An investigation by The BMJ highlights the failure of UK regulatory bodies, including the MHRA and ASA, to effectively enforce laws governing prescription drug advertisements, especially for weight loss drugs like Wegovy. This has resulted in inadequate monitoring and a lack of sanctions, potentially compromising patient safety.
Experts have filed numerous complaints about Wegovy’s online advertisements and criticize regulators for their failure to impose sanctions.
An investigation recently published by The BMJ reveals that UK organizations tasked with safeguarding the public from advertisements for prescription-only drugs are exposing patients to potential harm from weight loss medications due to their failure to enforce existing laws.
Legal responsibility for regulating adverts for medicines in the UK rests with the Medicines and Healthcare products Regulatory Agency (MHRA) on behalf of health ministers. But there is also a system of self-regulation with a number of bodies operating their own codes of practice, including the Advertising Standards Authority (ASA).
But The BMJ has found that the MHRA has not issued a single sanction for prescription drugs in the last five years. And among 16 cases where the MHRA took action by requesting changes to adverts for weight loss drugs between June 2022 and July 2023, all were triggered by external complaints, not internal mechanisms, and none resulted in sanctions.
James Cave, Editor in Chief of the Drug & Therapeutics Bulletin (DTB), a BMJ journal with a focus on drug safety, said that the lack of sanctions and internal monitoring provides only a weak incentive for companies to abstain from advertising prescription drugs.
Concerns Over Online Advertising of Wegovy
He became concerned about inadequate regulation after an online search for the prescription-only weight loss medicine Wegovy (semaglutide) prompted what he considered to be “a whole list of adverts,” even though he says long-term adverse effects of Wegovy are not known.
A web search by The BMJ for the terms “Wegovy,” “pharmacy, and “UK” had hundreds of thousands of hits, including a blog post by Pharmadoctor, a website which supports pharmacists to provide services for patients.
Pharmadoctor’s blog post, entitled “All about Wegovy,” stated that “Wegovy is a weekly weight loss injection made famous by celebrities such as Elon Musk and Boris Johnson. If Wegovy is suitable for you, your pharmacist will be able to provide it.”
In October, Shai Mulinari, associate professor of sociology at Lund University, and Piotr Ozieranski, senior lecturer of social and policy sciences at the University of Bath, filed a complaint to the MHRA alleging illegal prescription drug promotion.
In it they said they were “appalled” that the company was marketing Wegovy “directly to the public” and that the “All about Wegovy” blog post was linked to prominently from the patient-facing home page.
The post states, “Whether it’s Wegovy or another treatment, your Pharmadoctor partner pharmacist can discuss weight loss options” and provides the price of the drug and a link to find local pharmacists.
Inadequate Response from MHRA and Pharmadoctor
The MHRA responded saying that after its investigation reference to Wegovy on Pharmadoctor’s patient home page “has been removed in line with our guidance.” But only a link and the word “Wegovy” had been removed from the patient-facing home page, while the blog post remained online.
Pharmadoctor CEO Graham Thoms told The BMJ that Pharmadoctor only aimed to inform patients about Wegovy and that it had kept the blog post online because the MHRA hadn’t required it be taken down.
But Cave said the MHRA’s approach to focus on websites is “completely out of date.” People don’t enter websites via the home page, “They simply use a search engine,” he said. The Pharmadoctor post was among the first results when searching for “Wegovy,” “pharmacy,” and “UK.”
In the past year, Cave has filed over a dozen complaints about the advertising of semaglutide to the MHRA and the ASA, but he was disappointed with the results.
“These companies just wriggle and squirm their way out of any complaint from ASA and MHRA and carry on regardless,” he said. Cave also criticized the organizations’ apparent reliance on complaints from individuals to highlight online advertisements that break rules.
The MHRA told The BMJ that it actively monitors advertisements for prescription medicines, but it did not respond to a question about how many people are tasked with this.
A spokesperson for the ASA said that it too takes advertising of prescription medicine seriously and has scaled up its monitoring of online advertisements with the help of AI.
As Zepbound dominates headlines as a new obesity-fighting drug, experts warn that weight loss shouldn’t be the only goal.
