[Ming Pao News]From Hollywood celebrities to the super rich, in recent years everyone has been flocking to Ozempic, commonly known as the “weight loss shot”. Tesla CEO Musk once said that he lost nearly 14 kilograms by injecting Ozempic and dieting, making this drug originally used to treat type 2 diabetes a “miracle weight loss drug”, setting off a rush to buy around the world. Although the injectable drug Ozempic has obvious weight loss effects, it is not completely “painless weight loss”. Some users reported rapid weight loss, nausea, loss of appetite, and even suicidal thoughts after the injection. Today, when obesity has become a global health problem, what benefits and worries does the emergence of Ozempic bring?[Editor’s note: Some doctors pointed out that Ozempic and Wegovy (specialized drugs for treating obesity) are both prescribed by doctors. They are generally recommended for use by people with a BMI ≥ 30, or those with a BMI ≥ 27.5 and obesity-related complications such as three highs. If they are not If people who are too obese use these medicines, the weight loss effect will be less significant. The situation of some people injecting themselves without a doctor’s prescription is even less ideal. ]
Ozempic, a drug used to treat type 2 diabetes, became famous as a “miracle weight loss drug” due to its remarkable weight loss effect, and once set off a rush to buy it. (enisaksoy, CR@iStockphoto/Mingpao Drawing)
Are diabetes drugs used as weight loss injections? Must cooperate with diet and exercise to lose 14.9% weight in 68 weeks
Ozempic, an injectable drug, was originally approved by the U.S. Food and Drug Administration (FDA) for the treatment of type 2 diabetes. Weight loss is an off-label use. Lu Anxin, president of the Hong Kong Obesity Medicine Society and a specialist in endocrinology and diabetes, said that Ozempic contains semaglutide, which is a GLP-1 receptor agonist. GLP-1 can stimulate insulin secretion and effectively lower blood sugar. Later clinical studies found that this ingredient can also reduce weight at the same time. “There are two main ways. First, the satiety center of the hypothalamus controls the desire to eat, and there are GLP-1 receptors there. (By injecting GLP- 1) It can suppress appetite; secondly, it will slow down gastrointestinal motility and make you feel full after eating a small amount of food.” As Ozempic became popular, the pharmaceutical company later launched Wegovy, which is specifically designed to treat obesity. The ingredients of the two are the same, but the dose of Wegovy is higher, up to 2.4 mg.
Coordination with exercise – The use of Ozempic must be coordinated with diet and exercise. If you only rely on drugs without improving your lifestyle habits, your weight may rebound once you stop taking the drug. (torwai@iStockphoto) Lu Anxin (provided by interviewee)
Ozempic contains semaglutide to reduce fat and muscle mass
Some studies have found that in obese people without diabetes (BMI ≥ 30; or BMI ≥ 27 and one or more obesity-related diseases), 2.4 mg of semaglutide can be injected once a week, combined with diet control and exercise. , the average weight loss after 68 weeks was 14.9%, while the placebo group (only diet and exercise) lost 2.4%. “This is the most powerful (weight loss effect) among so many weight loss drugs!” Yuan Meixin, a specialist in endocrinology and diabetes, pointed out that oral drugs approved by the FDA in the past for the treatment of obesity can reduce weight by about 7%. to 10% body weight, the weight loss effect of semaglutide is obviously better. The actual effect varies from person to person. Yuan Meixin has a patient who took semaglutide for about half a year, and his weight dropped from more than 170 kilograms to more than 130 kilograms, a decrease of more than 20%. She emphasized that diet and exercise must be combined. “If you only rely on drugs without improving your living habits, once you stop taking the drugs, you will lose the only factor that helps you control your weight, and your weight may rebound.” Lu Anxin added that in addition to reducing fat, these drugs can also At the same time, it will also reduce muscle mass and slow down metabolism, which may lead to weight gain.
Yuan Meixin (provided by interviewee)
Wegovy specializes in treating obesity. Not available in Hong Kong
Ozempic and Wegovy were registered for use in Hong Kong in 2019 and 2023 respectively, but both doctors pointed out that Wegovy is not currently available in the Hong Kong market. Ozempic is a drug that treats type 2 diabetes. Yuan Meixin said that it is usually prescribed to patients with both diabetes and obesity. “Eighty percent of diabetic patients also have obesity. This drug is mainly targeted at them. Among patients with obesity, basically I will Check whether you have diabetes, even if it is not diagnosed, you are just pre-diabetic or you have insulin resistance, they are all suitable candidates.” At the same time, patients with fatty liver and younger patients are also suitable for this drug. “It can reduce the accumulation of fat in the liver. In addition, people with younger illnesses have better liver and kidney functions and lower drug side effects.” The patient’s acceptance of injections, medication history, drug price, etc. are also factors to consider when using medication.
“Sometimes when we encounter patients with severe obesity, if they are not treated in time, they may develop serious complications, we will explain clearly to the patients that this drug is not available in Hong Kong for weight loss. With the patient’s understanding, Will use Ozempic as off-label.” Yuan Meixin added.
