The buzz around a new weight-loss pill
I am (or should be) studying for my medical board recertification exam.
Instead of immersing myself in acid-base disorders, again, I’m learning:
- A mosquito’s mouthpiece has six needles.
- Cauliflower are actually flowers.
- Dr. Joseph Mercola, who's heavy on vitamins and light on facts and who's been warned multiple times by the FDA for his "unapproved and misbranded" products including COVID-19 treatment, makes a lot more money than any doctors I know.
But one newly FDA-approved, weight-loss drug – semaglutide (brand name Wegovy) – caught my attention.
I’ve read the studies and believe it has potential.
For the past decade, we’ve had four FDA-approved weight-loss drugs: orlistat (Xenical), liraglutide (Saxenda), naltrexone-bupropion (Contrave), and phentermine/topiramate (Qsymia).
They work modestly, with an average 7 to 20 pound weight loss in addition to what diet and exercise can do. On semaglutide, the weight loss averaged 30 pounds – impressive.
For a woman who is 5 feet 4 inches tall, she’d qualify for prescription weight-loss drugs if she weighs over 175 pounds (BMI 30) – or 158 pounds (BMI 27) if she has weight-related medical issues like diabetes.
For those who need to lose more weight (BMI greater than 35 to 40), bariatric surgery is superior. They can expect to lose one-third of their body weight. Plus, most of their weight loss can be maintained long-term.
Regardless, better medical advice is: Any weight loss, even a few pounds, can impact significantly on various medical conditions like joint pain, diabetes and high blood pressure. Don’t be discouraged.
About the new kid in town:
- Semaglutide is not that new. Around since 2017, it belongs to a class of diabetic drugs called glucagon-like peptide 1 (GLP-1). It’s used at low dose (1 mg) to treat diabetes, high dose (2.4 mg) for weight loss.
- Why do I like it? It’s a weekly injection – so easy. For the needle-queasy, a pill-form is around the corner. And it uses a novel, target approach. Semaglutide mimics an anti-hunger hormone. You crave food less and feel full earlier after eating.
I’m itching to prescribe the drug, but I’m stuck with the question: “For whom?”
- The drug is expensive. Wegovy costs $1,300 a month. Most insurance plans either do not cover or require preauthorization for weight-loss drugs.
- The hardest sell: If the drug works, great, but you can’t get off of it.
Obesity isn’t just self-control. It’s nature and nurture. Scientists have identified several hormones that regulate our hunger. Semaglutide holds nature at bay. But research shows that if you stay on the drug, you can maintain the weight loss. If you stop the drug, the weight comes back.
While the drug is relatively well tolerated, nobody knows what happens years down the line. But I believe we’re going in the right direction.
Weight loss is complicated. Science is complicated. My board exam, which lasts 10 hours, is complicated.
So I understand the attraction of Dr. Mercola and his many calming, simple blanket solutions, like: “Vitamin C at extremely high doses … actually [kills] viruses.” Imagine a world where that’s even remotely true: I could’ve aced the section on viral infection without a lick of work.