Antidiabetic drug turns into a weight loss miracle drug, experts warn of risks

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Text ◆ Zhang Shumei “Ming Pao”

From Hollywood celebrities to the super rich, in recent years everyone has been flocking to Ozempic, commonly known as the “weight loss shot”.

Tesla CEO Musk once said that he lost nearly 14 kilograms by injecting Ozempic and dieting, making this drug originally used to treat type 2 diabetes a “miracle weight loss drug”, setting off a rush to buy around the world.

(Hong Kong News) Although Ozempic has obvious weight loss results, it is not completely “painless weight loss”. Some experts said that after the injection, they experienced rapid weight loss, nausea, loss of appetite, and even suicidal thoughts. Today, when obesity has become a global health problem, what benefits and worries does the emergence of Ozempic bring?

14.9% weight loss after 68 weeks

Ozempic, an injectable drug, was originally approved by the U.S. Food and Drug Administration (FDA) for the treatment of type 2 diabetes. Weight loss is an off-label use.

Lu Anxin, president of the Hong Kong Obesity Medicine Society and a specialist in endocrinology and diabetes, pointed out that Ozempic contains semaglutide, a GLP-1 receptor agonist that mimics GLP-1 in the body. 1. Can stimulate insulin secretion and effectively lower blood sugar.

Later, clinical studies found that this ingredient can also reduce weight at the same time. “There are two main ways. First, the satiety center of the hypothalamus controls the desire to eat, and there are GLP-1 receptors there. (By injecting GLP- 1) It can suppress appetite; secondly, it will slow down gastrointestinal motility and make you feel full after eating a small amount of food.”

As Ozempic became popular, the pharmaceutical company later launched Wegovy, which is specifically designed to treat obesity. The ingredients of the two are the same, but the dose of Wegovy is higher, up to 2.4 mg.

Some studies have found that in obese people without diabetes (BMI ≥ 30; or BMI ≥ 27 and one or more obesity-related diseases), 2.4 mg of semaglutide can be injected once a week, combined with diet control and exercise. , the average weight loss after 68 weeks was 14.9%, while the placebo group (only diet and exercise) lost 2.4%.

“This is the most powerful (weight loss effect) among so many weight loss drugs!” Yuan Meixin, a specialist in endocrinology and diabetes, pointed out that oral drugs approved by the FDA in the past for the treatment of obesity can reduce weight by about 7% to 10% body weight, the weight loss effect of semaglutide is obviously better.

The actual effect varies from person to person. Yuan Meixin has a patient who used semaglutide for about half a year, and his weight dropped from more than 170 kilograms to more than 130 kilograms, a decrease of more than 20%. She emphasized that diet and exercise must be combined. “If you only rely on drugs without improving your living habits, once you stop taking the drugs, you will lose the only factor that helps you control your weight, and your weight may rebound.”

Lu Anxin added that in addition to reducing fat, these drugs also reduce muscle mass and slow down metabolism, which may lead to weight gain.

Suitable for those with fatty liver disease and younger age

Ozempic and Wegovy were registered for use in Hong Kong in 2019 and 2023 respectively, but both doctors pointed out that Wegovy is not currently available in the Hong Kong market. Ozempic is a drug that treats type 2 diabetes. Yuan Meixin said that it is usually prescribed to patients with both diabetes and obesity.

“80% of patients with diabetes are also obese, and this drug is mainly targeted at them. Among patients with obesity, I will basically check whether they have diabetes. Even if they are not diagnosed, they are just pre-diabetes or have insulin resistance, they are all suitable candidates. “

At the same time, patients with fatty liver and younger patients are also suitable for this drug. “It can reduce the accumulation of fat in the liver, and people with younger illnesses have better liver and kidney functions and lower drug side effects.”

She emphasized that the patient’s acceptance of injections, medication history, drug price, etc. are also factors to consider when using medication.

“Sometimes when we encounter patients with severe obesity, if they are not treated in time, they may develop serious complications, we will explain clearly to the patients that this drug is not available in Hong Kong for weight loss. With the patient’s understanding, , and will use Ozempic as an off-label.” Yuan Meixin added.

Safer if prescribed by a doctor

Compared with traditional oral weight loss drugs, the side effects of semaglutide are more concentrated in the gastrointestinal area, such as nausea, vomiting, diarrhea, constipation, etc. Lu Anxin pointed out that these side effects will generally gradually reduce with time of use. When prescribing, she would start with a lower dose, and after using it for a period of time, if there is no gastrointestinal discomfort, she would increase the dose.

