Hunger brake: lose weight with injections?

A new diabetes drug called semaglutide creates a feeling of satiety and curbs appetite. As a result, it lets the pounds tumble down vigorously. Is it also suitable for losing weight on its own?

The dream of many people who want to lose weight: a drug that eliminates hunger

© iStock / Deagreez

If you want to lose weight, you have to change your lifestyle. The main focus is on changing your diet, followed by more exercise. But obesity, the medical name for being very overweight, is extremely difficult to combat. Most of the time, all discipline is useless, and some people even continue to gain weight. Very few manage to stick to their diet plan.

Drugs that improve success would be a big step forward. Researchers and pharmaceutical companies place some hope in the substance semaglutide. It is injected under the skin once a week. With the highest dosage, obese people were able to reduce their body weight by an average of almost 14 percent within a year. That is more than was previously achieved with a drug in a weight loss study. The results of the study, supported by the manufacturer, were published in August 2018 in the specialist journal Lancet.

One year - 14% less weight

Semaglutide is similar to the endogenous intestinal hormone GLP-1 and mimics its effects. Among other things, it curbs the appetite and creates a feeling of satiety. The related active ingredient liraglutide has been on the market for weight loss in Germany for three years. Both substances are primarily drugs used to treat type 2 diabetes. Liraglutide was approved across Europe in 2009 and semaglutide in early 2018.

However, semaglutide is not yet allowed to be used worldwide for weight loss. This requires studies on a larger number of obese people. Only then will it be shown whether the weight loss effect is really significantly greater than with liraglutide. This is what the preliminary results suggest.

Not a panacea

However, these drugs are not a panacea for obesity. "Medicines are usually only prescribed if the change in diet, physical activity and behavioral therapy measures do not work," says Stefan Engeli, professor at the Institute for Clinical Pharmacology at the Hannover Medical School and board member of the German Obesity Society.

Medicines can only aid an individual's weight loss efforts. But at least: "Some patients achieve a weight loss with it that they previously could not achieve with lifestyle changes alone," says Engeli.

Active ingredients mimic the hormone - two important effects

© W & B / Jörg Neisel

TO THE PICTURE GALLERY

© W & B / Jörg Neisel

Semaglutide and related substances are injected under the skin with a pen once a week, for example on the stomach. Semaglutide is more durable than the natural hormone GLP-1

© W & B / Jörg Neisel

The effect on appetite and satiety helps shed excess pounds

© W & B / Jörg Neisel

Semaglutide normalizes blood sugar in type 2 diabetes

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Obesity is not a disease

Andreas Birkenfeld, Professor of Metabolic and Vascular Medicine at the Technical University of Dresden and co-author of the Lancet study, rates it similarly. But he also sees some hurdles. The statutory health insurances do not recognize drugs for weight loss as necessary - among other things because obesity is not considered a disease. Even nutritional advice and weight loss programs are by no means always paid for by health insurers.

If a doctor prescribes liraglutide or, in the future, semaglutide to lose weight to a non-diabetic, the patient has to pay the costs of several thousand euros annually out of his own pocket.

Another possible obstacle: semaglutide must be injected once a week. "Many diabetics are used to injecting themselves regularly, but those who do not have diabetes can shy away from it," says Birkenfeld. However, tablets are already being developed to be swallowed.

Small intestine intestinal hormone GLP-1

Effects on the body
About 20 minutes after starting a meal, the small intestine releases the hormone GLP-1 into the bloodstream. Several organs react to this.

The liver restricts the release of sugar into the blood.

The pancreas releases more of the hormone insulin. It lowers the sugar levels in the blood.

The stomach empties more slowly. It takes longer for the food to be digested and for nutrients to get into the blood.

The brain reacts with decreased appetite and a feeling of satiety.

Signals from the small intestine: the body reacts just a few minutes after starting a meal. A hormone with the abbreviation GLP-1 plays an important role in this

Professor Stefan Engeli, board member of the German Obesity Society

© W & B / Stefan Thomas Kröger

Lifelong therapy against the yo-yo effect

But how sustainable is the success supported by substances such as semaglutide within a year? "Weight reduction and maintenance require lifelong therapy. If you stop a diet, you gain weight. If you stop taking a weight-reducing drug, you gain weight," says Engeli. Most people therefore need medication on a permanent basis to avoid the yo-yo effect.

Another point is the side effects of semaglutide. Often nausea and vomiting occur in the first few weeks because the preparation delays gastric emptying. Usually the symptoms go away after a few days. However, it will take some time to tell whether and which undesirable effects occur after years of use.

Treatments for obesity

There is no entitlement to payment of the treatment costs. Therapies must be approved by the health insurance fund.

Clinical Weight Loss Programs: Under professional guidance, participants learn to change their diet. A long-term loss of up to ten percent of body weight is realistic.

Surgical interventions: last resort in the case of pronounced obesity. There are several procedures. The most common: surgeons reduce the size of the stomach and turn off part of the small intestine. A long-term reduction in body weight by a fifth to a third is possible. But the interventions also involve risks in the short and long term.