Semaglutide, the molecule that causes discussion

This article is published in number 11 of Vanity Fair on newsstands until March 14, 2023

At the beginning of October 2022, on Twitter I read that Elon Musk has publicly revealed that he has lost weight thanks to a new drug for obesity. The richest man in the world, founder of Tesla, answers those who ask him what his secret is for such a dazzling shape and quotes, surprisingly, Wegovya medicine recently launched in the United States based on semaglutide, an innovative molecule capable of controlling the appetite stimulus and the sense of satiety.

From the tweet to the birth of a real trend, the step is short. On the echo of the results achieved by Musk, the idea that semaglutide could be the effective solution for those who want to lose weight begins to spread: people start asking their doctor, the question grows more and more, someone, alternatively, starts to be prescribed Ozempica drug with the same active ingredient as Wegovy, but indicated for the treatment of type 2 diabetes. Seized by “aesthetic needs”, various personalities from the world of entertainment and the fashion system also begin to use off label, i.e. different from the prescribed indications, of products such as Ozempic. There is even a rumor that too Kim Kardashian tried it to lose weight in a short time and wear Marilyn Monroe’s dress at the last Met Gala, although she has never commented on it.

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In a short time, Wegovy And Ozempic appear as the two new reference points for those who want to lose weight. They are presented in injectable solutions to be administered upon medical prescription. Wegovy is in a 2.4 mg dose, approved for people with obesity, a body mass index above 30 or above 27 and at least one related disease (dysglycemia, hypertension, dyslipidemia, obstructive sleep apnea or cardiovascular disease), Ozempic is given in doses of 1 mg to type 2 diabetics.

It produces both Novo Nordisk, a Danish pharmaceutical company famous for its studies and campaigns against obesity. In the light of the interest born around this class of drugs, after Musk’s revelation I want to better understand how they work, what the possible side effects are and if the use of semaglutide is really advisable off label, simply to lose a few pounds. But the company is reluctant to talk and provide any kind of response. Meanwhile, videos of girls injecting themselves with semaglutide to fight against being overweight appear on the TikTok social network in Australia and the United States, generating the trendy hashtag #ozempicweightloss. At the same time, the medical-scientific environment began to be alarmed: due to excessive requests, the drug Ozempic – important for the treatment of diabetic patients – began to be scarce everywhere. Months go by and the situation evolves. Today, it is one of the hottest topics in the United States and even the main international newspapers are starting to present the “Ozempic case”, which seems to have conquered Hollywood and its surroundings, as it stands out on the cover of the latest issue of New York Magazine. I do new research and ask the specialists. I discover that Wegovy is expected to arrive in Italy by 2023 and that in the meantime, to remedy the shortcomings of Ozempic, the National Health System is guaranteeing the use of the drug exclusively for diabetic patients. Contact the president ofEndocrinologists Association Renato Cozzi and it confirms to me that, in the face of the results, here too there is a favorable attitude towards use off label for cases of obesity and overweight with pathologies.
The possible side effects of semaglutide medicines are transient and mainly gastrointestinal in nature. They understand mild to moderate nausea and vomiting but they can be managed by starting treatment with low doses, to allow the body to get used to the drug. An important question remains: what risks would emerge if someone with a body mass index of less than 27 – and therefore outside the prescribed indications – decided to indirectly obtain one of these drugs to use it purely for aesthetic purposes? “Substantially nothing, they are very safe drugs and their use has fairly low risks,” replies the professor Luke Busettopresident of the Italian Obesity Society. «However it is conceptually wrong, because these drugs have been designed, tested and produced for long-term use on patients with important weight problems. Moreover, in a situation of worldwide shortage of products, taking them for aesthetic purposes can represent a further problem. If you then think of finding a solution to excess weight by using the drug for only a few months, this will not happen, because in the end the kilos will recover. It’s the concept of short-term therapy that doesn’t hold up.”

A further scenario arises when a parallel phenomenon to the one unleashed by Ozempic emerges on TikTok Italia. In this case there is Saxenda, another treatment indicated for type 2 diabetes and obesity, based however on liraglutide, a molecule similar to semaglutide but with a shorter duration of action. From comparative studies, explains Busetto, “with liraglutide there was an average weight loss of 8% while with semaglutide the decrease was 16%”. The specialist adds that the mechanism by which they act on the central nervous system is also different: «Liraglutide seems to work almost exclusively on the hypothalamic part of the sense of satiety, while semaglutide would also act on the areas of the limbic system, those which control pleasure and are related to addictions.

So what can happen in the mind and body of a person who, despite not having the specific requirements of being overweight, decides to inject himself with one of these drugs? I find a testimony. «In the United States, at dinner with some celebrities, I discovered that many people use these drugs to lose weight», Eva tells me (the name is fictitious), a thirty-year-old entertainment professional who injects small doses of Saxenda. In Italy this category of drugs can only be prescribed by a doctor, but «I wanted to try it too and thanks to a friendship I managed to buy it», she says. “Before taking it, I did a lot of research, but I know I made a risky choice.” Every day, Eva injects herself with the minimum starting dose of 0.6 mg, which she has chosen not to increase. «The first few days I had so much nausea and vomiting that the thought of food didn’t even cross my mind. I even had to force myself to drink », she says. «The first month you lose weight because you eat very little, you feel full. Then, little by little, you regain the sense of hunger. In truth, I have always been a slave to food and this drug has allowed me to have more control over myself. In 5 months, Eva lost 8 kilos. But she, to tell her about her, is not a result to be encouraged: «When my sister asked me to help her get the drug, I didn’t feel like it. I don’t know what I’m doing to my body.” In fact, there are no studies on the short- and long-term effects on people outside the populations for which these drugs were designed. “Now I’m afraid that stopping using it will mean gaining all the weight back,” continues Eva. «I know that you can increase the gym, adopt a balanced diet, but I hope I have enough willpower. Lately I’ve started injecting the drug every other day and I’ve felt the sense of hunger come back. This thing scares me.”

There are those who argue that the phenomenon should also be investigated from a psychological point of view: “There is an important aspect that should not be underestimated: how and why we eat”, explains the psychologist and researcher Emanuel Mian, among the leading experts in Italy of disorders related to body dysmorphia. “Often there is also a problem of eating disorders and specific habits: if one does not intervene in this sense, after a slimming the weight will recover”, he clarifies, also underlining the importance of including psychological evaluations also in medical programs with intervention pharmacological. «The ideal would be to have a multidisciplinary approach with more professionals», Mian points out. «It will allow each patient with weight problems to feel safe in his path and followed in a controlled context from all points of view».

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