Obesity-Medicine - Hype about the subcutaneous injection - a year of 'Wegovy' in Germany
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It's rare for a medication to create a real hype. But that's what happened with "Wegovy": people are sharing on social media how they're using it to lose weight and reporting side effects. What's happened since its introduction a year ago? An overview:
What is "Wegovy"?
"Wegovy" is a prescription medication that is supposed to help with weight loss and maintaining weight loss by reducing appetite and increasing feelings of fullness. Doctors in Germany have been able to prescribe this drug from Novo Nordisk since mid-July 2023. Patients inject it once a week under the skin with a pen that resembles a pen.
The active ingredient in "Wegovy," Semaglutide, has been used for longer to treat Type 2 diabetes under the name "Ozempic." "Wegovy" contains a higher dosage of the active ingredient and was approved for people with obesity, starting at a Body Mass Index (BMI) of 30. The therapy should be combined with diet and exercise.
How does "Wegovy" work?
The active ingredient Semaglutide mimics the effect of the gut hormone GLP-1 (glucagon-like peptide-1). This hormone is released from the small intestine after eating, explains Matthias Laudes, Vice President of the German Obesity Society (DAG) and Director of the Institute for Diabetology and Clinical Nutritional Research at the University Hospital Schleswig-Holstein.
The pancreas is signaled to produce insulin. "That's the anti-diabetic effect," says Laudes. The second effect is that the brain is informed that something has been eaten and can develop a feeling of fullness. "That's the weight-regulating effect."
The third effect is that the stomach is signaled that there is still enough food in the small intestine, so the emptying of the stomach is delayed. Patients have noticed this effect as a side effect - namely, nausea. This usually goes away when people get used to eating smaller portions, says Laudes.
What are other side effects?
Nausea is common at the beginning of treatment, along with other gastrointestinal symptoms such as vomiting, diarrhea, and constipation, says Karsten Müssig from the German Society for Endocrinology (DGE), Chief Physician of the Department for Internal Medicine, Gastroenterology, and Diabetology at the Franziskus Hospital Harderberg. Therefore, treatment is started with a low dose, which is gradually increased. Rare side effects include pancreatitis and intestinal obstruction. "The treatment should only be carried out under medical supervision," warns Müssig.
A recently published study in the medical journal "Jama Ophthalmology" suggests that Semaglutide may in very rare cases be associated with a serious eye disease - non-arteritic anterior ischemic optic neuropathy (NAION). Although this has not been proven, it should be taken seriously, says Horst Helbig from the German Ophthalmological Society (DOG) and the University Hospital Regensburg. Clarifying this question requires further investigations and careful monitoring of patients.
Reports suggest another phenomenon, known as "Ozempic Face": In general, the face can sag and look much older when weight loss happens quickly.
Do I have to take "Wegovy" for the rest of my life?
Obesity is just as chronic a condition as diabetes, says Laudes, so the medication must be taken for life. With a diabetes medication, no one would say it can be stopped after six months, says Laudes. "Every obese person has a lifelong problem that they can continue to gain," as can be seen even after gastric bypass surgery.
What should patients be aware of?
An obesity therapy should always include a lifestyle change, such as balanced nutrition and regular physical activity, says DGE expert Müssig. The diet should be calorie-reduced and rich in fiber and also contain less saturated and more unsaturated fatty acids - similar to the Mediterranean diet.
How much does "Wegovy" cost?
The cost of obesity treatment is estimated to be around 300 Euros monthly by Müssig. Patients must bear the costs themselves, as the medication is not covered by statutory health insurance.
Does "Wegovy" affect female fertility?
Under treatment with Semaglutid - that is, "Wegovy" or "Ozempic" - there have been pregnancies in women who had an unfulfilled desire to have a child for a long time, says Ulrich Knuth, chairman of the German Association of Reproductive Medical Centers (BRZ). However, there are no valid figures on this. It is possible, according to the expert, that the weight loss plays a role. It is known that obesity reduces the likelihood of pregnancy.
During pregnancy and breastfeeding, the preparation should not be used. Women who want to have a child should discontinue Semaglutid with a lead time of at least two months, writes the European Medicines Agency (EMA).
What can be concluded after one year?
The diabetes medication "Ozempic" has been used off-label - that is, for weight loss - beyond its actual indication for some time, says diabetologist Müssig. The introduction of "Wegovy" a year ago was accompanied by the hope that "Ozempic" would no longer be used as an obesity medication and would be more readily available to diabetes patients. Although the availability of "Ozempic" has improved, there are still supply issues. Obesity expert Laudes says that the demand for "Wegovy" is also greater than the production.
This situation increases the risk of counterfeit products - the EMA explicitly warns against buying preparations on the black market. The preparations should only be used for their respective indications - Type 2 diabetes and obesity. If non-obese people use such medications solely to optimize their figure, they exacerbate the existing bottlenecks.
Is Novo Nordisk the only supplier of weight loss injections?
No. The US pharmaceutical company Eli Lilly now markets a weight loss injection under the name "Mounjaro," which contains the active ingredient Tirzepatide, which is also a GLP-1 receptor agonist like Semaglutide. It has been approved in the EU since the end of last year.
A study has recently shown that significantly more pronounced weight loss can be achieved with it than with Semaglutide. The side effect risks of both substances are comparable, reports the research team in the medical journal "JAMA Internal Medicine." Long-term effects and the achievement of important goals such as a reduced risk of heart attacks could not be derived from the analysis.
- The prescription medication "Wegovy" was approved for use in Germany from Novo Nordisk since mid-July 2023, primarily for individuals with obesity and a Body Mass Index (BMI) of 30 or higher.
- The Active ingredient in "Wegovy," Semaglutide, has been used for Type 2 diabetes under the name "Ozempic" for an extended period.
- Doctors and experts, such as Matthias Laudes from the German Obesity Society (DAG) and Karsten Müssig from the German Society for Endocrinology (DGE), have expressed excitement and intensive interest in "Wegovy" due to its potential weight loss benefits.
- Semaglutide mimics the effect of the gut hormone GLP-1 (glucagon-like peptide-1), which is released from the small intestine after eating and signals the pancreas to produce insulin, promoting an anti-diabetic effect.
- The medication also signals the brain that something has been eaten, inducing a feeling of fullness, and delays the emptying of the stomach to promote weight loss and appetite reduction.
- The side effects of "Wegovy" are primarily gastrointestinal, including nausea, vomiting, diarrhea, and constipation, but these symptoms usually subside after patients acclimate to smaller food portions.
- The cost of obesity treatment with "Wegovy" is estimated to be around 300 Euros monthly and is not covered by statutory health insurance in Germany.
- Patients should be aware that an obesity therapy should always include lifestyle changes, such as balanced nutrition and regular physical activity, to achieve optimal results.
- The German diabetes medication "Ozempic," which contains Semaglutide, has been used off-label for weight loss, and the introduction of "Wegovy" a year ago has not necessarily led to its increased availability for diabetes patients due to high demand.
