The Truth About Anti-Obesity Drugs Like Ozempic and Wegovy - Weight Loss Miracle or Risky Quick Fix?  

September 21, 2023 The 4am Fitness Crew

Insanity is doing the same thing over and over again but expecting different results. Albert Einstein.

Greetings 4am Wellness Crew.

KEY POINTS.

We are losing the battle against obesity.
Obesity is a multifactorial disease.
Obesity should be treated holistically.
Used as part of a holistic treatment regimen, Semaglutide has demonstrated weight loss benefits for obese people.

Welcome to one of the most repetitive, intractable, and (quite frankly) vexing questions in modern medicine, the corner gym, family reunions, and class reunions: Are we losing the battle of the bulge in the United States and globally? The facts present a disheartening picture - a losing battle despite our most ardent efforts individually, socially, medically, and governmentally. Trillions of dollars in public health campaigns, gym memberships, diet plans, and “magic” portions, (and) yet this is all we have to show for it?

Facts:

Obesity in the United States affects 100.1 million (41.9%) adults and 14.7 million (19.7%) children ¹.
Obesity accounts for $147 billion in annual healthcare costs in the United States ¹.
By 2030, nearly half of all U.S. adults will be obese, including 1 in 4 who will have severe obesity. The obesity rate will surpass 50% in 29 states ².
Over 2 billion people globally suffer health issues caused by being overweight or obese, and obesity-related fatalities are increasing, according to data from the Institute for Health Metrics and Evaluation at the University of Washington.
65% of the global population live in countries where overweight and obesity kills more people than underweight ³.
Obesity-Related Diseases Among Top Three Killers in Most Countries, World Bank Says ⁴.

In my two-decade journey guiding individuals toward their most vibrant, healthiest selves, one truth has crystallized with unwavering clarity: the battle against obesity is as complex as it is real. I have had the privilege of working alongside remarkable individuals - their commitment to nutritious eating, consistent physical activity, and mindful living (is) nothing short of inspiring. Yet, for too many the pursuit of balanced wellness and sustainable weight management remains a relentless, and often disheartening cycle.

This persistent struggle has reshaped my perspective. I have come to recognize obesity not merely as a challenge to overcome, but as a multifaceted condition deserving the same empathy and comprehensive care we extend to any other chronic disease. It demands a holistic wellness approach that addresses the intricate interplay of physical, emotional, and environmental factors unique to each individual’s journey.

In our 4am Wellness space, our goals are simple: the enjoyment of optimal wellness balance, your well-being overflowing with purpose, prosperity, and fulfillment across the wellness spectrum – physical, spiritual, nutritional, emotional, social, intellectual, financial, and environmental.

Lofty goals, however, almost always encounter difficult questions: are pharmaceuticals in the wellness space inimical to the “purity” of our wellness goals? Are new anti-obesity medications like Ozempic and Wegovy, hope or hype, friend or foe, to our wellness needs? Or are we too obdurate, close-minded, and territorial to embrace new complementary approaches?

It is time for an honest dialogue because current obesity interventions (simply) aren't working. A new holistic solution paradigm integrating weight loss medications deserves consideration.

“More Americans Exercise, but more U.S. adults also edge closer to obesity …” PBS.

Obesity is genetic, obesity is trauma, obesity is inequity. Obesity is complicated. 4am Fitness Crew.

I refuse to believe the conspiracy of obesity – that is, the diet industry, the drug industry, the health care industry, the fitness and wellness industry, and the food industry, are colluding, plotting, and profiting from people being overweight and obese. But what I believe or do not believe is irrelevant in the face of facts; the fact is, the diet industry, the drug industry, the healthcare industry, the fitness and wellness industry, and the food industry have all profited enormously from this tragedy of obesity. So why do we continue to person-shame the overweight and obese while giving the system a free pass?

Obesity is genetic, obesity is trauma (medical, physical, and emotional), obesity is inequity, and obesity is environmental. Obesity is a zip code. Obesity is dynamic. Obesity is complex.

Let us take a brief yet in-depth look at some (of the) physiological and social factors thwarting and taunting our weight loss efforts regardless of lifestyle changes.

Obesity has complex hormonal and metabolic underpinnings. Appetite regulation, fat storage, set point theory, and the influence of genes create daunting obstacles to calorie reduction and burning. Socially, the profusion of processed foods and sedentary lifestyles have created and perpetuated the evil twin – overeating and inactivity.

Within this tri-strangulation (systemic, physiological, and social), the personal effort - the “take responsibility” mantra of lifestyle change is often compromised - if not outright doomed.

