Semaglutide

[[File:Semaglutide PDB=7ki0.png|thumb|right|165px|Structure of semaglutide.]]
{{Drugs}}
[[File:Ozempic® 3ml.jpg|thumb|right|165px|An Ozempic injection pen.]]
'''Semaglutide''' is the active ingredient in certain [[drug]]s taken as pills or injections, to treat diabetes (primarily<ref>Steven Novella (June 28, 2023). [https://sciencebasedmedicine.org/does-intermittent-fasting-work/ "Does Intermittent Fasting Work?"]. ''Science-Based Medicine''. "There are medications available, such as Ozempic. These are primarily for diabetes, but are shifting to treatments for obesity itself. However, these medications are expensive and have to be taken indefinitely, with a risk of rebound if they are stopped. Medical interventions therefore have a role to play, but they are not for everyone."</ref>), [[obesity]],<ref name="FDAJ24"/> or not yet looking like a Tim Burton character.<ref name="KYM"/><ref name="HHPF24"/> For diabetes, it's prescribed under the brand names '''Ozempic''' (injection) or '''Rybelsus''' (pills), and for weight loss as '''Wegovy''' (injection).<ref name="FDAJ24">(January 10, 2024). [https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/medications-containing-semaglutide-marketed-type-2-diabetes-or-weight-loss "Medications Containing Semaglutide Marketed for Type 2 Diabetes or Weight Loss"]. ''Food and Drug Administration''.</ref> According to the manufacturer (Novo Nordisk), these all come "with different indications, dosages, prescribing information, titration schedules, and delivery forms … The products are not interchangeable".<ref name="HSSL"/> As of 2023, no generic versions had been approved by the [[FDA]].<ref>(July 19, 2023). [https://health.ucdavis.edu/blog/cultivating-health/ozempic-for-weight-loss-does-it-work-and-what-do-experts-recommend/2023/07 "Ozempic for weight loss: Does it work, and what do experts recommend?"]. ''UC Davis Health''.</ref>

Semaglutide is a glucagon-like peptide-1 (GLP-1) agonist, meaning it mimics the GLP-1 hormone usually released by one's intestines in response to eating food.<ref name="FDAJ24"/><ref name="CC73"/> This helps type 2 diabetics when it reduces blood sugar. It helps for weight loss because it suppresses appetite and slows stomach digestion.<ref name="CC73">(July 3, 2023). [https://my.clevelandclinic.org/health/treatments/13901-glp-1-agonists "GLP-1 Agonists"]. ''Cleveland Clinic''.</ref><ref name="HHPF24">Lisa Catanese (February 5, 2024). [https://www.health.harvard.edu/staying-healthy/glp-1-diabetes-and-weight-loss-drug-side-effects-ozempic-face-and-more "GLP-1 diabetes and weight-loss drug side effects: "Ozempic face" and more"]. ''Harvard Health Publishing''.</ref> [[Randomized controlled trial]]s (RCTs) suggest the drug also reduces risk of death from cardiovascular disease in either group.<ref>{{Cite journal |last=Lincoff |first=A. Michael |last2=Brown-Frandsen |first2=Kirstine |last3=Colhoun |first3=Helen M. |last4=Deanfield |first4=John |last5=Emerson |first5=Scott S. |last6=Esbjerg |first6=Sille |last7=Hardt-Lindberg |first7=Søren |last8=Hovingh |first8=G. Kees |last9=etal |first9=etal |date=2023-12-14 |title=Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes |url=https://www.nejm.org/doi/full/10.1056/NEJMoa2307563 |journal=New England Journal of Medicine ||volume=389 |issue=24 |pages=2221–2232 |doi=10.1056/NEJMoa2307563 |issn=0028-4793}}</ref><ref>(August 30, 2024). [https://www.acc.org/latest-in-cardiology/articles/2024/08/28/19/41/fri-435am-new-science-esc-2024 "New Science Suggests Semaglutide Improves CV Outcomes Beyond Weight Loss"]. ''American College of Cardiology''.</ref><ref name="BHIM24"/>{{rp|3}}

