Five questions about weight loss medications answered by Radboudumc Ozempic/Wegovy and Mounjaro: miracle drug or disguise?

17 October 2024

There’s a worldwide surge in demand for the weight-loss drug semaglutide, known by the brand names Ozempic/Wegovy, with an active illegal trade surrounding it. In early November, a new drug, Mounjaro, will hit the market, which has proven even more effective against obesity. Is this a positive development? 'These drugs can help with obesity, but we must be cautious not to view them as a miracle cure without addressing the underlying problems.'

Which medications work against obesity?

Semaglutide has recently garnered much media attention. Developed by the Danish company Novo Nordisk, it was initially intended for people with type 2 diabetes and marketed under the name Ozempic. It increases insulin production, thereby lowering blood sugar levels. It quickly became clear that it also aids in weight loss by reducing appetite and promoting a feeling of fullness. For this reason, semaglutide was also introduced as a weight-loss drug under the name Wegovy.

A large study showed that individuals with obesity using semaglutide, combined with lifestyle changes, lost an average of fifteen percent of their body weight in 18 months. Besides aiding weight loss, it also reduces the risk of cardiovascular diseases. Prior to semaglutide, other weight-loss medications like liraglutide and naltrexone/bupropion were available, though none were as effective as semaglutide.

However, even more effective medications are in development. In early November, Eli Lilly will introduce tirzepatide (Mounjaro), and retatrutide will follow later. These medications, when combined with lifestyle changes, lead to even greater weight loss. In the Netherlands, semaglutide, tirzepatide, and retatrutide are not covered by insurance for weight loss.

What are the side effects of these weight-loss drugs?

Rick Meijer, internal medicine specialist at Radboudumc specializing in diabetes, notes that up to half of diabetes patients stop using weight-loss medications within a year due to side effects: 'The main complaint is nausea, sometimes accompanied by vomiting. Additionally, patients often report diarrhea, constipation, stomach pain, headaches, and fatigue.' A study published in The Lancet showed that eighty percent of participants using semaglutide for obesity experienced side effects like gastrointestinal issues. Little is known about the long-term side effects.
A frequently mentioned complaint online is a wrinkled face, known as the 'Ozempic Face'. According to Meijer, this results from the reduction in body fat: 'There’s no change in the skin itself, but when subcutaneous fat decreases, wrinkles become more visible.'

Do weight-loss drugs make it easier to get pregnant?

Yes, it's possible. 'Obesity can disrupt the menstrual cycle, reducing the chances of pregnancy', says Annemiek Nap, gynaecologist and professor of Reproductive Medicine. 'When you lose weight, the cycle can normalize, increasing the likelihood of pregnancy. Therefore, we advise people with obesity and a desire to conceive to lose weight. They can work with a dietitian or doctor to find the best method. If weight-loss drugs can help, their use may be considered.'

Additionally, weight-loss drugs may affect the effectiveness of birth control pills. Nap explains: 'There are indications that the pill may be less effective when combined with weight-loss drugs. However, current studies are inconclusive, and more research is needed. Until then, caution is advised when combining contraception with weight-loss medications.'

Are weight-loss medications the solution for everyone with obesity?

'No', says Tijn Kool, professor of Appropriate Care. 'It’s positive that these innovations exist and are available, but we shouldn't treat these weight-loss drugs as a miracle cure without addressing the underlying problems. The first and most important strategy for weight loss remains lifestyle changes. If that doesn’t work, medications can be considered, but only alongside efforts to address lifestyle factors. An unhealthy lifestyle affects far more than just body weight.'

Additionally, stopping these medications often leads to weight regain, a phenomenon known as the yo-yo effect. Obesity disrupts the body’s appetite regulation system, causing the body to revert to a higher weight. When the medication is stopped, appetite returns, leading to weight gain. For sustained weight loss, people may need to continue using these drugs long-term, although little is known about the long-term effects.

Cost and availability are also issues. Semaglutide costs around 3,000 euros per person per year. If many people start using it, this will significantly increase short-term healthcare costs. The long-term effects on healthcare costs are still unknown. Additionally, the increased demand for this medication is threatening its availability for diabetes patients, for whom it was originally developed.

The use of these medications should be carefully considered. Kool emphasizes: 'We need thorough research on the consequences of these drugs, including their long-term effects. It’s important that people are clearly informed so they can make an informed decision. At the same time, a societal discussion on this topic is needed.'

What can be done about obesity?

An unhealthy lifestyle is the most common cause of obesity, though social, psychological, hormonal, or medical factors may also play a role. The most effective approach to obesity is lifestyle change. This involves healthier eating, more physical activity, better sleep, and reducing stress. Lifestyle changes are most effective when guided by a coach. If there is insufficient progress after a year, weight-loss medications may be considered for additional support.

Tijn Kool advocates for stronger government intervention in both healthcare and prevention: 'Unhealthy food is abundant, and it's heavily advertised. That needs to change. We need an active government that encourages supermarkets to offer healthy products at low prices. The government can also help raise awareness of the importance of healthy eating and living—not just for physical appearance, but for overall well-being.'

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