It’s hard to get a shot to lose 20 pounds without doing anything! Is the “most powerful weight loss drug in history” recommended by Musk suitable for you?

Recently, a "magic drug" for weight loss was launched in Europe and the United States. The demand for it among people who want to lose weight has been rising steadily. Driven by some celebrities, its exposure has also been increasing. Can you really lose weight by lying down?

Written by reporter Ding Lin, Photo and text editor Chen Yongjie

Many people want to lose weight, but find it difficult to achieve the desired effect through diet and exercise. Is there a drug that can effectively reduce weight?

Since the beginning of summer, semaglutide, a prescription drug used to treat type 2 diabetes, has been hard to come by, and its buyers are healthy young people who are eager to lose weight. If you search for "semaglutide" or "slimming injection" on social media, you can see many people sharing about losing weight: "I finally changed from a body prone to obesity to a body prone to slimming", "I took slimming injections for 5 months, and lost weight from 120 catties to 98 catties, and my body fat rate dropped from 27% to 19%"...

On June 3, the National Medical Products Administration accepted the application for the weight loss indication of semaglutide injection, which added fuel to the market. Scalpers and micro-businesses took the opportunity to hype this "magic weight loss drug". A 3 ml injection that cost 813.96 yuan in the hospital was sold for 1,250 yuan. Some people also took the opportunity to sell three-no products and illegal substitutes.

After hypoglycemic drugs "changed" into weight-loss drugs, a large number of people with weight-loss needs bought them through online platforms and purchasing channels. Due to the popularity, semaglutide was frequently out of stock, which also made many diabetic patients worried: the hypoglycemic drugs originally used to treat the disease are now becoming increasingly difficult to buy.

▲The demand for semaglutide among people who are losing weight is rising steadily (Photo source: Visual China)

In contrast to the huge demand for weight loss, the number of compliant weight loss drugs approved worldwide is very limited. The main weight loss drugs approved worldwide are orlistat, phentermine/topiramate, bupropion/naltrexone, liraglutide, and semaglutide. In the Chinese market, the only approved weight loss drug is orlistat, but its market size is not large.

Recently, the new indication application for semaglutide injection developed by Danish biopharmaceutical company Novo Nordisk was accepted by the National Medical Products Administration. Although the specific content of the new indication has not been disclosed, it is generally believed in the industry that the indication is likely to be related to weight loss.

The weight loss effect of semaglutide has been highly sought after by celebrities such as Musk and the capital market. How does semaglutide, which is "hard to get a shot", play a role in lowering blood sugar and reducing weight? Can it really help you lose weight without doing anything?

The weight loss drug that became a celebrity due to its "side effects"

Novo Nordisk's semaglutide injection (trade name Ozempic) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of type 2 diabetes in December 2017. However, during the relevant clinical trials, researchers soon discovered a significant "side effect" - many subjects obviously lost weight.

In March 2021, a large clinical trial published in the New England Journal of Medicine showed that after 68 weeks of semaglutide (combined with healthy diet and exercise habits), participants lost an average of 15% weight, compared to only 2% in the placebo group. This weight loss effect is very encouraging and comparable to the effect of "gastric resection" weight loss surgery.

This powerful data prompted the US FDA to approve Novo Nordisk's semaglutide injection (trade name Wegovy) in June of that year for chronic weight management in obese (BMI ≥ 30) or overweight (BMI ≥ 27) adults. Although the active ingredient is semaglutide, the dose of Wegovy is higher than that of Ozempic, which is used to treat type 2 diabetes. In December 2022, the FDA approved the use of the drug for weight loss in obese adolescents aged 12-18.

How does semaglutide work to lose weight? It turns out that this drug molecule simulates a hormone naturally present in the human body, GLP-1, with which it has 94% sequence homology. GLP-1 is one of the many hormones released by the small intestine after people eat. It can promote the secretion of insulin when it acts on the pancreas, slow down the emptying of the stomach when it acts on the digestive tract, and produce a feeling of fullness when it acts on the hypothalamus. Therefore, drugs that simulate GLP-1 (such as semaglutide) can activate the GLP-1 receptors in the human body, which can not only regulate blood sugar and treat diabetes, but also slow down digestion and suppress appetite. Not only that, semaglutide is more stable in the human body than GLP-1 and can work with a single injection per week.

After Ozempic and Wegovy were launched in Europe and the United States, their demand among people who want to lose weight has been rising steadily. Driven by some celebrities, their exposure has also been increasing. In October last year, Tesla CEO Elon Musk revealed on a social networking site that he lost 20 pounds (9 kilograms) in a month with the help of Wegovy, which attracted more people's interest and attention to the drug.

Earlier this year, demand for Wegovy was so high that doctors sometimes tacitly "considered other options," leading to a shortage of Ozempic, which affected the normal use of the drug by diabetics.

