A lately printed scientific trial of the anti-obesity drug, semaglutide, has produced a level of weight reduction which has led some to dub the treatment a “sport changer” within the remedy of weight problems.
The trial checked out 1,961 adults who had been obese or overweight. Roughly 75% of individuals had been feminine. Individuals got a weekly injection of semaglutide, a drug usually used to manage blood sugar within the remedy of diabetes. Individuals had been additionally suggested on methods to handle their weight via weight-reduction plan and train.
After 68 weeks of remedy, individuals misplaced a median of 15.3kg (round 15% of their physique weight) with semaglutide in comparison with simply 2.6kg in those that acquired the placebo injection, alongside food regimen and train recommendation. That is the most important impact ever noticed with an anti-obesity treatment. The weekly dose was administered by way of subcutaneous injection – which is uncommon, as most anti-obesity medicine are given as a pill taken by mouth.
However whereas the diploma of weight reduction is definitely promising, there’s nonetheless a lot researchers don’t find out about semaglutide – together with whether or not the drug was efficient by itself, or whether or not it was the mixture of the drug, the way it was administered, and whether or not it will produce the identical magnitude of weight reduction with out the life-style modifications.
Urge for food management
Semaglutide is a molecule that works by controlling urge for food. This has been proven in quite a few research, together with analysis carried out in 2017 by the College of Leeds which discovered that, in folks with weight problems, a once-weekly injection of semaglutide (the identical dose as used on this current research) was in a position to scale back day by day calorie consumption by 24% and scale back some meal sizes by greater than 30%. Regardless of consuming much less meals, folks skilled no improve in starvation and reported feeling fuller. This research additionally confirmed that semaglutide decreased cravings for (and consumption of) high-fat meals, and made folks really feel extra management over their urge for food.
Semaglutide controls urge for food by performing on the mind’s GLP1 receptors. GLP1 is a hormone which influences urge for food and is launched from cells within the gastrointestinal tract the place it stimulates the discharge of insulin and slows emptying of the abdomen. Analysis reveals that GLP1 receptors are positioned extensively all through the mind, together with in areas concerned in elements of urge for food akin to starvation and delight of meals.
Curiously, current analysis in rodents has proven semaglutide acts on mind areas answerable for each satiety and pleasure. Nevertheless, the actions of semaglutide on mind processes are advanced and stay to be totally labored out.
Though semaglutide seems to be efficient in controlling urge for food over a protracted interval, there are three components which could have influenced how efficient it was: the semaglutide molecule itself, the route of administration (injection) and having individuals change their food regimen and train habits.
There’s little doubt that the semaglutide molecule is potent in and of itself. However delivering it by injection might have affected how efficient it was. The authors consider the weekly injection could make it simpler for sufferers to stay to remedy than in the event that they needed to take it as a pill, as a result of they noticed it as a “medical” process. It might additionally make sufferers extra more likely to conform with the dietary and train recommendation as nicely as a result of an injection is perceived as a extra severe medical intervention than taking a capsule. This might remind folks of the seriousness of weight problems and inspire them to stay to dietary and train recommendation.
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It’s unsure whether or not semaglutide could be as efficient for weight reduction if it was given orally as a day by day pill, versus an injection. In a 12-week research on folks with diabetes, analysis confirmed a day by day oral dose of semaglutide is clearly efficient in controlling urge for food – leading to a lack of physique fats. This means that oral dosing might be efficient for weight reduction however must be examined in a long-term trial in folks with weight problems.**
Sufferers within the trial had been additionally instructed to food regimen and train to make sure they burned at the very least 500 energy greater than they consumed. This life-style modification was enforced via month-to-month particular person counselling classes. The authors of the research state the drug must be delivered alongside a way of life modification programme – so it’s unsure if the drug would have been as efficient with out making life-style modifications.
This isn’t to say the research’s outcomes aren’t promising. Semaglutide controls urge for food by inhibiting the drive to eat and rising emotions of fullness. All of this can be notably efficient at lowering physique weight, particularly in a society which promotes unhealthy life and overeating – and the place unhealthy high-calorie meals are in every single place.
This suppression of urge for food can also be long-lasting. Within the scientific trial, physique weight continued to say no for greater than a 12 months – physique weight was at its lowest round week 60. Semaglutide’s continued motion on the mind’s GLP1 receptors successfully inhibited the drive to eat at a stage far past what’s been seen up to now. In fact, if an individual stops taking the drug, urge for food will return to regular. And if no life-style modifications are made, this might lead to weight regain.
It’s additionally value declaring that though individuals misplaced round 15% of their physique weight on common and one-third misplaced 20% of their body weight, half misplaced lower than 15%. Which means that semaglutide can’t assure a certain amount of weight reduction, which can range from individual to individual. One other limitation of the research was that 75% of the individuals had been feminine. Future analysis might want to examine if gender impacts semaglutide’s efficacy.
However, when semaglutide is authorised to be used within the UK, it might very nicely be a promising new remedy for managing weight problems – when mixed with wholesome life-style modifications.
John Blundell has up to now acquired analysis funding from Roche, Servier, Sanofi, Lilly, Merck,Nestle, Danone Glaxo, Abbott and Novo Nordisk. JB has served on Weight problems Advisory Committees or been a guide for Servier, Sanofi, Merck, Nestle. Danone, Abbott, and Novo Nordisk. JB is presently a scientific governor of the British Vitamin Basis and a member of the Scientific Advisory Board of Zoe World.