Zepbound is the newest addition to the weight loss drug arena. In November 2023, it joined the list of obesity-fighting drugs – administered as an injection – to be approved by the U.S. Food and Drug Administration.
The key to Zepbound’s weight loss potential is its active ingredient, tirzepatide. This is the same active ingredient found in the drug Mounjaro, which is approved to treat Type 2 diabetes.
The relationship between Zepbound and Mounjaro is similar to two other popular drugs making headlines, Wegovy and Ozempic. Both Wegovy and Ozempic contain the active ingredient semaglutide, with Ozempic approved for the treatment of Type 2 diabetes and Wegovy approved for the treatment of obesity.
Tirzepatide and semaglutide both mimic the digestive hormone GLP-1, which is released by the intestines when we eat to stimulate insulin production and help regulate blood sugar. GLP-1 also suppresses appetite while promoting a sensation of fullness.
Weight loss medications are intended to be used in conjunction with lifestyle changes, such as exercise and a healthy diet. But too often, people view them as a silver bullet for weight loss. And the high price tag and variable insurance coverage for these popular weight loss drugs create a barrier for many people.
Obesity is not just an American issue, nor is it going away. The World Obesity Federation estimates that by 2030, 1 in 5 women and 1 in 7 men will be living with obesity worldwide.
However, long-term weight management depends on a number of complex factors. Meal timing and types of foods eaten can affect energy levels, satisfaction and hunger levels. A person’s typical schedule, culture and preferences, activity level and health history must be taken into consideration as well. No single “best strategy” for weight management has been identified, and research indicates that strategies for weight loss and maintenance need to be individualized.
In addition, it is critical to note that research on the long-term effects of these newer weight loss drugs is limited. The available research has focused specifically on weight loss, heart health and metabolism and has found that ongoing use of these new medications is necessary to maintain improvements in weight and related health benefits.
Common side effects and the emotional toll experienced by those who regain weight once they stop taking the drugs are trade-offs that need to be considered. More research is needed to better understand the long-term impact of both direct and indirect health consequences of taking drugs for weight loss.
It’s not just what you see on the scale
Throughout my years working as a registered dietitian, I have counseled numerous people about their weight loss goals. I often see a hyperfocus on weight loss, with much less attention being placed on the right nutrients to eat.
Societal standards and weight stigma in the health care setting can negatively affect patients’ health and can lead them to obsess about the number on a scale rather than on the health outcome.
Weight loss may be necessary to reduce risks and promote health. But weight loss alone should not be the end goal: Rather, the focus should be on overall health. Tactics to reduce intake and suppress appetite require intention to ensure that the body receives the nutrients it needs to support health.
Additionally, I remind people that long-term results require attention to diet and lifestyle. When a person stops taking a medication, the condition it’s meant to treat can often return. If you stop taking your high blood pressure pills without altering your diet and lifestyle, your blood pressure goes back up. The same effects can happen with medications used to treat cholesterol and obesity.
Nourish your body with nutrients
Despite the prevalence of obesity and the emergence of newer drugs to treat it, 95% of the world’s population doesn’t get enough of at least one nutrient. According to one study, nearly one-third of Americans have been found to be at risk of at least one nutrient deficiency. Additional research indicates that those actively trying to lose weight are more prone to nutrient deficiencies and inadequate intake.
For instance, a decline in iron intake can lead to iron deficiency anemia, which can cause fatigue as well as an increased risk of many conditions. Adequate intake of calcium and Vitamin D reduce the risk of bone fractures, yet many people get less than the recommended amounts of these nutrients.
It is true that a healthy body weight is associated with reduced health risks and conditions. But if a person loses weight in a manner that does not provide their body with adequate nourishment, then they may develop new health concerns. For example, when a person follows a diet that severely restricts carbohydrates, such as the ketogenic diet, intake of many vitamins, minerals, phytochemicals – or biologically active compounds found in plants – and fiber are reduced. This can increase risk of nutrient deficiencies and impair the health of bacteria in our gut that are important for nutrient absorption and immune function.
Nutrition recommendations set by the Food and Nutrition Board of the National Academies of Sciences, Engineering, and Medicine and the Dietary Guidelines for Americans provide guidance and resources to help meet nutrient needs to promote health and prevent disease, regardless of the strategy used to lose weight.
