By Yusuf Hassoun | Contributing Writer
As many as 18 million people die yearly from cardiovascular issues, most of which stem from chronic conditions including diabetes mellitus and hypertension. Recent reports by the Lebanese Medical Journal and the Faculty of Health Sciences at AUB warn about the rising obesity and overweight rates across all demographics, notably in children. Obesity is conducive to the early onset of non-communicable diseases (NCDs), which constitute 91% of all deaths in Lebanon.
The recent social media craze over type 2 diabetes medications like Ozempic and Wegovy (both brand names for the generic semaglutide) being used off-label as miracle weight-loss drugs has left skeptics shaking their heads at the thought of something this good to be true; indeed, there is a catch.
There seem to be a few mechanisms at play for the weight loss observed with these drugs. First, some biology: although many classes of weight-suppression drugs operate on similar principles, these in particular fall under the incretin mimetics. Incretin is a term that stuck from the early discovery of a gut hormone that influences pancreatic secretions. In reality, there are two incretin hormones: gastric inhibitory protein and Glucagon-like peptide 1 (GLP-1). The latter is the molecule of most interest pharmaceutically for reasons beyond the scope of this article, although some drugs work on receptors for both hormones, and yet other drugs known as DPP-4 inhibitors indirectly work on these systems. Thus, semaglutide and similar molecules are known as GLP-1R agonists, which is the term used from here on. These drugs show a reduced risk of stroke and as much as a 15% total body weight loss in adults. To put that into perspective, an individual weighing in at 90 kg could lose almost 14 kg using GLP-1R agonists.
Through their action on alpha cells (inhibiting glucagon release) and beta cells (stimulating insulin production), the drugs potentiate pancreatic response to glucose, improving insulin sensitivity. Obese individuals are known to suffer from heightened insulin resistance, which puts them at risk for type 2 diabetes, so these drugs are conducive to various improved health markers in these populations. However, the associated weight loss comes from the appetite suppressive qualities of the drugs. And that is the catch: these drugs do not significantly increase metabolic activity, but instead, by slowing gastric emptying and gut motility (literally moving food around your GI), they very effectively control the primitive urge to gorge. Literally, they just cause you to eat less. Traditionally, morbidly obese patients had to depend on stimulants to reduce their appetite and boost metabolism. However, as anyone who parties a little too much knows, stimulants are riddled with side effects, and GLP-1 agonists are much better at appetite suppression.
What are the side effects of GLP-1 agonists? Nausea is a common one, but it seems to subside with use. Forced eating under GLP-1 agonists increases the risk of pancreatitis and pancreatic cancer. Prolonged use was also associated with widespread increased risk of thyroid cancer, and thyroid issues are a contraindication. However, for most obese individuals, the benefits definitively outweigh the risks, and the use of these drugs could be life-changing.
Currently, however, the smaller scale of production and the relatively new status of these drugs as weight-loss medications (as approved by the FDA) drives their prices exorbitantly. As type 2 diabetes patients require them to live, they should be withheld from people who do not absolutely need them. The social media craze incited by influencers wanting to leverage pharmaceutics to achieve their summer bodies created a scarcity that compromises countless lives.
While GLP-1R agonists such as Ozempic and Wegovy may seem like miracle drugs for weight loss, they should not be taken lightly. While they can be effective in suppressing appetite and promoting weight loss, they also come with potential risks and side effects that should be carefully considered. Before considering these drugs, it is essential to consult with a doctor and consider lifestyle changes such as regular exercise and a healthy diet to manage weight and promote overall health.