Ozempic (semaglutide) has been used for weight loss, but it can cause serious side effects if used without medical supervision.
“First it must be said that there is no magic pen that fixes a bad lifestyle.” Thus begins the interview with endocrinologist and metabologist Tassiane Alvarenga, a member of the Brazilian Society of Endocrinology (SBEM) and the Brazilian Association for the Study of Obesity and Metabolic Syndrome (Abeso).
The specialist is referring to semaglutide, the active ingredient of Ozempic, a medicine to treat diabetes type 2 that has been used for obesity. In January of this year, the National Health Surveillance Agency (Anvisa) approved the use of another drug, whose active ingredient is also semaglutide, for the treatment of obesity. Before that, the drug was only recommended by the Agency to treat type 2 diabetes.
See also: What is the proper treatment for obesity?
here in this Portal we never use the trade name of drugs, precisely to avoid unethical advertising. However, we made the decision to make an exception due to the hundreds of messages and requests to talk about the medicine that has been sold as a cure for obesity.
In a quick survey, our reporting team found that sales of the medicine moved more than 6 billion dollars worldwide until August 2022. In Brazil, according to the Associação de Indústria Farmacêutica de Pesquisa (Interfarma), Ozempic was the best-selling medicine in 2021, when semaglutide had not even been approved to treat obesity by Anvisa. Hashtags involving the name of the product move all social networks, which accumulate millions of posts about the medicine, involving celebrities and anonymous people.
The main problem doctors point to with Ozempic is how many people have been using the drug. Even if, in theory, a medical prescription is required for sale, many people buy the medicine without medical advice, and start using it without follow-up. “Many make the wrong dose progression, which can cause nausea, vomiting, dehydration, cold and loss of muscle mass. This is when it is not used by people who are not obese and want to lose 3 or 4 kilos”, explains dr. Tassiane.
In addition, according to the doctor, people who use semaglutide without monitoring and without changing habits can regain the weight lost when they stop using it. “The person who lost weight only with Ozempic, without medical and nutritional monitoring, can gain weight again”, she says.
An important step in the treatment of obesity
Dr. Tassiane confirms that semaglutide, which is also sold in Brazil under another trade name, has changed the way obesity is treated. The drug basically works in three ways: 1) imitating the action of GLTP-1, the hormone produced in the intestine that signals the brain when we are fed, inducing satiety; two) delaying the emptying of stomach; 3) stimulating the pancreas to produce more insulin when we ingest carbohydrates – in fact, this was the main reason the drug was used to treat diabetes.
Studies show that patients lost up to 17% of their weight with the medication, in addition to showing improvement in metabolic parameters.
Another advantage is that semaglutide does not cause hypoglycemia (drop in blood sugar) or emotional side effects such as depressionirritability and insomnia, like other appetite suppressant drugs. “Even so, Ozempic is not for everyone, there are people who respond better to other medications”, stresses dr. Tassiane.
Indication and contraindication of Ozempic
The drug is indicated to treat type 2 diabetes and people with obesity (BMI greater than 30) or with a BMI equal to or greater than 27 who have at least one comorbidity, that is, a disease such as hypertensiondiabetes, cardiovascular problem, among others, associated.
However, there is a risk of allergic reactions and side effects. “It is important to note that there are people who are allergic to semaglutide and other substances contained in Ozempic. Therefore, like all medication, attention is needed before indicating or ingesting [o remédio]”, warns Dr. Thaís Mussi, endocrinologist by SBEM.
Regarding side effects, Dr. Thaís highlights some digestive problems. “About one in ten people have problems like diarrheavomiting and nausea, but with a very short duration.”
The drug is usually well tolerated, as long as the patient respects the prescribed dose and follows medical supervision. “Without follow-up, the patient can become dehydrated or suffer the consequences of a very restrictive diet due to loss of appetite, such as loss of muscle mass”, explains dr. Tassiane.
In addition, dr. Thaís explains that the drug is not indicated for people with type 1 diabetes and patients with diabetic ketoacidosis, an acute complication of this type of diabetes. People who have a family history of a type of cancer called medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN2), a rare syndrome that leads to the development of tumors in the endocrine glands, should pay attention. “It is very important to understand with your doctor if Ozempic can be used”, emphasizes dr. Thais.
According to the doctor. Tassiane, studies have already shown that semaglutide is safe for prolonged use, and can even be used continuously, provided that medical supervision is provided. “In addition to providing weight loss, patients who use the drug show improvement in metabolic parameters, such as a decrease in blood pressure, blood glucose, triglycerides, among others. In addition, semaglutide helps to reduce the risk of cardiovascular disease, without causing psychiatric side effects”, evaluates the doctor.
Pharmaceutical Novo Nordisk, which manufactures Ozempic, reinforced in a letter sent to the press at the beginning of the month: “It is important to point out that the company does not endorse or support the promotion of information of a off label [uso para outra indicação que não a aprovada pela Anvisa], that is, in disagreement with the instructions for their products. Ozempic, approved and marketed in Brazil for type 2 diabetes, does not have an indication approved by national and international regulatory agencies for obesity”.
In fact, Anvisa has approved the use of another medication, whose active ingredient is the same as that of Ozempic, semaglutide, to treat obesity, but has not yet authorized the use of Ozempic for this purpose.
See also: Why is obesity considered a chronic disease?
Obesity treatment must be individualized
Dr. Tassiane explains that the patient with obesity needs to be evaluated through clinical and laboratory tests before starting any treatment. It is necessary to understand the reasons that lead the person to gain weight and establish a plan with goals that includes habit changes and, in certain cases, medication. “Some patients need medication, but it should be part of a plan that includes other changes,” she says.
Very restrictive diets, induced or not by medication, can cause loss of muscle mass and other health problems, in addition to being difficult to follow them, which ends up discouraging patients. In order to lose weight without putting your health at risk, follow-up with a doctor and nutritionist is recommended.