Optimizing health
There is no doubt that striving for a healthy body weight can reduce certain health risks and prevent chronic disease. Whether a person strives to maintain a healthy body weight through diet alone or with medications to treat obesity, the following tips can help optimize health while attempting to lose weight.
Adopt an individualized approach to healthy behaviors that promote weight loss while considering personal preferences, environmental challenges, health conditions and nutrient needs.
Focus on nutrient-dense foods to ensure the body is getting required nutrients for disease prevention and optimal function. If medications reduce your appetite, it is crucial to maximize the amount of nutrients in the foods you do consume.
Seek professional help. If you are uncertain about how to adopt an individualized approach while ensuring adequate intake of essential nutrients, talk to a registered dietitian. They can learn about your individual needs based on preferences, health conditions and goals to make dietary recommendations that support health.
The American Medical Association officially recognized obesity as a disease in June 2013 after decades-long controversy.1 Although lifestyle interventions are promoted as a first-line obesity treatment, the resultant short-term weight loss often fails to improve long-term outcomes.2 In the search for other solutions, glucagon-like peptide-1 (GLP-1) receptor agonists such as tirzepatide (Mounjaro™) and semaglutide (Wegovy® or Ozempic®) have greatly increased in popularity throughout the past year.
However, the media frenzy surrounding tirzepatide and semaglutide has raised concerns about this latest obesity treatment. Originally developed for diabetes, tirzepatide and semaglutide faced widespread drug shortages as celebrities such as Elon Musk and Chelsea Handler accredited the drugs for their weight loss. Resultant backlash attributed the anti-obesity medication boom to fatphobia.3
Still, the myriad of obesity’s biological and psychosocial obstacles can feel insurmountable after lifelong efforts to lose weight. But are GLP-1 receptor agonists the right solution for patients struggling to climb uphill to a “healthy weight”? Or do these injectables amplify disordered eating, weight stigma, and reliance on expensive pharmaceuticals?
Perhaps it depends on who you ask.
For an insider’s view on this timely topic, we spoke with board-certified bariatric physician Kevin Huffman, DO and leading psychiatrist Michael Olla, MD, both of whom have decades of experience treating obesity and navigating its social implications.
Can BMI Justify Anti-Obesity Injections?
Although obesity is associated with higher risks for type 2 diabetes, certain cancers, mobility issues, and heart disease,1 some experts feel that anthropometric measures such as body mass index (BMI) fail to reflect true health status.
A veteran in his field, Dr. Huffman has treated more than 10,000 patients with obesity and trained and mentored hundreds of physicians and allied healthcare providers. He is also the CEO and founder of AmBari Nutrition and the founder and president of The American Bariatric Consultants.
Dr. Huffman admits that BMI does not tell the whole story about whether anti-obesity medication makes sense for an individual patient.
“BMI, a useful initial screening tool, necessitates more nuanced considerations when prescribing injectable weight loss medications,” he explains. “We acknowledge the uniqueness of each patient; body composition, fat distribution, metabolic health, and underlying medical conditions significantly influence our decision-making process.”
He continues, “For instance, certain patients may present with central obesity despite having a lower BMI — this suggests an escalated risk for obesity-related complications. Diabetes or hypertension, obesity-related health issues, may still qualify individuals for intervention despite a slightly lower BMI than the conventional threshold.”
Providing Quality Care in a “Fatphobic” Environment
Medical professionals are far from immune to stigmatizing patients with obesity. Research findings show that over 50% of healthcare professionals attribute obesity to a lack of willpower.4
In addition, more than half of adults with overweight in Western countries report experiencing weight stigma. As a result of this stigma, patients with obesity and overweight are more likely to avoid healthcare.2
According to Dr. Huffman, “Navigating through this deeply ingrained prejudice is crucial when prescribing injectable anti-obesity medications: potent tools in aiding patients on their weight loss journey. Unfortunately, many barriers arise due to the fear and stigma surrounding obesity — these factors tragically deter numerous individuals from pursuing these potentially life-altering treatments.”
