From the Guidelines
Semaglutide (Ozempic) is effective for weight loss, with a mean weight loss of 14.9% to 16.0% at 68 weeks, and should be used alongside lifestyle changes to achieve sustainable results. The medication works by mimicking GLP-1, a hormone that regulates appetite and food intake by acting on the brain's hunger centers, making you feel fuller longer and reducing calorie consumption 1. According to the American Gastroenterological Association, semaglutide 2.4 mg with lifestyle modifications is suggested for adults with obesity or overweight with weight-related complications, compared with lifestyle modifications alone 1.
The STEP trials examined the efficacy of semaglutide, showing that mean weight loss at 68 weeks was 14.9% (placebo, 2.4%; difference, 12.4%; 95% CI, 11.5%-13.4%) and 16.0% (placebo, 5.7%; difference, 10.3%; 95% CI, 8.6%-12.0%), respectively 1. However, after cessation of semaglutide, participants regained significant amounts of weight, highlighting the need for long-term use to maintain weight loss benefits 1.
Common side effects of semaglutide include nausea, vomiting, diarrhea, and constipation, which often improve over time 1. The medication can be expensive, with a cost of approximately $800-1,000 monthly without coverage, and insurance may not cover it for weight loss alone 1.
Key points to consider when using semaglutide for weight loss include:
- Starting with a low dose and gradually increasing as needed and tolerated
- Combining the medication with lifestyle changes, such as a reduced-calorie diet and regular physical activity
- Monitoring for potential side effects and adjusting the treatment plan as needed
- Considering the cost and insurance coverage of the medication
- Prioritizing long-term use to maintain weight loss benefits, as weight regain is common after discontinuation of the medication 1.
From the Research
Efficacy of Semaglutide for Weight Loss
- Semaglutide has been shown to be effective in achieving significant weight loss in individuals with overweight or obesity, with or without type 2 diabetes 2, 3, 4, 5.
- The Semaglutide Treatment Effect in People with obesity (STEP) clinical trial programme demonstrated that semaglutide 2.4 mg was associated with mean weight losses of 14.9%-17.4% in individuals with overweight or obesity without type 2 diabetes from baseline to week 68 2.
- In the STEP 1 trial, semaglutide 2.4 mg was associated with a mean weight loss of -14.9% compared to -2.4% with placebo, with 86.4% of participants achieving a weight loss of 5% or more and 50.5% achieving a weight loss of 15% or more 3.
- A systematic review and meta-analysis of randomized controlled trials found that semaglutide induced a significant body weight loss (MD: -10.09%; 95% CI: -11.84 to -8.33; p ˂ 0.00001) compared to placebo in obese or overweight patients without diabetes 5.
Safety Profile
- The safety profile of semaglutide 2.4 mg was consistent across trials, with primarily gastrointestinal adverse events, such as nausea and diarrhea, which were typically transient and mild-to-moderate in severity and subsided with time 2, 3.
- Gastrointestinal disorders were the most frequently reported adverse event, occurring in 43%-48% of patients receiving semaglutide 0.5 mg or 1.0 mg, and were also the most common reason for discontinuing treatment 6.
- Semaglutide exhibited a positive effect on blood pressure, C-reactive protein, and lipid profiles, but expressed more adverse effects than placebo, mainly gastrointestinal reactions 5.
Comparison to Other Treatments
- Semaglutide was superior to dulaglutide in improving glycaemic control and reducing bodyweight in patients with type 2 diabetes, with a similar safety profile 6.
- The SUSTAIN and PIONEER clinical trials demonstrated that semaglutide (injected or oral) has superior efficacy compared to placebo and other antidiabetic medications in weight reduction 4.