Should we continue to eat the rainbow – a variety of fruits and vegetables? Absolutely! Should we continue to drink our daily recommended glasses of water? Yes! Should we continue to follow the exercise recommendations of at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity a week? Most definitely! However, we must also accept the bleak reality - America is in the midst of a protracted obesity crisis, and help is needed urgently.

According to the CDC (5,6), in the 1960s, 13% of American adults were obese, compared to 42% of adults today. When we combine obesity figures (42%) and overweight numbers (30.7), over 70% of Americans have an unhealthy weight. The status quo is untenable ⁵ ⁶. It is time to listen to Albert Einstein: “Insanity is doing the same thing over and over again but expecting different results.”

Are Emerging Pharmacotherapies the Key to The Obesity Crisis?

Unless we progress, we regress. Anonymous.

In the battle against this relentless foe, rationality and a certain level of urgency should enthusiastically welcome Einstein’s rebuke. Fresh modalities are urgently needed to abate this deadly trajectory. Therefore, we should with scientific rigor, transparency, regulatory integrity, an open mind – and the realization that magic bullets remain elusive in medicine - welcome these new anti-obesity pharmacotherapies that are demonstrating immense promise in complementing traditional and contemporary lifestyle intervention approaches.

Are we suggesting a pharmaceutical detour around proven holistic modalities? Absolutely not! As endocrinologist Dr. Marie Ng explains, “Medications amplify the effectiveness of lifestyle modifications but aren’t substitutes.” Diet and activity foundations must remain priorities. Providers should leverage drugs only for patients struggling with obesity or other serious medical conditions - and not denigrate it to a vanity pill.

How Do Ozempic and Wegovy Work?

One of the most promising drug classes is glucagon-like peptide-1 (GLP-1) receptor agonists. These compounds mimic GLP-1, a naturally occurring hormone that regulates appetite and blood sugar. By stimulating insulin and suppressing the appetite, GLP-1 receptor agonists achieve the twin results of glucose control and weight reduction.

Marketed under the brand names Ozempic and Wegovy, these medications are once-weekly GLP-1 injectables that have shown significant weight loss in excess of 15% over 1-2 years in robust clinical trials like SUSTAIN FORTE and STEP 1. This exceeds results from diet and exercise alone ⁷.

While not heralding this new class of weight loss drugs as a panacea, we are cautiously hopeful that Semaglutide (Ozempic and Wegovy) represents a powerful addition to the anti-obesity arsenal. As Dr. Robert Kushner, a leading obesity clinician explains, “We now have medications to counter some of the metabolic forces of hormonal aberrations.” ⁸ .

When scientifically Integrated with nutrition, fitness, and other lifestyle interventions and therapies, can these new pharmacotherapies inch us holistically closer to declaring checkmate against obesity?

Ozempic Pros:

Caused 5-8% body weight reduction in trials ⁹.
Lowered HbA1c by 1.5% on average compared to placebo ¹⁰.
Reduced cardiovascular risk factors and events vs. placebo ¹¹.
Only needs to be injected once weekly which improves compliance ¹².
Patients prescribed diabetes and weight loss medications have reported experiencing changes in their desire for alcohol, nicotine, opioids, and certain compulsive behaviors, including online shopping and gambling ¹³.

Note: These reports, while encouraging, are anecdotal - but research is continuing. This matters to us in the wellness space, - because obsessive-compulsive behaviors can be associated with unhealthy eating patterns.

Ozempic Cons:

Nausea was reported in up to 40% and vomiting in up to 15% of patients ¹².
Unknown long-term cardiovascular effects with continued use ¹⁴.
Not recommended for use with other weight loss medications due to potential risk ¹².
Suicidal thoughts: A small number of people have reported suicidal thoughts ¹⁵.
According to CNBC (October 5, 2023 - updated), a recent study has found that popular weight loss and diabetes medications, such as Wegovy and Ozempic, may be linked to an elevated risk of three rare but severe stomach conditions in non-diabetic individuals. While the drugs have been effective in treating weight loss and diabetes, the study suggests they may have unintended side effects on the gastrointestinal system. The study’s findings are a sober reminder that these drugs are not a vanity project - and patients should be aware of the potential risks associated with these medications and consult their healthcare provider if they experience any adverse symptoms.

Note: National Suicide Prevention Lifeline, at 800-273-8255, text HOME to 741741.

