Semaglutide - the big breakthrough in obesity?

What is Semaglutide used for and how does it work?

Semaglutide is used to treat type 2 diabetes. It is intended to lower the blood glucose level in the blood and belongs to the group of GLP-1 receptor agonists. The active substance binds to the GLP-1 receptor, resulting in the following effects

• increased insulin secretion
• reduced glucagon secretion
• increased insulin sensitivity
• increased feeling of satiety
• reduced feeling of hunger

All these effects help to ensure that blood sugar levels are not derailed. A very significant advantage of semaglutide is that blood hypoglycaemia occurs less frequently, as the effect of the active ingredient only occurs when blood glucose levels rise.

Why is the active ingredient on everyone's lips right now?

The active ingredient semaglutide has been available in the EU and the USA since 2017, but for a long time it was only used to treat diabetes. In 2022 and 2023, it was also approved in various countries as an active ingredient against obesity. Through social media and celebrities such as Elon Musk, the active ingredient gained worldwide recognition. As a result, there were increasing shortages of medicines containing semaglutide in many countries, as the active ingredient was quickly prescribed to people with obesity. As a result, extra regulations were introduced in some countries - including Austria - for dispensing in pharmacies because patients with type 2 diabetes had no other alternatives and, as a result, in some cases no longer received any preparations. As a result, semaglutide was no longer allowed to be dispensed to patients without type 2 diabetes in order to ensure supply.

How does Semaglutide help with obesity?

The effect of weight reduction with semaglutide is significantly higher than the active ingredients currently available on the market. On average, study participants lost 14.9% - 17.4% (including lifestyle changes) of their body weight in 68 weeks. Semaglutide achieves this successful weight reduction through the following effects:

• reduced calorie intake
• reduced feeling of hunger
• increased feeling of satiety and fullness

The drugs currently available on the market only achieved an average weight reduction of 3% - 9% (including lifestyle changes) of their body weight in a comparable time.

What are the advantages?

Research results from Semaglutide are convincing! The weight reduction is significantly higher compared to other active ingredients. The reason why Semaglutide is so well known is that in addition to the significant weight loss, another study, the SELECT study, investigated a further beneficial effect. Semaglutide not only makes excess kilograms disappear, but also reduces the risk of dying from cardiovascular disease by 20%. However, only the risk of dying from existing cardiovascular disease was investigated. Whether and to what extent semaglutide reduces the risk of developing cardiovascular disease is still the subject of ongoing research. The study was published in December 2023, making the active ingredient even better known.

What are the disadvantages?

Despite the numerous benefits, semaglutide - like many other active ingredients - also has side effects. Gastrointestinal complaints are the most common. Inflammation of the pancreas, nausea or diarrhea are just a few examples of the undesirable side effects of semaglutide.

There are also some stumbling blocks when it comes to using the drug. The problem: Semaglutide is currently only available as a pre-filled pen and must be injected into the skin once a week. This can not only cause user errors, but also potentially trigger infections.

In addition, semaglutide would have to be administered for the rest of the patient's life, which requires lifelong continuous therapy. If semaglutide is discontinued, the weight-reducing effect also diminishes.

Semaglutide - an active ingredient for the wealthy?

If you look at the prices for the preparations, it quickly becomes clear that the cost factor is also a significant counterpoint. Depending on the dosage, the active ingredient costs between €200 and €300 for 4 ready-to-use pens. This corresponds to a treatment period of 4 weeks. Calculated over a year, the annual costs would be €3900. Those affected therefore have to dig deep into their pockets to be able to afford to lose their kilograms. Moreover, the weight reduction would not be as great without a change in lifestyle. In addition to the price of the drug, you would also have to add the cost of gyms and fitness trainers.

In order to make the drug available to everyone, health insurance companies would have to get involved and cover the costs of semaglutide. But who is the drug suitable for? What requirements must be met for health insurance companies to pay for the drug?

What could further promote the use of semaglutide?

The authors of the SELECT study state that the results of their study are only representative for secondary prevention, but not for primary prevention. In concrete terms, this means that the cardiovascular effects of semaglutide were only investigated in people who already had pre-existing cardiovascular disease. Whether the active ingredient also protects against cardiovascular disease before it exists is still being researched at the moment. It therefore remains to be seen whether semaglutide also primarily protects against cardiovascular disease.

Conclusion

Semaglutide has definitely earned the title of "Scientific Breakthrough of the Year 2023". The study results are convincing, the side effects are manageable. And the latest developments in minimizing the risk of cardiovascular events could be a big step in the right direction.

Nevertheless, a number of points still need to be worked out before the active ingredient is used as standard therapy for obesity. These include how to avoid bottlenecks, which could be dangerous for diabetics, and how to prevent drug abuse. It should not be forgotten that preparations containing semaglutide are also medicines that require a diagnosis and a doctor's prescription. The active ingredient can also cause side effects or interactions with other medications. Semaglutide will not be an indication for use in the future just to fit into clothes that are one size smaller.