Weight-loss shot may safely treat obesity, overweight

Many people find it challenging to achieve and maintain a moderate weight. The National Institute for Health and Care Excellence (NICE) has recommended a weight loss injection for use in the United Kingdom by the National Health Service NHS. However, the British regulatory bodies have not yet fully approved the treatment. The Food and Drug Administration (FDA) approved the treatment last year.

The drug, semaglutide, brand name Wegovy, mimics the hormone glucagon-like peptide-1, which the body releases after eating. The treatment makes people feel full, so they don’t get as hungry and eat less.

In a 2021 trial, 1,961 adults with a BMI over 30 (mean 37.9) were allocated in a 2:1 ratio to treatment with semaglutide or placebo. The treatment group self-administered weekly injections of 2.4 milligrams (mg) of semaglutide; the control group received a placebo in the same way.

The hearing was double blind — neither the participants nor the researchers knew which group each other was in.

All participants in the trial also followed a reduced calorie diet and increased their physical activity. They received counseling sessions every 4 weeks to help them maintain the lifestyle changes.

The results were impressive. In the treatment group, participants lost an average of 14.9% of their body mass over the 68 weeks of the trial. Those who received placebo reduced their weight by an average of 2.4%.

Kristin Kirkpatrick, a registered dietitian nutritionist at the Cleveland Clinic, tells WebMD Medical News Today she welcomed the results: “Any progress in helping individuals reduce their risk for common chronic conditions is a good thing.”

Just over half of those in the treatment group lost more than 15% of their body weight compared to 4.9% of the placebo group. People in both groups reported some mild to moderate side effects, such as diarrhea, flatulence, and indigestion.

However, despite these side effects, none of the participants discontinued treatment.

Semaglutide has been recommended for only some people with obesity, as many can achieve and maintain a moderate weight through diet and exercise.

NICE recommends that specialists prescribe the drug for people with a BMI of more than 35, and at least one weight-related health condition, such as hypertension, type 2 diabetes or coronary heart disease. They may prescribe it in exceptional circumstances to people with a BMI lower than 35.

NICE also says that a specialist should prescribe the drug as part of a weight management program and for a maximum of 2 years.

Could the drug be an alternative to bariatric surgery to lose weight? Dr. Mir Ali, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California, tells MNT he was not convinced: “No medical treatment option has been shown to be as effective, either in the short or long term, as surgical weight loss for those who meet criteria for surgery.”

Experts question whether this drug is a long-term solution for those trying to achieve and maintain a moderate weight. One trial participant, who lost 22% of her body weight during the trial, found her appetite returned once she stopped the injections, and she was gaining weight.

“Now that I am no longer using the drug, my weight is unfortunately returning to what it was. Losing weight while on the trial felt effortless, but now it felt like a constant battle with food again. I hope that, if the drug can be approved for people like me, me [doctor] will be able to prescribe the drug for me in the future.”

“All weight loss strategies require sustained lifestyle changes; otherwise, most people will regain most, if not all, of the weight they lost. If there is a shift to thinking of obesity more like a chronic disease, like diabetes or hypertension, then better long-term medication options need to be developed.”

– Dr. Mir Ali.

Kirkpatrick echoed these concerns: “What I’d like to see is the long-term data on long-term weight loss maintenance. Many of the patients I see not only need to change the way they eat, but they also need to change their relationship with food. Losing weight is hard, but keeping it off can be even harder.”