Weight-regulating medications have become a discovery in medicine. However, weight loss injections also have a downside. Endocrinologist Anastasia Kryuchkova told Rambler how “Ozempic” works and in what cases GLP-1 agonists will be useless. The doctor revealed when weight loss injections help and when they harm © Rambler The WHO considers obesity a global problem. Over the past 30 years, the number of people with excess body weight has doubled. Already one in eight people has obesity, and this figure is projected to rise. Fat deposits systematically affect the functioning of the entire body and cause serious ailments: arterial hypertension, ischemic heart disease, type 2 diabetes, and even some forms of cancer. Therefore, eliminating the problem of obesity is one of the primary tasks for the medical community. The main advice for such patients remains lifestyle change. A balanced diet and physical activity provide a calorie deficit—the key condition for weight loss. However, in some situations, this is not enough, and then medications—agonists of glucagon-like peptide-1 (GLP-1) receptors—are prescribed. “They simulate the action of the natural gut hormone GLP-1, which is mainly synthesized by the cells of the thin intestinal mucosa in response to food intake. This hormone signals the body that food has arrived, it’s time to stop and digest it.” Anastasia Kryuchkova Anastasia Kryuchkova endocrinologist at Lahta Clinic Synthetic GLP-1s function in several ways: * stimulate insulin production; * suppress the secretion of glucagon (a hormone that increases blood sugar levels); * slow down stomach emptying; * increase the feeling of satiety. “Due to this, GLP-1 contributes to maintaining proper glucose levels and reducing appetite—the most significant mechanisms in type 2 diabetes and excess weight. Simply put, the desire for food decreases, the amount of calories consumed decreases, a deficit is created, and weight gradually decreases,” explains the doctor. What “Ozempic” is Several agonists of glucagon-like peptide-1 (GLP-1) receptors are known. One of the most common is semaglutide. It is produced under various trade names, but the most famous is “Ozempic,” which has become a common term for all drugs in this category. The original “Ozempic” is not supplied to Russia, but there are substitutes with the same active substance. They are usually available as subcutaneous injections, although tablets also exist. aud-key.ru Advertisement Accounting services for organizations from 14900 rubles/month We handle all accounting or individual departments. All risks are insured up to 3 million. | Cost | What is included | FAQs | Reviews | There are also others besides semaglutide: They cannot be considered complete equivalents. Each has its own indications, limitations, and usage features. Therefore, only a doctor can select the drug. “The creation of synthetic GLP-1 agonists has become a real breakthrough: doctors now have effective tools for regulating body weight and blood sugar levels. However, it is important to remember that prescribing such medications does not eliminate the need for lifestyle changes: diet, physical activity, and sleep normalization,” warns the endocrinologist. Tirzepatide (Mounjaro, Zepbound) deserves a separate mention. This is already a dual receptor agonist. It simulates the action of not only GLP-1 but also glucose-dependent insulinotropic polypeptide (GIP, which stimulates the production of insulin by the beta cells of the pancreas in response to food). Therefore, tirzepatide has a more pronounced weight loss effect, but there are also more risks of side effects. The FDA has approved this drug only as an additional method for treating diabetes and controlling weight in adults with obesity or being overweight who have at least one weight-related condition. © Lacheev/iStock.com Indications and Contraindications for GLP-1 Semaglutide and other substances with a similar action are not just weight loss injections; they are hormonal drugs with a systemic effect, so there are strict rules for their use. According to the clinical guidelines of the American Diabetes Association and the European Association for the Study of Diabetes, synthetic GLP-1 agonists are indicated in two cases: 1. To improve glycated hemoglobin levels (reflects the average glucose level over a long period) and reduce cardiovascular risks in type 2 diabetes. 