He urges prescribers to approach these conversations with empathy, understanding, and a non-judgmental attitude to foster support and empower patients to access necessary, deserved care for a better quality of life.
Dr. Olla is the medical director at Valley Spring Recovery Center. He is a leading authority figure in the field of psychiatric medicine who focuses on holistic healing, patient well-being, and evidence-based practices.
“Believe it or not, fatphobia or weight bias is a common issue in plenty of medical professionals,” Dr. Olla explains. “Heavier patients tend to encounter lots of medical professionals with weight stigma. In these cases, doctors tend to focus so much on their weight that they ignore other symptoms these patients primarily come in for. This doesn’t just affect patients but also doctors who mean well.”
To address these biases, Dr. Olla encourages medical professionals to have honest conversations with patients before prescribing anti-obesity medications. He suggests openly discussing fatphobia’s potential influence on the decision-making process and explaining the medication’s benefits and risks without pressuring patients to use medication unless medically justified.
According to Dr. Olla, reviewing other treatment options respects a patient’s autonomy and right to make their own treatment decisions.
“The key is to focus on how the drug can help reverse or at least slow down the effects of obesity on the body,” he explains. “This can help the patient understand that their doctor is concerned about their overall health, rather than their weight.”
Weighing the Costs and Benefits of Anti-Obesity Medications
Prescribing anti-obesity medications in today’s cultural climate is no simple task. Physicians must carefully weigh the pros and cons to lead patients to the most appropriate and beneficial treatment path.
“As a doctor myself, I am 50/50 on prescribing weight loss medications,” Dr. Olla shares. “Obviously, you wouldn’t want your patients to develop metabolic or cardiovascular diseases caused by excess weight. However, at the same time, I don’t want to encourage a medication that can only cause more health problems to the patient. In my opinion, there should be more research on how anti-psychotics and weight loss medications could go hand in hand without putting an individual in further danger.”
A multidisciplinary approach is the key to ensuring that patients receive not just comprehensive care, but also unwavering support throughout their weight loss efforts.
According to research findings published in Endocrine Practice, over 70% of healthcare providers believe that anti-obesity medicine as an adjunct to lifestyle counseling is an appropriate therapy that can kick-start weight loss and give patients a greater sense of control over their weight.5
However, clinicans remain hesitant to prescribe anti-obesity medications, with some seeing anti-obesity medication as a short-term solution and others being concerned about safety, efficacy, and cost of staying on these medications. These barriers lead to low prescribing rates, which perpetuates a cycle of low perceived demand and lack of coverage by insurance carriers.6
Dr. Olla also explains how psychiatric comorbidities can complicate obesity treatment. He notes that anti-psychotics and antidepressants can raise hunger levels and cause unwanted weight gain.
“Some patients press for medications that can counteract the side effects,” he says.
He feels that it is not safe to prescribe anti-obesity medication to those with psychiatric conditions, particularly eating disorders. Doing so may increase body weight focus, promote disordered eating habits, increase anorexia risk, and lead to a psychological dependency on weight loss medication.
Aside from psychiatric comorbidities, clinicians must also consider whether a patient has diabetes or other physical conditions. As a bariatric physician, Dr. Huffman explains the counseling differences between those prescribed injectables for weight loss vs type 2 diabetes.
“In managing type 2 diabetes, the counseling provides specific guidance such as carbohydrate counting instructions, recommendations for blood glucose monitoring methods, advice on medication adherence — emphasizing its critical role in the effective management of this condition — and underlining consistency as key when maintaining stable blood sugar levels.”
Dr. Huffman emphasizes that, before prescribing injectables, clinicians should (1) take a holistic approach, (2) assess a patient’s motivation to implement lifestyle changes, and (3) monitor patient adherence to anti-obesity medication regimens. According to him, motivational interviewing and a tailored approach empowers patients to make lasting change.
Leveraging Collaboration to Ensure the Best Treatment
According to Dr. Olla, clinians should remember that they do not need to navigate the complexities of obesity treatment alone. For instance, psychiatrists may work with endocrinologists before prescribing weight loss medications to patients with mental health conditions.
“The expertise of an endocrinologist is needed because anti-psychotic drugs can cause significant weight gain, and careful health monitoring is required,” Dr. Olla explains.
