Weight loss injectables – the cons outweigh the pros

Author

Limbo Team

Date

February 07, 2023

Author

Limbo Team

Date

Feb 07, 2023

NOTE: Limbo does not sell medications, and has no connection to any of the manufacturers. This is provided for information only, not as medical advice. For any medical questions, please talk to your doctor.

By now you’ve likely seen many stories about the latest “celebrity weight loss drugs,” used by people like Elon Musk (officially) and stars like Khloe Kardashian (allegedly). The new drugs are injectables: you take a shot via an injection pen, usually once per week.

They're in a new drug category called GLP-1 agonists — they mimic the hormone GLP-1 in the body — which is key in signalling hunger: higher levels in the body mean less hunger, slower stomach emptying, and other effects that aid weight loss. They were first approved to treat obesity by the US FDA and European Medicines Agency in late 2014 and 2015, respectively.

Given the hype, you’re probably asking, do weight loss injectables work? What should I expect from them? What are the downsides and risks?

First, here is an overview of the pros and the cons:

Just because famous stars do something doesn't mean you should as well.

Beginning with the pros, medications are relatively effective, more so than older obesity medications and much better than the traditional and unhelpful “just diet and exercise” mantras. At the highest doses of semaglutide, taken over a one year period, weight loss of 13.8%^ was reported, versus 2.3% for the placebo group.

The drugs work by mimicking the GLP-1 hormone in the body, acting in multiple areas, including the stomach and the brain, to slow down digestion and to make you feel fuller, for longer, more of the time. The end result is a lower interest in eating, less food consumed over time, and an energy deficit where the body uses fat stores for fuel.

While 13.8% is significant, it's less than expected with a data-driven system like Limbo — with expected weight loss of over 20% in a year.

Adverse effects

In addition, research studies have not, to date, found serious complications connected to the GLP-1 agonists class of weight loss drugs. They were first developed for diabetics, and have been used in that context for years, among large populations. A metastudy published in the Journal of Pediatrics^^ found them to be generally safe, apart from a range of side effects that many may find unpleasant, and earlier fears of increased risk of pancreatitis to be unfounded.

Non-surgical

Another positive is that people classed as severely obese, that is, with a 35.0 or greater BMI, and who have been considering bariatric surgical solutions to obesity — gastric bypass, gastric band and the like — may perhaps avoid invasive surgery, which is inherently risky. While the risk profile has improved for surgery, invasive procedures are better avoided if possible.

For people who have struggled for a long time to reduce weight, any system that supports them in a journey toward a 13.8% reduction is worth considering. As a new option for most in this population, who have typically tried many approaches — dieting, calorie-counting, meal plans, exercise, and so on — it is a net positive when any innovative and safe approach becomes available.

Costs

While it varies from country to country, depending on retail prices and insurance subsidies, the cost is generally extremely high. And while some insurance companies and health services, including the NHS, may pay for it, under some circumstances, the GLP-1 meds will further increase medical costs, and stretch our already overtaxed health systems.

The cost of Ozempic, bought online from a reputable provider, is upwards of £750/€850 per month, for four injections, self-administered, on a weekly basis. Saxenda — a daily injection — costs even more: around £35/€40 per day, or over £1000 per month. The official price tag for the Wegovy drug, on Novo Nordisk’s website is $1349.02

Wegovy list price is $1349.02

The cost of Wegovy – per month – is $1349.02, at list price. (Don't forget those 2 cents.)

Weight returns after stopping

This high price is even more of an issue given that these medications have to be taken indefinitely. When the injections stop, so does the efficacy. In the key study, published in the Journal of the American Medical Association, a group of people took semaglutide for 20 weeks, losing around 10% of body weight on average. Part of the group then stopped injections, while the others continued. In the 48 weeks that followed, people who continued lost a further 7.9%, but the others regained 6.9% — the majority of the weight.

This is very troubling – instead of a "treatment" for obesity, it looks more like a lifetime subscription to expensive medication.

Post-GLP-1 weight regained

Most weight regained after stopping injections, one year in, and trajectory still going upwards.

Disempowering, not insightful

You dont need to have self control

"You don't need to have too much self-control" is the key issue.

Because GLP-1 meds are a ‘brute force’ approach that ‘override the system’ of satiety and food choices, they cover up problems instead of addressing them, a bit like “patching a wall when the foundation is rotting”.

This is not only short-termist and very expensive, it’s also disempowering. The fundamental Big Pharma message is “don’t worry about the causes of obesity, and your role in it — just pay your money, take the meds, and trust us.” There’s no education about food and the body, no illumination of what causes obesity or weight loss, no enhanced understanding. And weight loss without understanding always leads to regain, as nothing has changed in the person’s behaviour around food. Same behaviours, same end result.

Beyond even that, some people (and this is anecdotal) report gaining back more weight than they lost. It’s early to say, but one possible explanation: building up months of desire to eat enjoyable foods, and suddenly finding (after stopping injections) that they are no longer nauseating.

To understand the importance of a feedback loop and behavioural change, see the Limbo loop.

Side effects

The other notable downsides are side effects, including nausea, vomiting, diarrhoea and constipation, with some reporting feeling weak or tired, dizziness, and insomnia. Injection site reactions such as bruising, pain or a rash are occasionally reported. Some people, including Musk, report “rotten egg burps.” On a personal level, many people are averse to needles, so self-injecting can be a challenge.

Long-term questions and concerns

Finally, and very important, the long term effects are still in question, as these are relatively new drugs. As Dr Gareth Nye at Chester Medical School says, “The response to blood sugar is one aspect of hundreds that work together like an orchestra in the body. Taking Ozempic disrupts not only one feedback loop, but hundreds.”

It can facilitate changes in intestinal health, impact the body’s ability to absorb nutrients, and cause inflammation in the pancreas or gall stones. It also affects the subtle interplay of nerves — vagal activities, dopamine response — and the body’s ability to regulate satiation. Finally, there are some major “unknown unknowns” as we have no long term studies on pleiotrophic effects down the gut, and many other potential issues that may appear later — when millions of people have already been injected.

Conclusion

With the media attention and a spate of celebrity endorsements (Kevin Kline! Queen Latifah!), we’re seeing a major assault by pharma companies to medicalise obesity as a ‘chronic disease’ that can only be addressed by medication in perpetuity. But there are serious downsides to consider, especially the high risk of the “yo-yo effect” reverting to prior body weight after stopping the injections.