The drug is not meant as a "miracle drug" for these conditions, being more of an assistant to other treatment strategies.<ref name="CC73"/> Nonetheless, the expensive drug is touted by [[Hollywood]] and [[social media]] as an easy weight loss method.<ref name="MD22">Matt Donnelly (September 21, 2022). [https://variety.com/2022/film/actors/weight-loss-ozempic-semaglutide-hollywood-1235361465/ "Hollywood's Secret New Weight Loss Drug, Revealed: The Hype and Hazards of Ozempic"]. ''Variety''.</ref><ref name="HSSL"/> Many people instead find the common side effects like diarrhea, nausea and vomiting too difficult to bear, and cease treatment before achieving "clinically meaningful weight loss".<ref name="QWJ16"/> According to the studies of one research lab, semaglutide reduced risk for forty-two health conditions but increased risk for nineteen others.<ref>Ziyad Al-Aly (January 22, 2025). [https://theconversation.com/ozempic-and-similar-weight-loss-drugs-may-lower-risk-of-42-health-conditions-but-also-pose-risks-244243 "Ozempic and similar weight loss drugs may lower risk of 42 health conditions, but also pose risks"]. ''The Conversation''.</ref>

The drug's use as a weight loss assistant has caused shortages, including for diabetic people whose condition is typically more urgent to treat although obesity can also be life-threatening,<ref name="HSSL"/><ref>Stephen Fairclough (September 6, 2023). [https://www.bbc.com/news/uk-wales-66735012 "Ozempic shortage hits diabetes patient after weight loss use"]. ''BBC News''.</ref><ref name="BHIM24"/>{{rp|2}} and the pharma companies themselves may have contributed to the drug's scarcity via [[advertising]] campaigns.<ref name="HSSL">Sydney Lupkin (July 10, 2024). [https://www.npr.org/sections/shots-health-news/2024/07/10/nx-s1-5006103/ozempic-wegovy-semaglutide-shortage-type-2-diabetes-obesity "Ozempic's popularity leads to shortages for people with Type 2 diabetes"]. ''Health Shots'' (NPR).</ref> The demand has resulted in Novo Nordisk being, at times, the highest-valued company in the entire [[European Union]].<ref>Euan Healy (September 4, 2023). [https://www.ft.com/content/19357584-62e0-452f-a06f-7cda1d8cd0e3 "Weight-loss drug maker Novo Nordisk becomes Europe’s most valuable company"]. ''The Financial Times''.</ref> The [[Danish]] company's controlling shareholder, the Novo Nordisk Foundation, states its intent to reinvest profits into "[[philanthropy]], in the form of research, grants, education and even sometimes investments", e.g. [[stem cell research]].<ref>Hannah Kuchler (December 26, 2023). [https://www.ft.com/content/69324884-a626-4787-a4ce-aece410d1dcc "How anti-obesity drugs built the world’s largest charitable foundation"]. ''The Financial Times''.</ref><ref>James Waldron (October 6, 2023). [https://www.fiercebiotech.com/biotech/flush-wegovy-cash-novo-nordisks-owner-widens-investment-strategy-beyond-biotech "Flush with Wegovy cash, Novo Nordisk's owner widens investment strategy beyond biotech"]. ''Fierce Biotech''.</ref>

As of 2025, the American company Eli Lilly had put GLP-1 antagonist pills through late-stage trials to compete with Novo Nordisk's injection-based semaglutide products.<ref>Annika Kim Constantino (August 7, 2025). [https://www.cnbc.com/2025/08/07/eli-lilly-obesity-pill-weight-los-trial.html "Eli Lilly's obesity pill led to around 12% weight loss in closely watched late-stage trial; shares drop"]. ''CNBC''.</ref>

==Problems==
{{cquote|“Obesity is an epidemic,” cautioned Dr. Zhaoping Li, chief of clinical nutrition at the David Geffen School of Medicine at UCLA. “The issue is that this is one of the tools in our box, it is not the end-all. The longest study done on these injections was conducted over less than two years. A lot of questions have not been answered.”<br>
Dr. Li added that the maximum weight loss exhibited in most patients is 15% of body mass, bringing us back to the awful truth that the resourceful people of Hollywood are loathe to hear: “It comes down to lifestyle. Activity, eating right, and stress management.” |||''Variety'' (2022)<ref name="MD22"/>}}