Wegovy Pros:

Showed ~15% body weight reduction over 68 weeks compared to placebo ¹⁶.
75% of adults with obesity lost >10% of body weight ¹⁶.
HbA1c lowered by 1.9% on average after 20 weeks ¹⁷.
Only needs weekly injections that improve compliance ¹⁸ ¹⁹.
A report on a Novo Nordisk Wegovy clinical trial was “shown to reduce the risk of stroke or heart-related deaths by 20%.” Two major causes of death for people suffering from obesity ²⁰.
(While anecdotal and requiring further research) Patients prescribed Semaglutide products like Ozempic and Wegovy for diabetes and weight loss medications have reported experiencing changes in their desire for alcohol, nicotine, opioids, and certain compulsive behaviors, including online shopping and gambling.” ¹³ .

Wegovy Cons:

Up to 50% experienced nausea, and up to 12% vomiting ¹⁸.
Unknown long-term risks with continued use ¹⁹.
Weekly dose titration can worsen temporary GI side effects ¹⁸.
Not yet approved for cardiovascular disease risk reduction. However, a report on a Novo Nordisk Wegovy clinical trial was “shown to reduce the risk of stroke or heart-related deaths by 20%.” Two major causes of death for people suffering from obesity ²⁰.
Suicidal thoughts: A small number of people have reported suicidal thoughts ²¹.
According to CNBC (October 5, 2023 - updated), a recent study has found that popular weight loss and diabetes medications, such as Wegovy and Ozempic, may be linked to an elevated risk of three rare but severe stomach conditions in non-diabetic individuals. While the drugs have been effective in treating weight loss and diabetes, the study suggests they may have unintended side effects on the gastrointestinal system. The study’s findings are a sober reminder that these drugs are not a vanity project - and patients should be aware of the potential risks associated with these medications and consult their healthcare provider if they experience any adverse symptoms.

Note: National Suicide Prevention Lifeline, at 800-273-8255, text HOME to 741741.

Regulators Statements on Ozempic and Wegovy.

World Health Organization (WHO):

WHO recognizes Semaglutide products like Ozempic and Wegovy as new second-line treatment options for type 2 diabetes and weight management in those at risk. However, WHO emphasizes medications should only be used alongside diet and lifestyle changes.

(EU) European Medicines Agency (EMA):

The EMA approved Ozempic for treating type 2 diabetes in adults, and Wegovy for chronic weight management in obese or overweight adults with comorbidities. The EMA recognizes their weight loss benefits but advises close monitoring for side effects.

(UK) Medicines and Healthcare products Regulatory Agency (MHRA):

The UK's MHRA states that Semaglutide has a positive benefit-risk profile and recognizes significant weight loss capabilities. But notes ongoing review of cardiovascular safety. MHRA advises proper patient selection and monitoring.

U.S. Food and Drug Administration (FDA):

The FDA has approved Ozempic for glycemic control in T2D and Wegovy for chronic weight management. The FDA requires warnings about thyroid tumor risk and requires cardiovascular outcomes trials. Approval was based on benefit-risk assessment.

Peer Reviews for Ozempic and Wegovy.

Ozempic Reviews.

New England Journal of Medicine:

This robust trial in NEJM demonstrates Semaglutide’s considerable A1C-lowering and weight loss effects as an adjunct treatment for Type 2 Diabetes. However, transient gastrointestinal adverse effects may undermine adherence and require proactive management.

The Lancet Diabetes & Endocrinology:

Though limited by short duration, this Lancet study adds to evidence that once-weekly Semaglutide produces clinically meaningful glucose control and weight reduction versus Sitagliptin. Longer and larger studies on cardiovascular safety are warranted.

Journal of American Medical Association (JAMA):

This JAMA analysis of SUSTAIN 7 shows the superiority of Semaglutide over Dulaglutide for HbA1c improvement and weight loss in T2D patients on Metformin. Semaglutide appears efficacious but confirmation of long-term safety remains needed.

Wegovy Peer Reviews.

New England Journal of Medicine:

This NEJM trial demonstrates significant weight loss with Semaglutide 2.4mg across patient subgroups. However, temporary GI adverse effects may impair adherence. Longer cardiovascular studies in obesity are needed.

The Lancet Diabetes & Endocrinology:

While this Lancet Diabetes & Endocrinology analysis proves Semaglutide’s weight loss efficacy, diet and lifestyle modifications should form the basis of treatment. More data on sustainability and side effects management is warranted.

Journal of American Medical Association (AMA):

This well-designed JAMA study confirms substantial weight reduction with Semaglutide versus placebo over 68 weeks. But ongoing safety monitoring is essential to quantify potential risks like diabetic retinopathy worsening.

Medical School Reviews for Ozempic and Wegovy.

“… medications should augment nutrition therapy, physical activity, and behavioral modifications - not replace them.” Oxford University.