In Dr. Huffman’s practice, prescribing obesity medication is far from the final step in a comprehensive approach to weight management.
“Prescribing patients with injectable weight loss medications necessitates crucial care elements: ongoing support, referrals, and follow-ups,” Dr. Huffman says. “Primarily, I guarantee comprehensive counseling and educational resources for the patients.”
Dr. Huffman encourages prescribers to refer to registered dietitians for individualized meal plans and exercise specialists or physical therapists for safe and effective exercise programs. Mental health providers, behavioral therapists, and support groups can also play a pivotal role in a patient’s success.
“A multidisciplinary approach is the key to ensuring that patients receive not just comprehensive care, but also unwavering support throughout their weight loss efforts,” he says.
It remains to be seen whether anti-obesity medications will help or hurt in the fight against obesity and weight stigma. However, clinicians can build an army of specialists to not only optimize patient care but also help share the responsibility of treating this weighty issue.
The European Medicines Agency (EMA), the European Union’s (EU) version of the Food and Drug Administration (FDA), issued a drug safety signal this week about the elevated thyroid cancer risk associated with certain classes of pharmaceuticals for Type 2 diabetes and obesity.
Semaglutide, the active ingredient found in the widely used anti-diabetes and anti-obesity drugs Ozempic and Wegovy, respectively, are linked to an increased risk of thyroid cancer in patients who take the drugs in accordance with a doctor’s prescription.
Known as glucagon-like peptide-1 (GLP-1) receptor agonists, the drugs in question are manufactured by Novo Nordisk, AstraZeneca, Eli Lilly and Sanofi Winthrop, all of which must submit supplementary information about them to the EMA by July 26, 2023.
While a safety signal does not necessarily imply a direct causal relationship between a drug and the reported adverse event, the EMA uses it to help better determine whether or not a causal link exists by examining whatever the drug manufacturers send its way as part of the supplementary information requirement.
“Novo Nordisk is aware of the signal and the request by EMA and will deliver a thorough assessment of all relevant data to elucidate this topic,” said Lars Otto Andersen-Lange, the media relations director at Novo Nordisk, in a statement.
Andersen-Lange added that all associated Novo Nordisk products, including semaglutide, have been on the market for more than a decade, and that the safety data gathered from post-marketing surveillance of the drugs has not shown any “conclusive” evidence tying them to thyroid cancer.
(Related: Did you catch our earlier report about how doctors kill more people today than cancer does?)
Big Pharma criticizes researchers for exposing thyroid cancer risk of anti-diabetes, anti-obesity drugs – says their study contains “important limitations”
As usual, Novo Nordisk and the other drug companies responsible for producing the offending drugs continue to deny that their products are in any way unsafe. In fact, they even went so far as to take aim at the new study exposing the link, claiming it contains “important limitations.”
Some of the “important limitations” highlighted by Andersen-Lange includes the absence of validated case identification, inadequate differentiation of recurrent events, potential misclassification of events, and unconfirmed drug exposure, to quote one media source.
The study in question was pioneered by French researchers who looked at data from the French national health care insurance system database. From this, they noticed an increased risk of thyroid cancer among individuals who take the drugs in question, particularly between one and three years of being on them.
Diabetes Care reportedly published two commentaries on the study, one of which suggests that “detection bias” could be making it seem like the drugs cause thyroid cancer when they really do not. The other suggests the study might be invalid because it did not account for obesity as a confounding factor in thyroid cancer.
Interestingly, Novo Nordisk’s prescribing information for Ozempic and Wegovy contains a warning about the risk of developing thyroid C-cell tumors. The manufacturer also notes in the prescribing literature that semaglutide is linked to “dose-dependent and treatment-duration-dependent thyroid C-cell tumors” in rodents, but that human cancers remain “undetected.”
Those with a family history of thyroid cancer are warned against taking Wegovy by the FDA, which seems to be in acknowledgement that something is very wrong with these drugs in terms of their cancer risk.
It turns out that a big factor in Novo Nordisk’s success as a drug company is due to semaglutide. The company is now the second most valuable company in Europe, trailing only behind the French luxury goods group LVMH.