2. In cases of overweight (BMI ≥27) or obesity (BMI ≥30), but only if there are accompanying ailments. “In obesity (even without diabetes), drugs in this group are prescribed if there are coexisting conditions, such as arterial hypertension, prediabetes, or obstructive sleep apnea syndrome,” clarifies the doctor. Thus, the numbers on the scale alone are not enough to prescribe GLP-1 drugs. It must be a case where the dangers of obesity outweigh the risks of using the medication. According to the doctor, the use of semaglutide and other GLP-1 agonists with a relatively normal body mass index is impractical and unsafe. There are three reasons for this: 1. In people with normal BMI, losing even a few kilograms usually occurs due to muscle mass, not fat. 2. In people without excess weight, side effects occur more frequently and are more noticeable, including nausea, vomiting, weakness, constipation, nutrient deficiencies, and a sharp decrease in appetite. 3. The effect persists only while taking the medication. After discontinuation, weight usually returns unless diet, physical activity, and overall relationship with food are changed. “Using the drug to quickly lose a couple of kilograms is not only unreasonable but also potentially harmful. Short-term weight loss does not justify the risks. A more stable result without interfering with hormonal mechanisms is achieved through competent work on lifestyle,” states the specialist. How effective is “Ozempic”? GLP-1 receptor agonists help control blood sugar levels, reduce cardiovascular risks, and promote weight loss. Assessing the overall effectiveness of such drugs is difficult: much depends on the specific active substance and dosage. There is the most information about semaglutide, so people often focus on it. A series of clinical studies, SUSTAIN 1-7, showed: * The level of glycated hemoglobin in diabetic patients improved by 1.1–1.4% during semaglutide therapy. * Body weight decreased by 3.6–4.9 kilograms. * The risk of cardiovascular events decreased by 26%. Side Effects © m-gucci/iStock.com All drugs in this group have side effects. In most cases, they occur in the first few days of use and after a dose increase, but gradually become less pronounced. Mainly, these are gastrointestinal reactions: nausea, vomiting, diarrhea, or constipation. Less frequently found are pancreatitis, impaired kidney function (due to dehydration), delayed stomach emptying, and allergic reactions. “Some patients may experience local reactions at the injection site: redness, itching, slight swelling. At the beginning of therapy, weakness or dizziness may also occur, more often due to dehydration or insufficient nutrition,” comments endocrinologist Anastasia Kryuchkova. Experiments on mice have shown that the use of some GLP-1s affects the thyroid gland. Whether this side effect persists in humans is unknown. Nevertheless, the drugs cannot be used if the patient or their blood relatives have medullary thyroid cancer or multiple endocrine neoplasia type 2 (MEN-2). “They are also contraindicated for severe diseases of the stomach, intestines, or pancreas, where treatment can worsen the condition. Their use is not advised during pregnancy and breastfeeding, or if allergic to the drug components. In general, GLP-1 receptor agonists are recognized as effective and safe if used according to indications and under specialist supervision,” says the endocrinologist. Who needs weight loss injections and how harmless are they Key Points Semaglutide and other glucagon-like peptide-1 receptor agonists simulate the action of a natural gut hormone that is synthesized in response to food intake. Drugs in this group help control blood glucose levels and promote weight loss. However, they are only used to treat type 2 diabetes and for overweight or obesity when the body mass index is above 27 and 30, respectively. Taking GLP-1 with a normal BMI to lose a couple of kilograms is unsafe. First, weight loss in this case occurs due to muscle loss, not fat. Second, there is a risk of side effects. Third, if the lifestyle is not changed, the weight will return after the injection course. The main side effects of semaglutide are related to the gastrointestinal tract. Nausea, vomiting, diarrhea, or constipation are usually observed, although more serious consequences can occur: pancreatitis, liver, and kidney impairment. Besides semaglutide, there are other GLP-1 agonists; the active substance and dosage must be selected by a doctor. Important Research Management of hyperglycemia in type 2 diabetes, 2022. Consensus Report of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) Obesity and weight management for the prevention and treatment of type 2 diabetes: standards of diabetes care — 2024 Comparative efficacy, safety, and cardiovascular outcomes with once-weekly subcutaneous semaglutide for the treatment of type 2 diabetes: findings from the SUSTAIN 1-7 trials
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