▲In August 2022, Elon Musk, a billionaire who was troubled by obesity, claimed that he lost nine kilograms in a month by fasting and taking Ozempic (Sizogludec), a mysterious weight loss drug. (Photo source: Phoenix.com)

In my country, semaglutide was approved in April 2021 for the treatment of type 2 diabetes in adults and for reducing the risk of adverse cardiovascular events in patients with type 2 diabetes and cardiovascular disease. But so far, semaglutide has not been approved for weight loss in China. However, due to the effects of Internet celebrity publicity, it is also very popular in China. There is an endless stream of buyers in the Weibo super topic "semaglutide", and it is not uncommon for people of normal weight to use the drug off-label and buy the drug.

▲In April 2021, semaglutide was approved for marketing in China for the indication of type 2 diabetes (Photo source: Visual China)

Pharmaceutical companies are scrambling to develop similar drugs

Losing weight is not only related to people's aesthetics and self-image, but also a public health issue worthy of attention. At present, overweight and obesity can significantly increase the risk of other health problems, such as heart disease, type 2 diabetes, high blood pressure, stroke, asthma and arthritis.

The World Health Organization estimates that more than 4 million people die each year worldwide from being overweight or obese, and in recent years, obesity and overweight have increasingly affected adolescents.

Currently, there are about 650 million obese people in the world. By 2030, this number is expected to reach 1 billion. If no intervention is taken, obesity will become the most common chronic disease in the world. In some countries, obesity is already very common. The latest data released by the National Institutes of Health (NIH) in the United States shows that more than 40% of American adults are obese, and another 30% are overweight.

▲Obesity has become a global problem (Photo source: Phoenix.com)

At present, a variety of GLP-1 receptor agonists have been approved for marketing at home and abroad. The three most well-known ones are semaglutide, liraglutide and telpotide, all of which are liquid drugs administered by subcutaneous injection.

Liraglutide, a "predecessor" of semaglutide, is also a GLP-1 receptor agonist developed by Novo Nordisk. It was approved by the FDA for weight loss in obese people as early as the end of 2014. According to research data, its weight loss effect is only 5% to 10%, and it needs to be injected every day.

As a "new wave", tirpotide is an innovative GIP/GLP-1 dual-acting agonist. In May last year, Eli Lilly's tirpotide injection (trade name Mounjaro) was approved by the FDA for the treatment of diabetes in adults. However, this hypoglycemic drug is challenging semaglutide's status as the "king of drugs" for weight loss.

▲Mounjaro has submitted its application documents in China (Photo source: Phoenix.com)

Although it has not yet been explicitly approved for the treatment of obesity, clinical trial results of tebuconazole injection have shown very optimistic prospects: obese or overweight subjects with type 2 diabetes lost more than 20% of their weight after 16 months of maximum dose (15 mg per week).

In addition, pharmaceutical companies such as Pfizer and Amgen are also developing GLP-1 receptor agonist drugs. Some of the drugs undergoing clinical trials are "orally administrable", some are longer-acting, and some have fewer side effects...In the future, competition among these drugs may become increasingly fierce.

There is no "magic bullet" for weight loss. Compared with previous weight loss drugs, "new internet celebrities" such as semaglutide have indeed performed well, but these drugs are not perfect either.

These drugs are not without side effects, and it is not realistic to want to "lose weight by lying down" comfortably. In clinical trials of semaglutide, about 20% to 45% of participants reported gastrointestinal discomfort such as nausea, vomiting, diarrhea, and constipation. These side effects are less common at low doses and usually do not last for a long time, so the drug is currently considered safe. However, it will take longer to follow up and observe what results people will get from long-term medication to maintain their weight.

It is unrealistic to hope that you can "keep losing weight" after using semaglutide. Studies have shown that after a period of medication, the weight loss effect of semaglutide will enter a plateau period. Follow-up studies of participants in clinical trials found that within six months to a year after stopping the drug, most people regained most of their pre-trial weight. It is worth noting that subjects who maintained a healthy diet and exercise after stopping the drug had relatively less weight rebound.

So, although drugs such as semaglutide can help reduce appetite, they cannot change people's original eating habits and lifestyles. If these drugs are stopped, appetite may return and weight may rebound. It is worth affirming that these drugs give many dieters the confidence to act, but they cannot "cure" obesity once and for all.

▲According to a global adult weight survey report published by the medical journal The Lancet, scientists conducted a 40-year trend survey of the body mass index (BMI) of 19.2 million surveyed adults and found that the number of fat people in the world has now exceeded that of thin people, and China's obese population has surpassed the United States to rank first. China has 43.2 million obese men and 46.4 million obese women, accounting for 16.3% and 12.4% of the world respectively. The United States ranks second with 41.7 million obese men and 46.1 million obese women (Photo source: Phoenix.com)

These emerging weight loss drugs that have attracted attention are not "magic drugs". Weight loss should not be a blind follow-up behavior, but a scientific process. Before using any drug, you should consult a professional doctor to understand your physical condition and adaptability, and follow the doctor's advice and use the drug reasonably. Only in this way can you truly improve your quality of life and health level.