Gastrointestinal issues like nausea, vomiting, and diarrhea have been reported as common side effects since some of the earliest [[RCT]]s with semaglutide as a weight loss treatment, combined with exercise and dietary coaching; said trials have found the drug effective for weight loss when combined with those.<ref>Harriet Hall (April 6, 2021). [https://sciencebasedmedicine.org/a-new-medication-to-combat-obesity/ "A New Medication to Combat Obesity"]. ''Science-Based Medicine''.</ref> So-called "Ozempic face", that being sagging skin on the face, can also happen. It's attributed to the drug (for which it earned a place in Internet meme canon<ref name="KYM">[https://knowyourmeme.com/memes/ozempic-face "Ozempic Face"]. ''KnowYourMeme''.</ref>), though it can actually occur as a result of any quick weight loss.<ref name="HHPF24"/> It is suggested that makeup would be a cheaper option for ''Corpse Bride'' cosplayers.{{nofact}}

{{quackbox|Patients commonly discontinue semaglutide weight-loss treatment. An analysis of nationally representative, commercial insurance data has found while prescriptions of semaglutide drugs for weight management have increased exponentially, many patients discontinued the drugs before achieving clinically meaningful weight loss.<ref name="BHIM24">[https://web.archive.org/web/20240701135926/https://www.bcbs.com/sites/default/files/BHI_Issue_Brief_GLP1_Trends.pdf Real-world trends in GLP-1 treatment persistence and prescribing for weight management]. Blue Health Intelligencer Issue Brief, May 2024</ref> Key findings include:

*about half the patients who received prescriptions stayed on treatment for a minimum of 12 weeks, enough time to achieve clinically meaningful weight loss
*30% of patients discontinued treatment within four weeks, before reaching the targeted dose
*patients aged 35 and older were more likely to stay on GLP-1 treatment for at least 12 weeks
*patients who regularly visited their healthcare providers were more likely to stay on the drugs

The report notes that almost all new users of the drugs suffer some gastrointestinal side effects. Patients often stop treatment due to difficulty coping with vomiting, nausea, and diarrhea.|<ref name="QWJ16"/>}}

Not to [[FUD]] the drug — but it's clearly a commitment.

===Shortages, fakes, and "alternative" forms===
Although approved for weight loss in cases of obesity and sometimes overweight when additional health problems related to excess weight occur,<ref name="FDAJ24"/> the semaglutide has also been sought after by people who want to lose weight for "cosmetic" purposes, which has helped to fuel shortages.<ref name="HSSL"/> The shortages have also led people in both categories to seek out "compounded" [[alternative medicine|alternatives]] which may not be up to standard and could in some cases contain different active ingredients such as "[[salt]] formulations" of semaglutide, {{IdEst}} semaglutide sodium and semaglutide acetate.<ref name="FDAJ24"/> In the United States, these compounded versions are regulated at the state level rather than by the US [[Food and Drug Administration]] (FDA).<ref>Anna Claire Vollers (July 8, 2024). [https://stateline.org/2024/07/08/compounded-weight-loss-drugs-are-a-growing-problem-for-state-regulators/ "‘Compounded’ weight-loss drugs are a growing problem for state regulators"]. ''Stateline'' (States Newsroom).</ref> The FDA says:
{{blockquote|FDA has received adverse event reports after patients used compounded semaglutide. Patients should not use a compounded drug if an approved drug is available to treat a patient. Patients and health care professionals should understand that the agency does not review compounded versions of these drugs for safety, effectiveness, or quality.<ref name="FDAJ24"/>}}
As of 2024, the FDA was investigating allegations of counterfeit semaglutide sold online.<ref name="FDAJ24"/> Some reports suggest the drug has been incorporated by online [[scam]]mers promising big discounts, especially if paid in [[cryptocurrency]] — just like your real doctor asks for!<ref name="QWJ16">(June 16, 2024). [https://quackwatch.org/ncahf/digest24/24-24/ "Consumer Health Digest, Issue #24-24"]. ''Quackwatch''.</ref><ref>Abhishek Karnik (June 12, 2024). [https://www.mcafee.com/blogs/internet-security/how-ozempic-scams-put-peoples-finances-and-health-at-risk/ "How Ozempic Scams Put People’s Finances and Health at Risk"]. ''McAfee''.</ref> [[Penis enlargement]] suddenly has some competition in the [[spam]] market.

