This article appeared in the January / February 2022 issue of To discover magazine. Become a subscriber for unlimited access to our archives.

Obesity is a modern scourge, affecting 42 percent of Americans and increasing the overall risk of cardiovascular disease, diabetes and cancer. It is also notoriously difficult to control; for most people, diet and exercise only offer temporary results, even when combined with medication. Gastric bypass and similar procedures – although more effective – themselves carry significant health risks. In June, however, the United States Food and Drug Administration approved a treatment that could transform that prospect for millions of people.

Semaglutide, a synthetic version of a gut hormone called glucagon-like peptide-1 (GLP-1), increases insulin production and adjusts metabolic parameters in the brain, helping to regulate appetite rather than suppressing it. Developed by Danish company Novo Nordisk, the drug has been used since 2017 to treat type 2 diabetes. Subsequent clinical trials, however, have shown that higher doses (combined with a low-calorie diet and exercise) could help shed fat at double or triple the rate of existing weight loss drugs.

In a 68-week study of nearly 2,000 patients, those who received weekly injections of semaglutide lost an average of 15% of their body weight, or about 34 pounds. More than a third lose 20% or more, which is comparable to weight loss surgery. Side effects, mainly gastrointestinal, were generally mild and transient.

“In the past, weight loss drugs weren’t very effective,” says endocrinologist Clifford Rosen, senior scientist at the Maine Medical Center Research Institute. Stimulants reduce appetite but can trigger insomnia or cardiac events. Drugs that block the absorption of fat can lead to bowel problems. Those that alter neurotransmitters can cause fatigue and dizziness.

Many experts have hailed the FDA’s approval of high-dose semaglutide, marketed as Wegovy, as the dawn of a new era in the treatment of obesity. This not only reflects the apparent safety of the drug, but also its ability to maintain weight in the long term.

“We’re not seeing that rebound effect, which is really encouraging,” says Rosen.

The cost of Wegovy is less encouraging: over $ 1,200 per month. Sounds inexpensive compared to the $ 147 billion spent annually on obesity-related medical bills in the United States, but it is a hefty expense for the average consumer. And, like other weight loss drugs, the drug is currently not covered by Medicare or most private insurers.

“There is nothing more devastating than having to tell a patient, ‘I have nothing else for you,’ says Jennifer L. Kirby, associate professor of endocrinology and metabolism at the Faculty of Medicine. medicine from the University of Virginia, which supports legislation to change reimbursement rules. “This is a huge and untapped way to improve the health of our country and the world. “