By María Josefa García - The Conversation
In the last year we have seen how Ozempic has gained enormous popularity for treating obesity around the world.
Promoted by actors and influencers through social media, its fame has led to high demand and even supply shortages in some countries.
Does the buzz make sense? Who is it really for?
Why do you lose weight?
Generically called semaglutide, this drug is an incretin marketed exclusively by the Danish laboratory Novo Nordisk under the trade names Ozempic, Rybelsus and Wegovy.
To explain how it works, we have to go back to the research carried out in the first half of the 20th century. They showed that oral administration of glucose produced a greater release of insulin than if it was done at an equivalent dose intravenously.
It was in the laboratory led by Professor W. Creutzfeldt that the existence of certain peptides responsible for this effect was discovered in the 1970s. They were given the rank of hormones under the denomination of incretins.
Endogenous incretins, such as GLP-1 (glucagon-like peptide 1) and GIP (glucose-dependent insulinotropic peptide), are produced in intestinal L and K cells, respectively. These hormones are released in the gut after food intake and act directly on their specific receptors.
Its main target is the pancreas, stimulating the release of insulin and inhibiting the release of another hormone: glucagon. In this way, they manage to regulate glucose levels in the blood, although they also act on other organs. This made incretin an important therapeutic resource in the treatment of type 2 diabetes and, subsequently, weight loss.
Specifically, Ozempic is an analogue of GLP-1 that was originally developed, like others in the same group, to treat type 2 diabetes.
Now it has also become a valuable resource against obesity. In fact, the U.S. Food and Drug Administration (FDA) in 2021 and the European Medicines Agency (EMA) in 2022 authorized a new indication for this drug for adults with obesity, overweight or associated comorbidities.
This effect is due to the fact that it crosses the blood-brain barrier and acts on the central nerve networks that regulate food intake. In this way, it manages to reduce appetite and slow down gastric emptying, which prolongs the feeling of satiety and reduces the desire to eat.
In addition, Ozempic may improve insulin sensitivity. This helps those who have resistance to this hormone, which is very common in obesity and type 2 diabetes. It is also worth remembering other favorable actions on blood pressure, inflammation and plasma lipids.
What are the risks?
Like any other medication, Ozempic is not without adverse effects. The information available so far describes the most common unwanted effects as those that occur at the gastrointestinal level. These include nausea, vomiting, diarrhea, flatulence, dyspepsia, and hypoglycemia.
Particular caution should be exercised when prescribing it in patients with diabetic retinopathy and reporting on the potential risk of thyroid C-cell tumors and pancreatitis.
Ozempic and Wegovy are administered subcutaneously once a week with very good bioavailability. In other words, the amount of drug that reaches the blood unchanged is almost 90%. Novo Nordisk also produces semaglutide for oral administration (Rybelsus), but offers reduced bioavailability.
Who would it be suitable for?
Currently, the number of obese people in the world is increasing, to the point of being considered a pandemic. This pathology is associated with other diseases, such as high blood pressure or type 2 diabetes. Therefore, the loss of between 5% and 10% of body weight is essential to reduce the risks of developing these comorbidities.
To that end, the FDA and EMA have approved the subcutaneous administration of semaglutide to reduce and maintain weight in adults who are obese or overweight or who suffer from at least one of the related pathologies, such as high blood pressure, type 2 diabetes, or high cholesterol.
In any case, this treatment is always the complement to a low-calorie diet and an increase in physical activity. In other words, it must be associated with changes in habits in these two areas of our lives.
Prescription only
Currently, therapeutic options for shedding pounds are scarce, so the positive impact of Ozempic has sparked a great deal of interest in the medical community and among the general population. However, it is futile to try to fight obesity if the dietary habits or lack of physical activity that triggers it are not corrected.
According to experts, weight loss with Ozempic after 60-68 weeks stops or stabilizes. If the treatment is withdrawn, the patient can regain the lost pounds. That means continued use would be required to keep that reduction stable, although we don't know if there are any long-term adverse effects.
The "miracle drug" with which you can lose weight quickly and without any effort does not exist. In obesity, medical supervision is essential; Failure to do so turns out to be self-deception and a health risk.