The weight-loss drug Wegovy, made by Novo Nordisk (which also makes Ozempic) became available in Canada in early May 2024.
While Ozempic treats both Type 2 diabetes and weight loss, Wegovy is prescribed only for weight loss. It contains a higher dose of semaglutide, a synthetic hormone that helps regulate blood sugars and makes a person feel full.
Health Canada’s approval of Wegovy indicates it is to be used for obese people with a body mass index (BMI) of 30, or overweight people with a BMI of 27 or higher who also have a chronic health condition like diabetes or hypertension.
While it may seem like a magic weight-loss bullet, Wegovy, like Ozempic, does cause side effects, mostly gastrointestinal ones like nausea, diarrhea, vomiting and others. It is also expensive, costing an estimated $4726 per patient per year, according to the Canadian Journal of Health Technologies.
With the addition of another weight-loss drug to the Canadian marketplace, we thought it would be a good time to revisit this story written by St. Paul’s Hospital dietitian Dani Renouf last year.
The relationship between being overweight and developing chronic disease has been repeatedly emphasized in both scientific literature and popular diet culture. The main premise from both groups is “lose weight, gain health”. In other words, a lower body weight results in better health outcomes.
Cue semaglutide – perhaps better known by its two brand names: “Ozempic” (for diabetes management) or “Wegovy” (for weight loss).
Semaglutide, when injected once a week can help with five-per-cent weight loss or more when coupled with lifestyle interventions, according a 2021 study in the New England Journal of Medicine. How long the weight loss lasts is not clear, but it happens effectively and efficiently.
Not only is semaglutide being prescribed as a weight-loss option, it appears that it is also being used for that purpose by celebrities. In a recent issue of Vogue magazine, one article had a plastic surgeon offering recommendations on corrective surgery for what is referred to as “Ozempic Face”, whereby dramatic weight loss leads to loss of facial fat pads, resulting in more visible wrinkles and skin sagging.
Intended Use and Unfortunate Side Effects
Semaglutide wasn’t originally intended for weight loss. It was designed to help those with diabetes manage their blood sugar levels. The drug works by slowing down the movement of food through the stomach and promoting the release of insulin from the pancreas. In a nutshell: when more insulin is released, glucose in the blood is more effectively stored where it belongs, inside the body’s cells. An unanticipated side effect is that semaglutide seemed to also lower body weight, so its use as a weight-loss injectable took off.
So if someone does not have diabetes and is instead taking semaglutide for weight loss, this puts a higher strain on the pancreas to pump out insulin beyond its natural capacity. This injectable also comes with some unfortunate side effects including nausea, vomiting and diarrhea, and even organ disease.
Your Weight Is Not Your Worth
As a dietitian, I can appreciate that supporting clients in healthy weight loss is important. However, our discipline focuses more on the quality of nutrition, overall wellbeing and other health metrics than the number of kilograms lost over time. We emphasize that “your weight is not your worth.” We know that pushing weight loss as the primary goal can result in harmful and disordered eating behaviours, increased weight preoccupation, and impacts on mood, overall quality of life and self-confidence in those living in larger bodies.
What we don’t know is what happens when semaglutide is stopped. Will the weight come back? If five-per-cent weight loss is beneficial for health outcomes, could it be healthfully achieved through lifestyle alone, without the use of a drug to expedite the process? How long should patients remain on a drug to sustain weight loss and during this time, are they at risk for other diseases?
At this point, there are more questions than answers when it comes to semaglutide for weight loss. We need to not just consider the short-term goal of weight loss but really understand the long-term consequences of this dieting strategy.
And all weight loss strategies require support of the underlying cause for weight gain. That requires a multi-disciplinary approach that includes counseling and nutrition support from a dietitian.
Story by Dani Renouf, Registered Dietitian at St. Paul’s Hospital