Side effects: nausea, vomiting, diarrhea, constipation, weight loss too fast or gallbladder inflammation
Compared with traditional oral weight loss drugs, the side effects of semaglutide are more concentrated in the gastrointestinal area, such as nausea, vomiting, diarrhea, constipation, etc. Lu Anxin pointed out that these side effects will generally gradually decrease with time of use. When prescribing, she would start with a lower dose. After using it for a period of time, if there is no gastrointestinal discomfort, she would increase the dose. “However, some patients decide not to use it anymore due to nausea, vomiting or gastrointestinal discomfort.” Yuan Meixin also pointed out that after some people with poor kidney function use it, their gastrointestinal motility becomes very slow, which may develop into intestinal obstruction. Losing weight too quickly may also lead to gallbladder enlargement or even inflammation, but this is uncommon.
Related reading: Diabetes | What are the different side effects of 7 types of oral diabetes drugs? Will I gain weight after taking medication?Doctors explain 5 questions about diabetes drugs
Prescription drugs are recommended for use with a BMI of at least 27 and do not self-inject
Both Ozempic and Wegovy are prescribed by doctors, and some people inject them themselves without a doctor’s prescription. Both doctors think the situation is not ideal. It is generally recommended to be used by people with a BMI ≥ 30, or a BMI ≥ 27.5 and obesity-related complications such as three highs. “If people who are not too obese use these drugs, the weight loss effect will be less significant; and if there is no problem with GLP-1 secretion, , forcibly injecting additional amounts may cause more side effects.” Yuan Meixin continued to point out that patients who use it on their own may not know what side effects they should stop using, how long to take the medicine, etc. “It is safer to always have a doctor evaluate the patient’s constitution before prescribing.”
Know more: “Slimming injections” raise concerns about suicide risk
In July last year, the European Medicines Agency (EMA) received reports that there were two cases of suicidal thoughts after using Ozempic and Saxenda, which is also a GLP-1 drug. The authorities are now involved in the investigation. Psychiatrist Huang Zongxian pointed out that the risk of depression among people with diabetes is twice that of ordinary people. In addition, if the patient is worried about his weight and makes him very stressed, it may affect his mood or increase the risk of suicide, so it is not easy. Determine if medication is causing it.
After some users reported suicidal thoughts after using Ozempic, the European Medicines Agency intervened to investigate. (Design pictures and models have nothing to do with the cases mentioned in the article, bymuratdeniz@iStockphoto)
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A study published earlier this month found no increase in suicidal thoughts
Lu Anxin, a specialist in endocrinology and diabetes, cited a study published in the medical journal Nature Medicine earlier this month. The team reviewed the health records of 240,000 overweight or obese people and compared their results after taking semaglutide with other weight loss drugs. Have you experienced suicidal thoughts or behaviors? The results showed that there was no increase in related risks after taking the medication. However, Yuan Meixin, a specialist in endocrinology and diabetes, said, “We have come across cases of depression after using GLP-1 drugs, so we start prescribing at a low dose. If we find that the patient has emotional problems, we will consider discontinuing the drug or discuss other options.” .
In addition, some psychiatric drugs can cause weight gain as a side effect, reducing patients’ willingness to take the drugs. In view of the outstanding weight loss effect of semaglutide, some psychiatrists in foreign countries will prescribe it to psychiatric patients in the hope that patients will be more willing to comply with medical advice. Preliminary research has found that if patients are troubled by the obesity problem caused by psychiatric drugs, but the prescribed diabetes drug metformin has average weight loss results, when they switch to semaglutide, the weight loss effect is good. Can patients with similar problems in Hong Kong benefit?
Huang Zongxian pointed out that there are many reasons for patients to gain weight. Mental illness itself may cause patients to have low motivation and inactivity for a long time; or people who are emotionally distressed and eat a lot when they are stressed are prone to weight gain themselves. Medications also have a certain impact, such as antipsychotics for treating schizophrenia, delusions, etc., as well as antidepressants, mood stabilizers, etc., which can easily make people gain weight. Take antipsychotic drugs as an example. Drugs may affect the secretion of serotonin and dopamine in the brain, or reduce leptin in the brain, which is responsible for weight control, causing patients to have an appetite. “When we notice that a patient has gained a lot of weight after taking medication, we need to find out whether it is caused by unhealthy lifestyle habits or medication.” Then we can decide to change the medication or intervene from the lifestyle perspective to improve it through diet and exercise. If the effect is not effective, some doctors will prescribe metformin. “There is data showing that when used in patients without diabetes, it can reduce weight gain and even return to normal levels.” As for the use of semaglutide for weight loss, it is still new in Hong Kong. As far as he knows, there is no prescription for treating overweight problems in psychiatric patients in Hong Kong, so it is difficult to comment on whether it is feasible and there are not many relevant studies. . He has never prescribed weight-loss drugs. “Every time a patient comes for a follow-up visit, I will measure their weight and blood pressure, so I will know early on if there are any changes in their body, and I won’t let them gain too much weight before I figure out how to deal with it.”
Huang Zongxian (provided by the interviewee)
Text: Zhang Shumei
Editor: Liang Xiaoling
Art: Xie Weihao
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2024-01-22 07:23:10
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