==Eating disorders==
A [[cohort study]] concluded semaglutide's use for binge eating disorder (in which somebody has excessive urges to eat) warranted investigation,<ref>{{Cite journal |last=Richards |first=Jesse |last2=Bang |first2=Neha |last3=Ratliff |first3=Erin L. |last4=Paszkowiak |first4=Maria A. |last5=Khorgami |first5=Zhamak |last6=Khalsa |first6=Sahib S. |last7=Simmons |first7=W. Kyle |date=2023-09-01 |title=Successful treatment of binge eating disorder with the GLP-1 agonist semaglutide: A retrospective cohort study |url=https://pubmed.ncbi.nlm.nih.gov/37990682/ |journal=Obesity Pillars |volume=7 |doi=10.1016/j.obpill.2023.100080 |issn=2667-3681}}</ref> which makes intuitive sense given it suppresses appetite. Though, non-pharmaceutical strategies exist and may be pursued first.<ref>Casey Kuhn (September 25, 2023). [https://www.pbs.org/newshour/health/patients-say-drugs-like-ozempic-help-with-food-noise-heres-what-that-means "Patients say drugs like Ozempic help with ‘food noise.’ Here’s what that means"]. ''PBS NewsHour''.</ref>

Some (non-)food for thought, quoted in part:
{{blockquote|Emerging research strongly supports that for many, eating disorders are brain-based illnesses and in most cases, there exists a co-morbidity like anxiety, mood disorders, or [[substance abuse]].

“GLP-1’s can’t help someone deal with their stress, anxiety, [and] trauma-history,” said [[psychologist]] Cynthia Bulik, one of the world’s leading eating disorder researchers, and Founding Director of the University of North Carolina Center of Excellence of Eating Disorders. “All of that background distress—fundamental distress that might be driving the BED in the first place—is temporarily bypassed by removing the desire to eat.”

… Further, these drugs are often intended to be taken for a person’s entire life. “When they go off the drug, or can’t access it due to supply problems, the urge to binge comes right back and they have not developed any psychological (or) behavioral skills to manage the urge,” Bulik told me. Just like with a diet, any lost weight will likely be regained when a person stops taking the drugs. Weight fluctuations, themselves, may increase a person’s risk of chronic illnesses like type 2 diabetes, according to multiple studies.

“The focus on weight and erasing the desire to eat could indeed do harm,” cautioned Bulik. “The potential for abuse is high and will become higher with new preparations that don’t require an injection … Remember, these drugs are ‘for life.’ Stop them, and everything comes rushing back.”<ref>Cole Kazdin (April 16, 2024). [https://time.com/6966957/ozempic-eating-disorders-essay/ "Ozempic Hurts the Fight Against Eating Disorders"]. ''TIME''.</ref>}}
(There can be "feedback loop" situations between body shame and overeating,<ref>{{Cite journal |last=O’Loghlen |first=Elyse |last2=Galligan |first2=Roslyn |last3=Grant |first3=Sharon |date=2023-06-13 |title=Childhood maltreatment, shame, psychological distress, and binge eating: testing a serial mediational model |url=https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-023-00819-7 |journal=Journal of Eating Disorders |volume=11 |issue=1 |pages=96 |doi=10.1186/s40337-023-00819-7 |issn=2050-2974 |pmid=37312168}}</ref> and so it's hard to entirely rule out such an option to break a vicious cycle, but there may be better ones.)

==See also==
*[[Fad diet]]
*[[Food woo]]

==External links==
*See entries for [https://medlineplus.gov/druginfo/meds/a618008.html "Semaglutide Injection"] and [https://medlineplus.gov/druginfo/meds/a619057.html "Semaglutide"] at MedlinePlus.

==References==
{{reflist}}

[[Category:Chemicals]]
[[Category:Drugs]]
[[Category:Medicine]]

Categories: Chemicals, Drugs, Medicine