At the beginning of the year, many people traditionally decide to slim down a bit. Are the currently much-discussed drugs that you inject yourself under the skin a good idea?
For some people who are severely overweight or even obese, the effort is in vain: Even if they change their diet and exercise, the pounds don’t really want to tumble. This means frustration, especially when the weight is also linked to other health problems such as diabetes. Novel obesity drugs are intended for such people, which are injected under the skin in addition to lifestyle changes. The European Medicines Agency Ema writes about the effect of a certain preparation: The appetite is regulated, the feeling of satiety increased, hunger reduced.
Recently, prescription drugs have been causing a stir on social media. Also because some celebrities are said to have lost weight. When asked about the secret of his appearance on Twitter, tech billionaire Elon Musk mentioned fasting and the name of such a drug. Also because healthy people in the USA are apparently increasingly resorting to injection pens to lose a little weight, the topic has recently appeared more often in the German media. “My patients are increasingly asking about it,” said Hamburg endocrinologist Stephan Petersenn, spokesman for the German Society for Endocrinology (DGE).
The active substance that is currently being discussed is called semaglutide. In Europe it has been approved as a diabetes drug (“Ozempic”) since 2018 – it’s about lowering blood sugar levels. New, from the beginning of 2022, is an approval in the EU specifically for the application area of weight loss and control (“Wegovy”): It is intended for people with a body mass index (BMI) from 30, i.e. obesity. And for overweight people (BMI from 27) with at least one weight-related comorbidity.
“Wegovy” is not yet available in Germany, where about one in four adults is considered obese. Upon request, the manufacturer named Novo Nordisk Pharma neither a date nor a planned price. However, he assures that he will work “at full speed” to make the preparation accessible to certain patient groups in this country as well.
In view of previous data, experts expect a benefit for certain affected persons. In one study, patients who received one dose of semaglutide per week in addition to lifestyle changes lost an average of almost 15 percent in weight after 68 weeks. According to the New England Journal of Medicine, a comparison group that received a dummy drug only lost a good two percent over the same period. Around 1960 people with obesity or overweight with at least one weight-related comorbidity were divided into two groups.
Semaglutide isn’t the only weight-loss drug out there, but others require one to three doses a day, according to the study. According to the DGE, semaglutid has the highest effectiveness among the currently approved active ingredients of the substance class in relation to weight reduction.
As good as that sounds, in practice experts still see obstacles and dangers. The DGE warned of risks and side effects and “uncontrolled use not approved by the regulatory authorities”. Since “Wegovy” is not yet available, the lower-dose “Ozempic” is used as a lifestyle drug to lose weight in overweight people. In so-called off-label use: Patients would then have to inject more active ingredient for the weight-loss drug to work, said Petersenn. Depending on the dose administered, the costs could amount to between 80 and around 200 euros per week.
“One of the problems with this is that a lifestyle application has not been studied,” says Petersenn. “It is unclear whether an overweight patient who is not obese loses weight at all.” Side effects such as nausea and diarrhea are also possible. In general, the application should be embedded in an overall therapy concept with nutrition and sport under medical supervision. Another fear is that it will be more difficult to provide care for people with diabetes due to the high demand from healthy people who just want to lose some weight.
Even for people who fall under the eligibility criteria, the injections do not automatically mean permanent normal weight. The drug can only work as long as you take it, emphasized Petersenn. “It’s not a silver bullet and doesn’t change anything in terms of genetic factors or lifestyle.” Anyone who is obese must either take it into account for years – or apply “considerable discipline” after stopping to maintain the weight. However, any effects of long-term use are unexplored. Petersenn believes that for some of those affected, medication could make stomach surgery obsolete in the future, which has so far proven its worth in the case of massive obesity and significant comorbidities.
No. So far, the weight loss injections have also been a question of money. Experts complain that the costs are not covered by statutory health insurance. “The new active ingredients could become game changers in the treatment of obesity if the legislator clears the way for them,” said Jens Aberle, President of the German Obesity Society. He sees the fact that people who are severely overweight should pay for their treatment out of their own pockets as “an expression of the ubiquitous stigmatization of those affected”.
Incidentally, the new drug is not cheap. According to the “Bild” report, a syringe in the USA costs 900 dollars (923 euros). One shot per week would be over 3600 euros per month.
As Matthias Blüher, head of the obesity outpatient clinic for adults at the Leipzig University Hospital, told MDR, this does not mean that the injections will also be so expensive in Germany. “The American prices cannot be transferred to Germany, because they have a completely different price structure for medicines. Prices like in the USA are typically not to be expected in Europe,” he emphasizes.