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Semaglutide: Is it The Panacea for Weight Loss?

Health & Gender Policy Brief #139 | By: S. Bhimji | November 1, 2021

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Photo taken from: Medpage Today

Policy Summary

There are over 70 million Americans who are considered obese and 99 million more who are said to be overweight. Today obesity has replaced smoking as  public health enemy number one. Obesity has repercussions beyond just excess weight- it negatively affects almost every organ in the body and shortens the lifespan. 

Studies show that even achieving a minimum of 5% of initial weight loss in obese individuals can result in a marked lowering of the risk factors for heart disease as well as preventing the onset of type 2 diabetes.

Over the years, many drugs have been developed to reduce body weight but most have proven to have dangerous side effects and the weight loss is not significant even after 1 year. The other option is for obese individuals to undergo surgery. Bariatric surgery has been shown to produce significant weight loss and improve risk factors for heart disease. 

Unfortunately, not only do many individuals not meet the criteria for surgery, the surgery is prohibitively expensive and can lead to life-threatening complications, which are not rare. Most important, regaining weight after surgery within the first year is very common. Only about a third of individuals who undergo surgery can prevent weight gain. And for patients without healthcare insurance, the cost of weight loss surgery can run as high as $35K. 

Now a new drug has been approved by the FDA for the treatment of obesity- called Semaglutide. Many think it is perhaps the best and safest drug on the market- but does it work?

Policy Analysis

Semaglutide was developed for the treatment of type 2 diabetes but it was observed that many obese diabetics also lost a significant amount of weight while lowering their blood sugars. This led to a clinical trial involving over 1,960 obese adults. At a dose of 2.4 mg administered weekly by injection, participants lost a significant amount of weight compared to those treated with a placebo and lifestyle changes. 

The weight loss began within the first 4 weeks of starting treatment and by the end of week 68, there was an average of 33.7-pound weight loss in the majority of obese individuals. Besides weight loss, Semaglutide also lowered blood pressure, reduced waist circumference, decreased blood glucose and cholesterol levels- all risk factors for heart disease. 

Overall the study revealed that more than 50% of participants lost 15% of their initial body weight and at least a third lost 20% body weight- which is far superior to previous weight-loss drugs. The most common adverse effects in the trial were related to the gastrointestinal system which included nausea, vomiting, bloating, and diarrhea.

To date it appears to be the most effective drug treatment for weight loss when it is combined with lifestyle changes; There is an oral form of the drug now available for weight loss today- sold under the trade name Rybelsus. 

Photo taken from: Medpage Today

Despite the hype, it should be noted that animal studies have shown the oral agent to cause pancreatitis and thyroid tumors in rodents. No such findings have been observed in humans but it may be too early. 

Another clinical trial is set to assess the oral formula and also look more closely at potential adverse effects that can occur in the long term. 

For obese consumers, the bad news is that this agent is not covered by insurance and the cost per month ranges from $800-$1300, depending on which pharmacy you buy it from and if you have a discount coupon. Without a government subsidy, it is unlikely that many obese individuals (who are also poor/unemployed) will be able to afford the cost of this drug. 

 

To lose weight, you need to take the drug for about a year and hence a year’s supply would cost about $12K-$15K, which is still far cheaper than surgery AND SAFER. 

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