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Obesity effects about 1 in 4 adults in the US. Semaglutide (Ozempic, Rybelsus), a GLP-1 receptor agonist used for diabetes, has recently been shown to have a significant impact on weight loss. In the STEP 1 study, adults who were overweight or obese were assigned a subcutaneous injection of semaglutide 2.4 mg per week (a substantially higher dose than the usual 0.5-1 mg/week dose used for diabetes) or placebo for 68 weeks. Participants did not have diabetes, but 40-45% were considered pre-diabetic. All participants received either face-toface or phone counseling sessions from registered dietitians every 4 weeks to help with diet, physical activity, behavioral strategies, and motivation. Compared with individuals in the placebo group, more than half of the participants in the semaglutide group lost 15% of their body weight, and one-third lost at least 20% of their initial weight. People who received placebo and counseling did not see any significant weight loss. The most common side effects of semaglutide were nausea and diarrhea, which were transient and mild-to-moderate in severity.

The most effective weight loss strategy for obesity is bariatric surgery, which results in an average weight loss of 25% – 30% of body weight. Oral phentermine therapy in overweight individuals results in about a 7.5% weight loss and it can only be taken for a short time. Semaglutide use, while not FDA approved for weight loss, will likely be a welcomed strategy. It remains to be seen whether insurance carriers will pay for the treatment. The lower dose used to treat diabetes retails for nearly $1,000 a month.

 

• Wilding J, et al. N Engl J Med 2021; doi:10.1056/NEJMoa2032183
‘A Game Changer’: Drug Brings Weight Loss in Patients With Obesity 

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