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Is Wegovy the cure for obesity we’ve been waiting for?

Robbie Puddick
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Robbie Puddick

20th July 2023
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Jump to: Individual variability and tolerance | Lack of long-term data | Weight regain on Wegovy | Take home message

The short answer is no, Wegovy isn’t the cure for obesity. The longer answer is: it’s complicated, and here are the three main reasons why:

  1. Around 7% of people discontinue the medication as they can’t tolerate it. Additionally, 10-15% of participants lose less than 5% of their weight, which isn’t clinically significant.
  2. We don’t have long-term data on its safety; it’s possible it won’t ever be available as a lifelong medication
  3. The majority of people regain the weight they lost when the medication is discontinued

For these reasons, we can’t consider this medication a ‘cure’ for obesity. However, we can call it a very effective treatment, which it is.

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Wegovy weight loss

Semaglutide (sold under the brand name Wegovy, during this guide, we’ll use these terms interchangeably) is a highly effective medication that reduces appetite and supports weight loss.

A lot of weight loss, in fact, compared to standard lifestyle interventions that don’t use semaglutide medications. Additionally, semaglutide is the most effective obesity medication to hit the market to date.

Its effectiveness depends on the dose achieved and the dose-escalation protocol.

While semaglutide promotes weight loss in a linear fashion, earlier studies showed that increasing the dose too quickly led to intolerable side effects and medication discontinuation.

However, the latest evidence suggests semaglutide with an intensive lifestyle intervention leads to an average weight loss of 15-20% compared to 5-10% with lifestyle interventions alone.

This sounds promising; why shouldn’t we say it’s a cure? We listed three main reasons above; keep reading as we look at these in more detail.

1) Individual variability and tolerance

All medications have side effects, and people will always respond differently. Wegovy is no exception.

A randomised controlled trial involving over 1,900 people living with obesity showed that 7% of participants discontinued their medication due to adverse events and side effects.

Wegovy is a powerful medication that significantly impacts the gastrointestinal tract and directly communicates with the appetite centre in the brain, the hypothalamus.

Unfortunately, these effects will result in negative responses for some people that aren’t tolerable to enable them to continue leading fulfilling lives.

Additionally, 86.4% of individuals in this study lost at least 5% of their body weight; an impressive amount. Still, that means 13.6% of participants lost less than 5%.

A weight loss intervention is typically considered successful if participants achieve more than 5-10% of weight loss. So, for some people, semaglutide doesn’t lead to clinically meaningful weight loss.

2) Lack of long-term data

The current research on Wegovy is very promising. Never before have we seen a weight loss medication support weight loss to this degree and be well-tolerated.

However, this doesn’t mean the medication won’t have long-term effects on the body that become irreversible if it’s overused.

There are examples of drugs being withdrawn from the market as more long-term data comes to light.

Lorcaserin was a weight loss drug approved by the Food and Drug Administration (FDA) in the U.S. but was recently withdrawn as data indicated that it increased cancer risk.

The example of lorcaserin is why you must weigh the pros and cons when considering Wegovy and only use it for as long as necessary.

3) Weight regain on Wegovy

Similar to lifestyle interventions where participants typically regain weight following the intervention’s end – weight regain is significant following the cessation of semaglutide.

The greater the initial weight loss, the more significant the weight regained.

However, those who lose more weight initially maintain more significant weight loss compared to baseline than those who lose less before the medication is withdrawn.

In this post-analysis of 327 participants in a study looking at Wegovy and weight loss, the average weight loss after 68 weeks was 17.3% with semaglutide and 2% with placebo.

52 weeks of follow-up, after the medication was withdrawn, showed that the average weight loss was 5.6% with semaglutide and 0.1% with placebo; a weight regain of 11.6% in the semaglutide group and 1.9% with placebo.

This has led to some suggesting that the medication should be considered a lifelong treatment, as it’s only effective when using it.

However, as discussed above, we don’t have any long-term data suggesting this drug is safe and effective for use beyond the two years recommended by NICE guidelines in the UK.

Additionally, these drugs lead to ongoing (albeit mild for many) side effects that might be considered tolerable in the short term. Still, it’s unclear how many would accept that as a lifelong commitment.

Take home message

Wegovy is a highly effective weight loss medication, the most effective to date. But this doesn’t mean it’s a magic cure.

Wegovy is simply a tool. A tool that many people will choose to use to support them in losing weight, gaining control of their health, and living longer, happier lives.

But obesity isn’t merely a condition of appetite dysregulation. There are social, environmental, habitual, biological, and psychological factors that lead to the development of obesity.

Semaglutide addresses the biological element by managing your appetite. But it doesn’t solve the underlying psychological, social, and environmental issues that impact people’s ability to manage their eating habits.

Wegovy will allow people to tackle these issues whilst the medication looks after their appetite. But without addressing everything else that led to the weight gain in the first place, the weight is likely to return once the medication stops.

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