New research has concluded that drugs from the glucagon-like peptide-1 receptor agonists (GLP-1RA) class do not increase the risk of pancreatic cancer.
There had been concerns about these drugs because they’re prescribed to treat type 2 diabetes, a condition associated with pancreatic cancer.
Drugs from this class are effective at treating both type 2 diabetes and weight loss when combined with lifestyle changes.
Experts say anyone considering the use of these drugs should consult with their physician.
In a studyTrusted Source published in the medical journal JAMA, researchers analyzed a wide population of people with type 2 diabetes and reported that GLP-1RA drugs do not increase the risk of pancreatic cancer compared to basal insulin over a 7-year period.
They said this is an important finding as type 2 diabetes is associated with a higher risk of most cancers.
The study’s lead author told Medical News Today that this data should help doctors and patients alike to make informed choices when treating type 2 diabetes – and the implications for people with obesity are significant as well.
Dr. Rachel Dankner of the Gertner Institute for Epidemiology and Health Policy Research at the Sheba Medical Center in Israel led the study.
She told Medical News Today that her earlier research showed a strong correlation between type 2 diabetes and most cancers, particularly liver cancer and pancreatic cancer.
Because of this, it was especially important to know if drugs commonly used to treat type 2 diabetes – like those in the GLP-1RA class – might help explain the association.
“We were especially interested to reveal if there is any association between the incretines like DPP-4 inhibitors and GLP-1RAs and pancreatic cancer, since early on, when these drugs were just released, there were concerns that they may be associated with pancreatitis and with pancreatic cancer,” Dankner explained.
Because the GLP-1RA class is relatively new, researchers don’t have decades of data to draw from. However, Dankner and her colleagues did analyze a large population of nearly half a million adults with type 2 diabetes, with a follow-up period of 7 years.
“When you embark on a study with a new question, you try to stay objective and not to expect positive or negative findings,” she said. “Nevertheless, we were happy to find no association between these very important medications and a very aggressive cancer that is causing a lot of suffering and a very high mortality rate. We were also relieved to find out that this association persisted when we accounted for past history of pancreatitis, which is an important risk factor for pancreatic cancer.”
This finding was particularly important, Dankner said, because physicians often avoid prescribing GLP-1RAs to people with a history of pancreatitis.
Various types of GLP-1RA have been approved by the U.S. Food and Drug Administration, including exenatide, liraglutide, albiglutide, dulaglutide, lixisenatide, semaglutide, and tirzepatide.
These names might be unfamiliar, but the brand names they’re sold under – such as Ozempic, Rybelsus, Wegovy, and Mounjaro – are quickly becoming household names.
Dr. Mir Ali, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California, outlined some of the ways in which the drugs work.
“The observation was made that patients taking these medications would lose weight,” Ali, who was not involved in the study, told Medical News Today. “Patients feel less hungry because these drugs slow the emptying of the stomach, so they feel full for longer.”
Ali said that while these drugs have been on the market for some time, they’ve really gained in popularity in the past few years – a factor that’s led to shortages as manufacturers struggle to keep up with demand.
For those who are prescribed a GLP-1 receptor agonist, it’s important to note that they’ll be most effective when combined with lifestyle changes.
“We as physicians really require the patient to change to a healthier lifestyle and those are the patients who are most successful,” Ali said. “So medication helps, but if the patient fails to make the right food choices, they may not see the expected results. Or if they go back to the old ways after stopping the medication, they may regain weight. So these medications are more like chronic treatment, like we treat high blood pressure or diabetes.”
Ali points out that while most side effects of these medications are relatively mild, it’s still important that anyone considering these drugs consult with a physician.
“Endocrine conditions and relatively rare thyroid conditions have a contraindication to take these medications, so patients definitely need to start with their primary doctors if they fall into any of these categories,” he said.
Dankner says that more data will help researchers better understand the factors at play beyond the initial 7-year follow-up period.
However, she noted that the data published this week should help guide physicians when prescribing medications from the GLP-1RA class.
“These medications are proven excellent for weight reduction and weight control, and since obesity is such a huge problem, especially in diabetic patients, these medications not only treat hyperglycemia, but also obesity, which makes them a great choice when treating a diabetic patient with obesity,” she explained.
