Injection against obesity: is it good for anything?

Injection against obesity
A spade to lose weight?

It sounds tempting: inject yourself slim – without giving up, starvation diets and sports excesses. This trend is spilling over to us from the USA: Tech billionaire Elon Musk reportedly lost 13 kilos with fasting and injections. Reality TV star Kim Kardashian reportedly fit into a slim-fitting glittery Marilyn Monroe dress with the help of injections at the 2022 Met Gala.

The active ingredient that performs these miracles is called semaglutide. It was originally developed for diabetics to lower blood sugar levels. Specialists have been able to prescribe it under the trade name Ozempic in Germany since 2018. The drug has various effects: On the one hand, it releases more insulin from the pancreas and thus lowers the blood sugar level. At the same time, it reduces weight because it curbs appetite and makes you feel full faster. Because the participants in several diabetes studies noticeably lost kilos, Semaglutid has also been available as an injection for weight loss under the name Wegovy for some time. The double dose ensures that the satiating effect increases – perfect for a diet.

Can you also get the injection in Germany?

Not at the moment: Wegovy has been approved for weight loss in Germany since 2022, but is not available. The run on the drug is so huge that the Danish pharmaceutical manufacturer Novo Nordisk cannot keep up with production. Theoretically, there is still Ozempic, which is only approved for diabetics to lower blood sugar. “At the moment, drug weight loss therapy with semaglutid can only be used in diabetes,” says Beate Herbig, chief physician at the obesity clinic at the Bielefeld Clinic.

Could Ozempic also be used in higher doses to lose weight?

In principle, it is possible and has been used by doctors for a long time. However, this is problematic from an ethical point of view: In the meantime, there are also delivery bottlenecks at Ozempic because of all those who want to lose weight – bad for diabetics who really need the drug.

Do the cash registers pay for the remedy?

So far, the statutory health insurance companies have not covered any medication for losing weight – even if morbid overweight, known as obesity, has been officially recognized as a disease since 2021. “We can currently only prescribe these drugs on a private prescription,” says Herbig. Should Wegovy be available from us at some point, it could be expensive for those who want to lose weight: In the USA, Novo Nordisk calls for a list price of 1350 dollars for four syringes – that’s enough for four weeks. How expensive the treatment will be in Germany is unclear.

Is Wegovy suitable for everyone?

Basically, semaglutide can help all overweight people. Doctors are allowed to use the drug according to the approval only prescribed from a body mass index (BMI) of at least 30, then one is considered to be morbidly overweight. Or from a BMI of 27 if the extra kilos are already affecting your health and diseases such as diabetes, high blood pressure or increased blood lipid levels occur.

How long do you have to take it?

Studies show that patients usually only maintain their reduced weight as long as they inject semaglutide. “If people don’t change their lifestyle and eating habits, no matter how effective the injection may be – as soon as they stop using it, they will gain weight again,” says Herbig. Therefore, in addition to the injection, the patients must be encouraged to change their diet and do more sportso that they can maintain the weight without medication.

And what about side effects?

Almost all patients complain of nausea at the beginning of therapy, some have diarrhea and vomiting. Therefore, the dose is usually increased slowly every four weeks over three months. During therapy, the risk of gallstones and pancreatitis is slightly increased. In animal models, there was an increased tendency to malignant tumors in the thyroid and pancreas. There is no evidence of this in humans.

Could the slimming injection lead to fewer people having their stomachs reduced?

In fact, semaglutide is similarly effective to surgical therapy: It reduces body weight by more than 20 percent. Herbig believes that a certain number of patients would probably try to choose medication instead of surgery. However, Wegovy would have to be reimbursed for this. The surgeon would like to use the drug primarily as a short-term relapse therapy: If patients gain weight again after an initially successful stomach operation, they could be treated well with it.

Are there already copycat preparations?

Tirzepatid is a new diabetes drug that can also be used to lose weight. It combines two substances and acts even more effectively than semaglutide: In studies, the test subjects lost 22.5 percent or 24 kilos of their weight depending on the dose. The procedure at the European approval authority EMA is underway to use tirzepatid not only against diabetes, but also in overweight. Obesity expert Herbig warns against too high expectations of the new drugs. Complicated mechanisms keep weight at a certain level, regulate appetite, hunger and satiety. “If a mechanism is blocked with medication, nature will look for another way. That was the case with all drugs up to now,” explains the surgeon. In this respect, the new weight loss medications are building blocks for treatment. But they alone would not bring the desired weight and health.

Bridget