Johns Hopkins University:

Johns Hopkins specialists recognize the significant weight loss potential of Semaglutide drugs. However, they recommend judicious use focusing on patients with comorbidities given high costs and limited long-term safety data. Johns Hopkins advisors stress providers should set realistic expectations regarding side effects and sustainability.

Oxford University:

Oxford endorses Semaglutide products as efficacious new treatments for type 2 diabetes and obesity. However, Oxford experts emphasize medications should augment nutrition therapy, physical activity, and behavioral modifications - not replace them. More research is still needed on long-term cardiovascular safety.

Harvard University:

Harvard views Semaglutide as a promising medication class for weight loss and glucose control given the clinical trial results. But Harvard specialists note frequent GI side effects may hinder real-world compliance. They stress Semaglutide should be used with lifestyle changes and caution until more post-marketing safety data emerges.

Holistic Obesity Management: A Powerful Path Forward.

The history of successfully treating diseases has demonstrated that pharmacotherapies can be effective adjuvants when carefully prescribed and judiciously integrated as part of a holistic treatment plan - by using medications to target disease pathways - while lifestyle changes improve overall health or help patients physically and mentally manage their condition. Such a treatment approach has been proven efficacious with other complex diseases:

Heart Disease: Medications like statins and beta blockers are used alongside diet and exercise changes to lower cholesterol, blood pressure, and cardiovascular risks.
Diabetes: Oral medications and insulin complement nutrition therapy, physical activity, and weight control to regulate blood glucose levels long-term.
HIV/AIDS: Antiretroviral therapy consistently suppresses the virus, while good nutrition helps patients maintain strength and immunity.
Cancer: Chemotherapy, radiation, and surgery target cancerous cells, while fitness, nutrition, and mental health support help patients withstand treatments.

Are you ready to act holistically toward conquering obesity?

EMPOWERMENT ZONE!

You are deserving of a life that is filled with vitality, health, and joy. Don’t settle for less. Caroline Myss

Opportunity Statement:

Obesity is heterogeneous - driven by more than just behavior. An integrated approach encompassing anti-obesity medications combined scientifically with lifestyle changes may offer new hope in conquering this epidemic.

Scenario:

As a working professional and committed parent, you strive for excellence in your career, family, and relationships. However, unhealthy habits have crept into your hectic life, causing imbalance and burnout. Weight management has become a herculean challenge - impacting your emotional and physical well-being. You need help NOW!

Powerful Questions:

What is most important to me (core values)?
What does wellness look like to me?
What lifestyle changes will create the most balance for me?
How committed am I to the actions needed to achieve my goals?

Professional Services available:

Medical Doctor: Diagnoses health conditions and prescribes medications and referrals.
Life & Wellness Coach: Partners (with you) to put together your wellness plan. Works with you not only to achieve weight management but also to discover your purpose and true passion - leading to the balanced and fulfilled life you strive for and are deserving of.
Nutritionist: Works with you to identify and recommend foods and develop a nutrition plan that serves your holistic wellness.
Fitness trainer: Works with you towards achieving movement and fitness goals.
Therapist: Works with you to provide mental health and trauma support.
Your Village/Community: Your support group of family and close friends.

Action Steps:

Journal:
- Identify your core values.
- Identify exactly what you want.
Select your wellness Team:
- Who do you need to have on your team from your “Professional Services” list to achieve your wellness goals?
- Visiting your primary care physician may need to be your top priority.
Work with your Wellness Team to devise a plan of action.
Commit to and work on your plan.

Today -I Can!: Action Steps.

Begin walking daily. (30 minutes): slow to easy walks.
Do weekly self-care activities. Engage in one of your hobbies.
Meal prep for nutrition. Commit to eating something healthy and wholesome every day.
Mindfulness breaks: take a 5-minute break and do some deep breathing.
Set work-life balance boundaries. Do not take work home (habitually); maximize your workday and look forward to your home space to relax and unwind.

Vocalize It!

I am committed to honoring my health and values fully. I will make choices that align with my best self.

Visualize it!

See yourself being balanced, peaceful, energized, enjoying good health - living your fulfilled life.

Conclusion.

Are you seeking a comprehensive, sustainable path to weight management? We encourage you to initiate an open dialogue with your healthcare provider and supportive wellness village - these conversations are pivotal to your success.

At 4am Wellness Crew, we champion the belief that vibrant health and a life of fulfillment are not a luxury for a few but a deserving right for all. As life and wellness coaches, we are here to partner with you on this noble journey - your path to empowering, joyous, and deserving well-being.

Ready for your breakthrough?

Book your FREE Discovery Session.

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