The pharmaceutical company Novo Nordisk has announced the results of a study designed to evaluate the weight loss drug Wegovy, and its ability to provide long term maintenance of weight loss. Wegovy is the brand name for the GLP-1 peptide medication  Semaglutide, which is also the ingredient in their brand name diabetes medication Ozempic. The presentation of their data was made at the European Congress on Obesity in Venice, Italy.

Novo Nordisk’s spokesman said, “We see that once the majority of the weight loss is accrued, you don’t go back and start to increase in weight if you stay on the drug.” This is an important development not only in terms of proving the medication’s long term benefits, but also in the attempt to seek greater acceptance of insurance coverage for the medication. Britain’s public health service decided two years ago to limit coverage for the medication. According to Dr Simon Cork from A Ruskin U. this was done “because of questionable long term effectiveness.”  This issue is also of great importance in the US, as more patients and their doctors are requesting insurance coverage for weight loss medications.  Approximately 70% of the adult population in the U.S. is overweight according to government surveys.

The current study of Semaglutide’s long term effectiveness consisted of over 17,600 subjects. They lost an average of 10% of their body weight after being on semaglutide for 65 weeks. After being on the medication for four years the study’s participants maintained their weight loss, actually slightly exceeding the 10% weight loss figure- calculated to be at 10.2% body weight lost after four years. The Novo Nordisk spokesman Martin Host Lange confirmed, “This is the longest study we’ve conducted so far of semaglutide for weight loss”.

In the FDA’s press release John Sharretts, M.D. states, “Wegovy is now the first weight loss medication to also be approved to help prevent life-threatening cardiovascular events in adults with cardiovascular disease and either obesity or overweight. This patient population has a higher risk of cardiovascular death, heart attack and stroke. Providing a treatment option that is proven to lower this cardiovascular risk is a major advance for public health.”

The classification GLP-1 stands for Glucagon-like peptide. Along with the peptide Semaglutide, the other well known similar medication is Tirzepatide (brand names Mounjaro and Zepbound). Both medications were originally developed for control of diabetes and were then found to be very effective for weight loss. And now,  it appears that these medications are also able to provide other health benefits. The company Eli Lily which produces Zepbound released the results of two studies that showed that their medication improved sleep apnea. Sleep apnea is a condition most commonly diagnosed in those who are overweight. Along with the weight loss benefit, the subjects with sleep apnea reported an approximately 70% improvement in sleep apnea itself.

WEIGHT LOSS MEDICATIONS and LOWERING CANCER RISK

Recently published data in the Journal of the American Medical Association showed that diabetics who took GLP-1 agonist medications lowered their risk of Colorectal cancer by a greater degree than  those with Type 2 Diabetes who took other medications for their diabetes. REDUCED RISK OF OTHER CANCERS-  Somewhere between 4 and 8% of all cancers are felt to be obesity related. The risk for uterine cancer, breast cancer and cancers of the kidneys, gallbladder, liver and pancreas are all felt to be related to obesity.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9857053/#:~:text=Obesity%20has%20been%20linked%20to,cancers%20are%20attributed%20to%20obesity

HELP WITH ALCOHOL ADDICTION

The GLP-1 medications are successful in great part for weight loss due to their ability to reduce the desire for food. With their greater and more widespread use it is increasingly being reported that these medications also decrease the desire for alcohol. There seems to be a logical connection here. If these  medications reduce the desire and craving for food, why not the craving for alcohol ? Indeed physicians are now recommending these “weight loss’ medications to those with alcohol abuse problems to better manage their consumption of alcohol.  https://news.unchealthcare.org/2023/12/use-of-glp-1-receptor-agonists-to-treat-substance-and-alcohol-use-disorders-is-promising-but-premature/

A large study which was done by Epic Research showed that those taking GLP-1 weight loss medications  were prescribed less anti-anxiety and less anti-depression medications. They surveyed over three million diabetic patients and nearly one million non-diabetic patients taking GLP-1 medications. Both tirzepatide and semaglutide reduced the need for psychiatric medications. It is yet to be determined whether this benefit for anxiety and/ or depression is related to an action of the medication itself, or is a byproduct of the improvement in mood that accrues when a person has successfully achieved a weight loss goal.

DEMENTIA PREVENTION  Type 2 diabetes is associated with the development of vascular dementia.A study from Denmark followed diabetics who were prescribed semaglutide for five years. They found that those study subjects had a lower occurrence of dementia. Given the cardiovascular benefits of weight loss and GP-1 medication this result also seems to be consistent with the other cardiovascular benefits of taking these medications. It might be that the benefit of these medications will be beneficial for certain types of dementia-those of vascular origin- but not for other types of dementia.

PCOS

Polycystic Ovarian Syndrome is a hormonal imbalance characterized by menstrual cycle irregularities, infertility, excessive hair growth, and acne. These patients also tend to be overweight, and related to their excess weight, they exhibit insulin resistance, which is consistent with pre-diabetes. It has long  been observed that in patients with PCOS weight loss will improve menstrual irregularities, restore ovulation, and improve fertility. Again we have a logical inference, although it remains to be proven that PCOS treatment will be yet another use of GLP-1 medications. Since neither semaglutide nor tirzepatide is approved as a treatment for  PCOS, it’s current use in these patients is considered an off-label use of the medication. But many leading gynecologists around the US are indeed prescribing these medications for Polycystic Ovarian Syndrome patients. https://www.nbcnews.com/health/health-news/ozempic-other-health-conditions-pcos-alzheimers-rcna90457  F. Haperin, MD, an Endocrinologist, states “because these medications (Semaglutide and Tirzepatide) cause significant weight loss and improve insulin resistance, it makes sense biologically, that they would be helpful for women with PCOS.” It is important to note that those who are pregnant or breastfeeding are advised not to take these medications as their safety has not been studied in these situations. If a woman is taking either of these medications there should be a period of two to three months of discontinuing the medication before actively trying for a pregnancy.

In summary, obesity is linked to cardiovascular disease risk. Cardiovascular disease is the number one cause of mortality in the country and the world. Cancer is also a major cause of mortality, and is also associated with obesity. It seems clear that any medication which can reduce obesity and maintain the weight reduction long term will lower overall mortality of the population at large. It would seem not only logical but eventually imperative that insurance coverage for these successful weight loss medications will inevitably follow.