It does, but that’s not unexpected or dangerous, obesity experts say
While “Ozempic faceopens in a new tab or window” may still dominate headlines around the potential side effects of semaglutide (Wegovy, Ozempic) and other popular new weight-loss drugs, social media has started to raise questions about whether losing muscle mass is yet another complication.
But endocrinologists and obesity medicine specialists interviewed by MedPage Today said that while muscle mass loss can occur, it’s not unique to or more dramatic with semaglutide or its GLP-1 agonist drug class more broadly.
“Muscle mass loss is part-and-parcel to losing weight,” said Amy Rothberg, MD, of the University of Michigan in Ann Arbor, who is also a spokesperson for the Endocrine Society. “So in the context that semaglutide helps people lose weight, they are going to lose muscle mass.”
“But you lose muscle mass irrespective of the modality, whether that’s diet and exercise, bariatric surgery, or medications,” she said.
Karl Nadolsky, DO, an endocrinologist and obesity medicine specialist at Holland Hospital in Michigan, echoed that “all weight-loss interventions result in some lean mass loss.” Lean mass loss includes muscle loss but also includes things like fluid loss, Nadolsky said.
He pointed to subgroup data from the main clinical trial of semaglutide, the STEP 1 Studyopens in a new tab or window, looking at 95 people who were on the drug and 45 people who were taking placebo, all of whom had scans to monitor their body mass.
On average, those on the drug lost 10.4% of their fat mass and 6.9% of their lean body mass, while those on placebo lost 1.2% of their fat mass and 1.5% of their lean body mass.
“The placebo group lost almost 50% more lean mass than fat mass,” Nadolsky noted. While the data show that there is indeed lean mass loss with the drug, “the percentage of fat mass loss to lean mass loss is favorable.”
Rothberg noted that the study wasn’t powered to assess this outcome, but she said very generally speaking that with weight loss, people lose fat mass to lean mass at a ratio of 2:1. This certainly varies by age, gender, and physical conditioning, she said, but the STEP 1 data appear to fall within those parameters.
Nadolsky said with any weight loss intervention, physicians should aim to minimize muscle mass loss as much as possible, “as it’s beneficial for metabolic health and prevention or treatment of comorbidities, including type 2 diabetes,” he said.
That means encouraging resistance training in anyone who is working to lose weight, he said. It’s critical to have patients who are trying to lose weight also focus on building muscle, he said.
Semaglutide and newer weight-loss drugs should also be reserved for people who truly have obesity and overweight — not just anyone who wants to lose a few pounds, Rothberg and Nadolsky said.
“Some people just want to lose a little weight, but we shouldn’t give it to people who don’t need it,” Nadolsky said. “The benefits outweigh the risks in people who have obesity or overweight, especially when it’s complicated by cardiovascular disease, sleep apnea, and other conditions.”
Nadolsky noted that even with the lean mass loss seen with weight loss from semaglutide, trials have shown other benefits such as improvements in blood pressure, lipids, and glycemic control.
“All of those parameters improve with the weight loss, regardless of how much lean mass they lost,” he said. “We shouldn’t be scaring away people who have obesity and obesity-related complications.”
It does, but that’s not unexpected or dangerous, obesity experts say
While “Ozempic faceopens in a new tab or window” may still dominate headlines around the potential side effects of semaglutide (Wegovy, Ozempic) and other popular new weight-loss drugs, social media has started to raise questions about whether losing muscle mass is yet another complication.
But endocrinologists and obesity medicine specialists interviewed by MedPage Today said that while muscle mass loss can occur, it’s not unique to or more dramatic with semaglutide or its GLP-1 agonist drug class more broadly.
“Muscle mass loss is part-and-parcel to losing weight,” said Amy Rothberg, MD, of the University of Michigan in Ann Arbor, who is also a spokesperson for the Endocrine Society. “So in the context that semaglutide helps people lose weight, they are going to lose muscle mass.”
“But you lose muscle mass irrespective of the modality, whether that’s diet and exercise, bariatric surgery, or medications,” she said.
