Wegovy: From rebound weight to that black box warning

Being overweight is a risk factor for serious health conditions including diabetes and heart disease.

So when the wonder drug Ozempic was approved in 2017 for people with type 2 diabetes — it stirred quite a bit of excitement.

Diabetics who manage their weight greatly reduce the risks of serious complications including stroke. And suddenly, people with diabetes who’d struggled with weight maintenance were losing it with ease thanks to a weekly injection of Ozempic — or, specifically, its active ingredient semaglutide.

But something else happened…

It wasn’t long before Ozempic was prescribed “off-label” to people without diabetes solely for weight loss. If you could pay the price, there were doctors more than glad to help. You may have heard about Hollywood’s obsession with the drug.

But just so everyone could get on board, and insurance companies would pay the outrageous cost, semaglutide was dressed up and reintroduced as a new product: Wegovy.

Marketed and approved by the FDA for “chronic weight management,” the only difference is dosage: Wegovy gets you 2.4 mg of semaglutide to Ozempic’s 1 mg.

So, it seemed that the “magic weight loss pill” so many have hoped for had finally arrived. But not without a cost… and I don’t just mean the $1,400 monthly price tag…

Be careful what you wish for

It’s really no wonder that we’d be willing to try almost anything to lose weight. There are so many kinds of diets, choosing the right one could take a doctorate. But even doctors, in recent years, have admitted they receive less than a handful of instructional hours in medical school about diet to improve health.

That’s why a personal friend of mine, was ready to jump on the Wegovy bandwagon — and it’s a cautionary tale that’s echoed by many others…

“It was awful,” she said. “I would wake up in the middle of the night with extreme acid reflux and feeling like I was going to throw up. And then it caused fatigue so bad I could barely do anything. And because it’s an injection you have to ride it out for a week before the side effects subside.”

I’ve come across several personal stories like this online. Wegovy users have lamented they miss enjoying food or going out to eat. One stated, “If I take too many bites, I have to run to the bathroom.”

Some have gone so far as to say they now hate food. It’s no wonder when you hear why…

“It started off making me nauseous and after eating or drinking a very small amount, I felt full. If I tried to eat a few more bites it felt like everything was backing up in my esophagus.”

These complaints fall right in with semaglutide’s most common so-called side effects — nausea and vomiting — that some experts say may not beside effects at all, but the mechanism by which it works so well. If you can’t keep the food down, it won’t pack on the pounds.

Is Wegovy worth the risk?

Semaglutide is a synthetic form of the natural hormone called glucagon-like peptide-1 (GLP-1) which is released when we eat to stimulate insulin and prevent the release of another hormone called glucagon. These actions regulate blood sugar levels and slow the passage of food from the stomach to suppress appetite.

Dr. Robert Kushner of Northwestern University, who also serves on a medical advisory board for Novo Nordisk, the manufacturer of Wegovy, explained, “What the pharmaceutical companies have done is taken this hormone that is naturally occurring and restructured it into a drug.”

And like quite a few drugs, semaglutide comes with a warning…

A black box warning — or boxed warning, as the FDA prefers to call them — is the most serious type of warning mandated by the FDA. Such a warning, usually prominently featured on a drug’s label, warns of serious adverse reactions or special problems associated with a drug.

And both Wegovy and Ozempic have their very own — for thyroid cancer.

While clinical trials have not demonstrated if Wegovy increases thyroid cancer risk in people, in rodents, “semaglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures.” If a patient has a family history of medullary thyroid carcinoma or the genetic condition MEN2, they are warned not to take the drug.

But other concerning issues with Wegovy did show up in clinical trials with humans…

Some patients experienced acute pancreatitis and acute gallbladder disease. Symptoms for both are similar, including abdominal pain, jaundice, vomiting, diarrhea, loss of appetite and dark urine in the case of gallbladder disease.

What happens if you stop the drug? Rebound weight gain

Additional problems have plagued people who have somehow found a way to stick with it, at first…

One is sticker shock… then gaining the weight back quickly.

Yolanda Hamilton, a nurse from South Holland, Illinois, told NRP that, at first, using Wegovy gave her more energy. Her sugar cravings subsided, and she felt satisfied with smaller meals. She dropped 60 pounds, and her blood sugar and blood pressure both came down.

But then Yolanda changed jobs, and her new health insurance plan didn’t cover the cost of Wegovy. When she could no longer afford to use the drug at a sticker price of about $1,400 a month, the weight started coming back surprisingly fast.

In a matter of months, she has gained back 20 pounds. “I’m very frustrated about the weight coming back on in so little time,” she says.

Based on how the drug works, the “rebound” weight gain is no surprise. And it may be even harder to reign in according to what a study in the New England Journal of Medicine found over a decade ago…

Altered hunger-related hormones

That research found that hunger-related hormones disrupted by dieting and weight loss can remain at altered levels for at least a year, fueling a heartier-than-normal appetite.

That’s one reason that severely restricting calories isn’t the best way to lose weight. But can you imagine how difficult it might be for our hunger hormones to recover following drug-induced disruption?

Fruits and vegetables give the body the nutrients it needs to restore balance to our hunger hormones to do their jobs naturally — without being starved or manipulated by a drug.

Take berries. In studies snacking on berries create a sense of fullness that other snacks don’t. And, because of their anthocyanin content, they help make the body more sensitive to insulin — the hormone that takes glucose out of the blood and into cells to be used for energy.

Soluble fiber stabilizes blood sugar, slowing down the time it takes food to empty from the stomach and sugars to break down. This is good news for diabetics, hypoglycemics and anyone looking to lose weight naturally. Aiming to eat 30 grams of fiber each day can help with weight loss, lower blood pressure, and improve the body’s response to insulin just as effectively as a more complicated diet.

A diet high in protein has been shown to help suppress ghrelin, the hormone that signals hunger. It’s especially helpful to start your day with a protein-rich breakfast. Protein also has a positive impact on leptin (the hormone that signifies satiety).

Black seed oil from the plant Nigella sativa has numerous studies that indicate its positive effects on blood sugar and weight. It’s found in supplement form or bottled, like olive oil.

Side effects? It’s possible it could take a little longer to lose weight by eating better than with Wegovy and may require some exercise. But using the right food to achieve your goals will leave you with habits you’ll benefit from for the rest of your life — and won’t leave you nauseous or running for the bathroom, require an injection or empty your savings account.

Sources:

New Medication has Implications to avoid Would-be Chronic Disease — Pharmdive.com

Wegovy works. But here’s what happens if you can’t afford to keep taking the drug — NPR (Maine Public)

The dark side of A-list weight drugs — Evening Standard

I miss eating: the truth behind the weight loss drug that makes food repulsive —The Guardian

After dieting, hormone changes may fuel weight regain — CNN Health