Is it cheating to lose weight with drugs?（2/3）

Mutsuko Ohnishi, MD.

Internal medicine physician in Boston, USA

Semaglutide: 40% Continue Prescriptions After One Year

Researchers at the Cleveland Clinic studied "the continuation rates of various anti-obesity medications at 3, 6, and 12 months" and "factors for continuing treatment for 12 months," reporting their findings in the Obesity Journal on December 6, 2023.

The study included 1,911 adults with a body mass index (BMI) of 30 or higher who were first prescribed FDA-approved anti-obesity medications between 2015 and 2022.

The median follow-up period was 2.4 years, with the overall medication continuation rate dropping from 44% at 3 months to 33% at 6 months, and further to just 19% at 12 months. Semaglutide had the highest continuation rate: 63% at 3 months, 56% at 6 months, and 40% at 12 months. For participants prescribed older generations of anti-obesity medications like Naltrexone-Bupropion, only 10% continued prescriptions after a year.

Larger weight loss at 6 months was associated with a higher likelihood of continuing treatment after a year, with a 1% increase in weight loss at 6 months raising the probability of continuation by 6% after a year. Patients who continued treatment lost an average of 10% of their weight after 12 months, compared to just 2% for those who did not continue.

This means that if there's no weight loss, people tend to stop treatment. Moreover, most participants (84%) were privately insured, but medication adherence for weight loss drugs varied significantly among insurance companies. Private insurance coverage differs by company, and when applicable, it's subject to stringent prior authorization criteria.

However, like other chronic disease management, stopping Semaglutide treatment can lead to weight regain and diminished health benefits. Moreover, the health benefits of Semaglutide are not limited to weight loss.

Changing Perceptions of Weight Loss Medications

A report in the New England Journal of Medicine (NEJM) on December 14, 2023, based on a large-scale, multicenter international clinical trial, showed that "people who are obese or overweight but do not have diabetes" and receive Semaglutide treatment for more than 3 years have a 20% lower risk of heart attacks, strokes, or cardiovascular disease-related deaths compared to participants in the placebo group. Additionally, participants lost an average of 9.4% of their weight with Semaglutide.

The trial targeted patients aged 45 and older, overweight or obese, with a history of heart attacks, strokes, or peripheral arterial disease, but not diagnosed with type 1 or type 2 diabetes. Over 17,000 patients from 41 countries were enrolled and randomly assigned to receive weekly injections of Semaglutide 2.4mg or a placebo, followed for an average of 40 months.

Interestingly, this trial is the largest and longest (4.5 years) study of Semaglutide in adults without type 1 or type 2 diabetes, causing a significant stir.

On the day the paper's results were presented at the American Heart Association conference in Philadelphia, the New York Times reported that Novo Nordisk, the manufacturer of Wegovy and Ozempic and the study's funder, had "already submitted documents to the FDA and the European Union (EU) regulatory authorities to update the labeling of Wegovy to include reducing the risk of cardiovascular events in certain patients."

Dr. Scott Hagan, an assistant professor of medicine at the University of Washington, said, "This new finding could pressure more insurance companies to cover Wegovy, and Medicare might also start covering it."

Dr. Lindsey Allen, a health economist at Northwestern Medicine, stated, "This study could lead to another important outcome: prompting the medical field and the general public to view Wegovy and Ozempic not as mere vanity drugs but as treatments for chronic diseases," "Clearly, this indicates a shift in how these weight loss medications are perceived."

However, there's the issue of thin women wanting Ozempic prescriptions to lose more weight, which is not only dangerous for health but can also cause an aged appearance.

Ozempic Face: Aging with Ozempic

While weight loss brings health benefits, rapid weight loss can reduce muscle mass, potentially leading to sarcopenia.

Dr. Shebani Sethi, an obesity medicine specialist and clinical assistant professor of psychiatry and behavioral sciences at Stanford University School of Medicine (SCOPE), cautioned on June 5, 2023, "Ideally, most of the weight loss should be from body fat, but it's common for lean body mass, muscle, to decrease with weight loss treatments," "Partial analysis of clinical trials showed that 39% of the weight lost with Semaglutide was lean body mass, which is a significantly higher proportion of lean mass loss compared to most other weight loss techniques."

"Therefore, we recommend a resistance training program when starting these treatments. When you stop the medication, the weight that comes back is not muscle but fat. There's a heightened risk of sarcopenic obesity, where muscle mass decreases, and fat tissue increases. This means a reduction in muscle mass, strength, and function, which is particularly concerning in the elderly," she added.

Dr. Lekha Kumar, a clinical assistant professor of medicine at Weill Cornell Medicine, warned in Healthline on May 2, 2023, "Sarcopenia affects the elderly and is usually associated with aging. However, using GLP-1s like Ozempic or Wegovy to rapidly lose weight without proper diet or exercise can cause sarcopenia at any age, reducing stamina and daily living abilities (such as climbing stairs), negatively impacting quality of life," "It's important to note that being underweight doesn't necessarily mean healthy. Once a certain level of weight loss is achieved, it's crucial to assess body composition."

Ozempic Face: Aging Appearance

Furthermore, in the December 2023 issue of the Journal of Facial Plastic Surgery, Dr. Clinton D. Humphrey, an otolaryngologist-head and neck surgeon at the University of Kansas School of Medicine, and colleagues reported, "Rapid weight loss and fat reduction with Ozempic can decrease facial volume and fat, leading to skin wrinkles and sagging, creating the characteristic 'Ozempic face.' Healthcare professionals prescribing Ozempic rarely counsel patients on the potential impact on the face."

"As a result, the plastic surgery community faces the challenge of managing facial changes associated with rapid weight loss. Skin fillers, skin tightening techniques, and surgical interventions can help restore facial volume and manage excess skin. Due to gastrointestinal side effects such as delayed gastric emptying, discontinuation of Ozempic should be considered before general anesthesia. As Ozempic's popularity grows, facial plastic surgeons need to be aware of both the impact on facial appearance and perioperative considerations."

In summary, recent developments in the U.S. regarding Semaglutide treatments like Ozempic highlight their groundbreaking potential in extending the healthy lifespan of individuals with chronic diseases. However, it's crucial to consult with a specialist for individual applications. Also, don't forget about physical activity and a balanced diet even when starting these treatments! Lastly, it's paradoxical for thin people to seek Ozempic prescriptions to lose more weight. This might be an opportunity to reconsider what health truly means.

This article is a translation of Japanese MRIC published on Dec 18, 2023