A small percentage of patients have gastrointestinal side effects, similar to what a person might experience after eating a large meal. But most patients who experience these side effects say they subside within a month.
What is on the horizon as far as weight-loss medications?
Dr. Aronne: A pill form of semaglutide—Rybelsus— that is currently available for the treatment of diabetes, is being studied in higher dosages for weight loss. I think this could have a major impact because some people don’t like injections and are more comfortable with an oral medication. Tirzepatide, known by the brand name Mounjaro, is another injectable medication being studied for weight loss. Mounjaro mimics the effect of two different hormones, so it has a dual mechanism of action. Studies show that when medications that affect weight regulation and appetite are combined, you can get past the plateau phenomenon, meaning that additional weight loss can be achieved when two medicines that work in totally different ways are used together. According to a study that we recently published, patients treated with Mounjaro lost as much as 22.5% of their body weight over 12 months, and that is similar to bariatric surgical weight loss.
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