Karl Nadolsky, DO, an endocrinologist and obesity medicine specialist at Holland Hospital in Michigan, echoed that “all weight-loss interventions result in some lean mass loss.” Lean mass loss includes muscle loss but also includes things like fluid loss, Nadolsky said.
He pointed to subgroup data from the main clinical trial of semaglutide, the STEP 1 Studyopens in a new tab or window, looking at 95 people who were on the drug and 45 people who were taking placebo, all of whom had scans to monitor their body mass.
On average, those on the drug lost 10.4% of their fat mass and 6.9% of their lean body mass, while those on placebo lost 1.2% of their fat mass and 1.5% of their lean body mass.
“The placebo group lost almost 50% more lean mass than fat mass,” Nadolsky noted. While the data show that there is indeed lean mass loss with the drug, “the percentage of fat mass loss to lean mass loss is favorable.”
Rothberg noted that the study wasn’t powered to assess this outcome, but she said very generally speaking that with weight loss, people lose fat mass to lean mass at a ratio of 2:1. This certainly varies by age, gender, and physical conditioning, she said, but the STEP 1 data appear to fall within those parameters.
Nadolsky said with any weight loss intervention, physicians should aim to minimize muscle mass loss as much as possible, “as it’s beneficial for metabolic health and prevention or treatment of comorbidities, including type 2 diabetes,” he said.
That means encouraging resistance training in anyone who is working to lose weight, he said. It’s critical to have patients who are trying to lose weight also focus on building muscle, he said.
Semaglutide and newer weight-loss drugs should also be reserved for people who truly have obesity and overweight — not just anyone who wants to lose a few pounds, Rothberg and Nadolsky said.
“Some people just want to lose a little weight, but we shouldn’t give it to people who don’t need it,” Nadolsky said. “The benefits outweigh the risks in people who have obesity or overweight, especially when it’s complicated by cardiovascular disease, sleep apnea, and other conditions.”
Nadolsky noted that even with the lean mass loss seen with weight loss from semaglutide, trials have shown other benefits such as improvements in blood pressure, lipids, and glycemic control.
“All of those parameters improve with the weight loss, regardless of how much lean mass they lost,” he said. “We shouldn’t be scaring away people who have obesity and obesity-related complications.”
Experts explain that taking medications like Ozempic and Wegovy, for type 2 diabetes and weight loss, can cause an aged appearance in the face
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Medications intended for type 2 diabetes and clinical obesity — like Ozempic, Wegovy and Mounjaro — are trending on social media as drugs for quick weight loss.
However, some have reported the drugs cause an aged appearance, a side effect that is dubbed “Ozempic face.” One of those people is Jennifer Berger, who told The New York Times that she used Mounjaro (tirzepatide) to lose weight following her pregnancy.
Mounjaro, at higher doses, has been proven to be highly effective for weight loss similar to Wegovy.
Berger explained that although using the drug — taken weekly by injection in the thigh, stomach or arm — allowed her to lose 20 lbs. and she loved her results, the 41-year-old said her face started to look very gaunt.
“I remember looking in the mirror, and it was almost like I didn’t even recognize myself,” she told the outlet. “My body looked great, but my face looked exhausted and old.”
Dr. Oren Tepper, a New York-based plastic surgeon, explained to the Times that it’s common for weight loss to deflate key areas of the face, which can result in a person looking more aged.
“When it comes to facial aging, fat is typically more friend than foe,” he said. “Weight loss may turn back your biological age, but it tends to turn your facial clock forward.”
Dr. Paul Jarrod Frank, a dermatologist in New York, coined the term “Ozempic face” to describe this side effect, noting that it’s typically people in their 40s or 50s who are concerned about the sagging that occurs as a result of the weight loss in their face.
“I see it every day in my office,” Frank said. “A 50-year-old patient will come in, and suddenly, she’s super-skinny and needs filler, which she never needed before. I look at her and say, ‘How long have you been on Ozempic?’ And I’m right 100 percent of the time. It’s the drug of choice these days for the 1 percent.”
To restore volume in a patient’s face, doctors will often perform noninvasive, but expensive, procedures such as injecting Radiesse and hyaluronic acid-based fillers or Sculptra injections, which stimulates collagen production. Doctors can also restore volume with a face lift or by transferring fat from other body parts to the face.
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