Semaglutide for Obesity: A Game Changer?

A new study of semaglutide in the New England Journal of Medicine is causing quite a stir in the news. (If you can get past impeachment headlines.) In fact, both experts and headline writers are calling semaglutide for obesity a game changer. Meanwhile, the only sour note comes from the futility school of obesity care.

An Advance in Effectiveness

This is not news to us. Two years ago, we were seeing excellent efficacy in phase 2 research with semaglutide. Because the the numbers from a dose-ranging study in Lancet – up to 14 percent weight loss – was twice as good as other drugs produce, we saw great promise. As more results came in, the superior effectiveness of semaglutide became more and more evident.

In the new NEJM paper, the average weight loss was 15 percent at the end of 68 weeks. But the more striking news is that roughly a third of the patients in this study had lost 20 percent or more of their starting weight. For those patients, the results were close to typical results for gastric sleeve surgery. Indeed, this is impressive. This is especially true because these results come from a weekly injection instead of surgery. One of the patients from the trial who lost more than 20 percent of her weight spoke to the BBC and sounded a lot like a bariatric surgery patient:

“The drug changed my life and completely altered my approach to food.”

Just like any other serious drug, some people have adverse reactions to semaglutide. Nausea and diarrhea are the most common. Those reactions were typically mild or moderate and they faded with time in this study. Serious adverse events occurred in ten percent of patients taking semaglutide and six percent of patients getting a placebo.

The Futility School of Obesity Care

Julia Ingelfinger and Clifford Rosen wrote a skeptical editorial alongside this new study. They call the study “a good beginning” on the face of it. But they go on to say that a once weekly injection such as semaglutide would likely be unacceptable in the long run.

They are also dismissive of other tools for obesity care. Behavioral therapies for obesity “fail more often than not,” they write. On bariatric surgery, their bottom line is that it is “invasive and, often, eventually followed by regain of weight.” They go on to list drugs approved for obesity treatment and neglect to mention the most successful one in this small group – liraglutide (Saxenda).

Maybe they just don’t know about it. We note that neither physician author is board-certified in obesity care.

A Step Along the Way

However, they are correct in one sense. Depending upon your view of the world, the glass for obesity care is either half full or half empty. Obesity is a challenging and complex chronic disease. The tools available for treating it are helpful, but far from ideal. Skilled providers can make a big difference in the lives of people with obesity. But it remains a struggle.

When semaglutide gains approval for treating obesity, it might be a game changer. Even then, though, much more progress will be necessary on many fronts in obesity care.

Click here for the study and here for the editorial. For further reporting on this study, click here, here, and here.

Changing Pastures, painting by Rosa Bonheur / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.

February 11, 2021