The Chronicity of Obesity

"You hear people talking about it -- 'I'm so much happier now, because I'm free'."

"Planning your day around food, that's a lot of brain space. It's frustrating, and exhausting."

"[Semaglutide has to be used in conjunction with a reduced calorie diet. It does not melt fat.] It helps you eat properly. The drug helps you sustain caloric restriction on whichever diet you want to be on -- keto, intermittent fasting, Mediterranean, or just plain old healthy heating."

"I'm not talking about [someone] who is five pounds too high. People living with obesity -- excess adipose tissue that's causing disease -- have a genetic condition that drives their eating behaviurs."

"That genetic condition will never change. All this medication does is mask that genetic behaviour."

"If you had excess weight, you may have fat in your face. You lose the weight; the face goes to where it would have been had you never had that excess weight in the first place."

Dr. Sean Wharton, obesity medicine specialist, adjunct professor, McMaster University, Hamilton, York University, Toronto

"While we cannot discern whether the [prescription] was written for diabetes or for off-label use, the growing numbers may reflect the potential for use as anti-obesity medication for long-term weight management."

Madeline Gareau, spokeswoman, IQVIA CompuScript

Both Ozempic and its sister drug, Wegovy, are once-weekly injections using pre-filled pens that are injected into bellies, thighs or arms. Photo by Getty Images

A new weight-loss sensation is revolving around off-label use of an approved diabetes drug for adult-onset, Type II non-insulin-dependent diabetics. Ozempic, brand name for semaglutide, the drug that lowers blood-sugar levels, for people who are not diabetic has proven to be an invaluable assist in helping control food cravings, hunger and eating. Ozempic and its sister drug, Wegovy have proven to be extremely effective as weight-loss agents.  "I think it's a breakthrough", said Dr. Wharton.

The drug, however, does not 'cure' the health condition that leads to obesity. Anyone who believes in its efficacy based on the results will be advised that a life-long partnership with the drug will be a necessary commitment to lose weight and to keep it off. Remove oneself from the drug therapy, and in time the condition reasserts itself, the excess weight returns. Both Ozempic and Wegovy are now social media megastars. A Tiktok video featuring the  #ozempic hashtag has been viewed 600 million times.

Not officially approved for weight loss, Ozempic is prescribed by doctors who may recommend it "off label" for weight management. Wegovy containing a somewhat higher dose of semaglutide was approved in 2021 by Health Canada for weight loss specifically. It is produced by Novo Nordisk, but not yet launched in Canada. Both drugs are once-weekly injections with the use of pre-filled pens, injected into thighs, arms or stomach areas.

University of Toronto endocrinologist Daniel Drucker, helped discover GLP-1, an endogenous hormone "meaning we make it ourselves after we eat food", noted Dr. Wharton. In a trial with close to 2,000 adult subjects published in the New England Journal of Medicine, those taking semaglutide lost on average 15 percent of body weight following 68 weeks of treatment. In the semaglutide group the change in average body weight came to 15.3 kg as opposed to 2.5 kg in the placebo group.

The movement of food through the gut is slowed by the drug. Among the most commonly reported side-effects, are nausea and diarrhea, most of a mild-to-moderate effect, subsiding with time. Vomiting, constipation and stomach pain can also occur as side-effects. As for serious side-effects they can include inflammation of the pancreas or gallbladder or kidney problems. There is a warning on the Ozempic box from Health Canada of semaglutide's potential to cause a type of thyroid cancer.

Some users of the drug also lose desire for alcohol consumption, according to The New York Times. "It's certainly something that I've heard many patients say, usually in a positive way", commented the chief scientific and medical officer of the American Diabetes Association.  There is a widespread belief that semaglutide affects the brain's mesolimbic system "the hedonic part of the brain, where you want more than what you need to sustain yourself", explained Dr. Wharton. 

Researchers found that one year after ceasing once-weekly semaglutide injections, people  regained two-thirds of their weight loss -- in a study co-authored by Dr. Wharton. The researchers wrote that findings "confirm the chronicity of obesity and suggest ongoing treatment is required to maintain improvements in weight and health".

There were other diet-pill enthusiasms, like fen-phen -- when the fenfluramine-plus-phentermine regimen had to be stopped in 1997, when it discovered that the combination caused serious heart valve conditions.Another drug, Merida, a top-selling weight-loss drug in Canada, was withdrawn from the market related to an increased risk of heart attack, stroke and cardiovascular death.

"Is there going to be a problem 15 years from now, 30 years from now? I don't know. But we're not seeing any [safety] signals." There is an individual risk-benefit ratio that people must come to terms with. Semaglutide has been prescribed to millions of people with Type 2 diabetes for 15 years "without any adverse effect profile", Dr. Wharton concluded.

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