“However, some patients decide not to use it anymore due to nausea, vomiting or gastrointestinal discomfort.”

Yuan Meixin also pointed out that some people with poor kidney function may experience slow gastrointestinal motility and may develop intestinal obstruction. Losing weight too quickly may also lead to gallbladder enlargement or even inflammation, but this is uncommon.

Ozempic and Wegovy are both medications prescribed by doctors.

Some people self-injected without a doctor’s prescription, and both doctors said the situation was not ideal.

“It is generally recommended that BMI ≥ 30, or BMI ≥ 27.5

And it is used by people with obesity-related complications such as triple height.

If people who are not too obese use these drugs, the weight loss effect will not be significant;

And if there is no problem with GLP-1 secretion,

Forcibly injecting additional amounts may cause more side effects. “

Yuan Meixin continued to point out that patients who use it by themselves may not know which side effects they should stop using, how long to take the medicine, etc. “It is safer to always have a doctor evaluate the patient’s constitution before prescribing.”

2 suicide cases raise suspicion Authorities intervene in investigation

In July last year, the European Medicines Agency (EMA) received reports that there were two cases of suicidal thoughts after using Ozempic and Saxenda, which is also a GLP-1 drug. The authorities are now involved in the investigation.

Psychiatrist Huang Zongxian pointed out that diabetic patients are twice as likely to suffer from depression as the general population. In addition, if the patient is very worried about his weight and makes him very stressed, it may affect his mood or increase the risk of suicide, so it is difficult to distinguish Is it caused by drugs?

Feeling depressed after taking medication

Lu Anxin, a specialist in endocrinology and diabetes, cited a study published in the medical journal Nature Medicine earlier this month. The team reviewed the health records of 240,000 overweight or obese people and compared their effectiveness after taking semaglutide with other weight loss drugs. There were no suicidal thoughts or behaviors, and no increase in related risks was found after taking the medication.

However, Yuan Meixin, a specialist in endocrinology and diabetes, pointed out, “We have come across cases of depression after using GLP-1 drugs, so we start prescribing from a low dose. If we find that the patient has emotional problems, we will consider discontinuing the drug or discuss other options. .”

In addition, some psychiatric drugs can cause weight gain as a side effect, reducing patients’ willingness to take the drugs. In view of the outstanding weight loss effect of semaglutide, some psychiatrists in foreign countries will prescribe it to psychiatric patients in the hope that patients will be more willing to comply with medical advice.

Preliminary research has found that if patients are troubled by the obesity problem caused by psychiatric drugs, but the prescribed diabetes drug metformin has average weight loss results, when they switch to semaglutide, the weight loss effect is good. Can patients with similar problems in Hong Kong benefit?

Antidepressants can make you fat

Huang Zongxian pointed out that there are many reasons why patients gain weight. Mental illness itself may cause patients to have low motivation and inactivity for a long time; or people who are emotionally distressed and eat a lot when they are stressed are prone to weight gain themselves. Medications also have a certain impact, such as antipsychotics for treating schizophrenia, delusions, etc., as well as antidepressants, mood stabilizers, etc., which can easily make people gain weight.

Take antipsychotic drugs as an example. Drugs may affect the secretion of serotonin and dopamine in the brain, or reduce leptin in the brain, which is responsible for weight control, causing patients to have an appetite. “When we notice that a patient has gained a lot of weight after taking medication, we need to find out whether it is caused by unhealthy lifestyle habits or medication, and then decide to change the medication or intervene from the lifestyle perspective to improve it through diet and exercise.”

If the effect is not effective, some doctors will prescribe metformin. “There is data showing that when used in patients without diabetes, it can reduce weight gain and even return to normal levels.” As for the use of semaglutide for weight loss, in Hong Kong It is still a new thing. As far as he knows, there is no prescription for treating overweight problems among psychiatric patients in Hong Kong, so it is difficult to comment on whether it is feasible and there are not many related studies. He has never prescribed weight-loss drugs. “Every time a patient comes for a follow-up visit, I will measure their weight and blood pressure, so I will know early on if there are any changes in their body, and I will not let them gain too much weight before I think of ways to deal with it.”

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