Is it reliable to burn calories with hypoglycemic drugs?

"You don't need to exercise or diet, just one shot can help you lose 10 pounds. This slimming shot is great news for obese people!" As more and more people share their successful weight loss experiences with the "magic slimming drug" semaglutide on social networking platforms, semaglutide has become a "net celebrity slimming shot" and even "hard to get one shot". So, who is semaglutide?

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01

What is GLP-1?

Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist and a new type of hypoglycemic drug developed in recent years. Its approved indication in China is the treatment of type 2 diabetes in adults, but it has not yet been approved in China for weight loss. So why do people want to use it to lose weight? Because in clinical trials, it was observed that patients using semaglutide not only had lower blood sugar, but also had significant weight loss, so this drug has a weight loss effect.

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02 How does GLP-1 achieve weight loss?

In the normal human body, GLP-1 is a type of incretin secreted by intestinal L cells that stimulates insulin secretion, usually after eating. As blood sugar rises, the secretion of GLP-1 also increases, thereby playing a role in lowering blood sugar. In addition, GLP-1 can also slow down gastric emptying and suppress appetite, thereby achieving the effect of reducing weight.

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However, the GLP-1 secreted by the human body is metabolized very quickly in the body. Even if GLP-1 is directly injected, it will be metabolized in just a few minutes, which greatly limits the clinical application of GLP-1. In order to prolong the action time of GLP-1 in the body, scientists have modified its structure and developed GLP-1 receptor agonists. This type of drug has the same efficacy as natural GLP-1, but has a longer action time, which is convenient for clinical use. At present, the commonly used GLP-1 receptor agonists in clinical practice in my country include liraglutide, benaglutide, dulaglutide, loxenatide, semaglutide, etc.

03 How to lose weight scientifically?

Before a drug is put on the market, it must undergo a series of safety and effectiveness assessments to prove that it is safe and effective before it can be approved for marketing by the State Food and Drug Administration. However, the approval of weight loss drugs does not mean that everyone can use them at will to lose weight, and the possible side effects of using drugs for weight loss cannot be ignored.

GLP-1 receptor agonists have good overall safety, and the most common adverse reactions are gastrointestinal reactions, including nausea, diarrhea, and vomiting. Usually, these reactions occur in the early stages of medication (within the first 4 weeks), last for a short time, and gradually subside with prolonged treatment. In addition, the use of GLP-1 receptor agonists may increase the risk of medullary thyroid cancer and pancreatitis , so it is recommended to conduct appropriate evaluations before using GLP-1 receptor agonists. Currently, all GLP-1 receptor agonists used in clinical practice are prescription drugs, which require a doctor's prescription before they can be dispensed, purchased, and used.

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In addition to GLP-1 receptor agonists, lipase inhibitors represented by orlistat are also common weight loss drugs. The drug directly exerts its efficacy in the gastrointestinal tract, reduces the absorption of fat in food, reduces energy intake, and thus achieves the effect of weight loss. It is clinically suitable for obese and overweight people who have already exercised moderately and exercised.

The over-the-counter weight loss drug orlistat is contraindicated for the following groups: ① Children under 18 years old, pregnant women and lactating women; ② Patients with chronic malabsorption syndrome and cholestasis; ③ Patients with organic obesity. It is not recommended for people who are not overweight, that is, those with a body mass index (BMI) less than 24kg/m².

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Although weight loss drugs have significant effects and may even have the magical effect of "lying down to lose weight", it is still not recommended for the general population to use drugs for weight loss. In particular, for people with a body mass index (BMI) between 24-28kg/m², lifestyle intervention is recommended as the first choice. For people with a BMI between 28-35kg/m², if lifestyle intervention is ineffective, drug treatment can be used on this basis. Lifestyle intervention mainly includes diet, exercise and psychology.

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Scientific diet (not starving, not dieting, controlling the total calories consumed in a day), reasonable exercise methods and exercise intensity, a positive attitude and good sleep are the core of lifestyle intervention. Lifestyle intervention is the best way to lose weight scientifically and effectively, and it is a continuous pursuit of a healthy lifestyle.

References

[1] Chinese Diabetes Society, Guidelines for the prevention and treatment of type 2 diabetes in China (2020 edition). Chinese Journal of Diabetes, 2021. 13(4): 315-409.

[2] Yang Baofeng, Chen Jianguo. Pharmacology[M]. 9. People's Medical Publishing House, 2018.

[3] Semaglutide drug instructions

[4] Liraglutide drug instructions

[5] Orlistat Drug Instructions

Author: Cai Qingqing, Department of Pharmacy, Zhongshan Hospital Affiliated to Fudan University

Editor: Tiara

Acknowledgements: Li Zhiling, deputy director of the Department of Pharmacy at Shanghai Children's Hospital, master's tutor at Shanghai Jiaotong University, and leader of the Safe Medication Science Popularization Group of the China Science Writers Association, provided scientific guidance for this article

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