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Are weight loss drugs the future of fitness?

Image of a Semaglutide injection kit.

The inspiration for this blog was a panel discussion titled "Are weight loss drugs the future of health & fitness?" organised by UFIT in Singapore. The panel consisted of Dr Neil Forrest (GP), Stuart Bauld (Physiologist), Ellie Cheale (Dietician), and Kim Fisel (Psychotherapist).

Have you heard of Semaglutide or one of its counterparts, Wegovy or Ozempic? They are all weight-loss drugs and, in recent times, they've taken the market by storm.

The drug mimics a hormone called GLP-1 that is released by the small intestine in response to the presence of food. It helps to control appetite, blood sugar, and metabolism.

Semaglutide has proven to be effective in promoting weight loss in people with obesity, In clinical trials, overweight or obese participants who received Semaglutide lost an average of 15–20% of their body weight in 104 weeks. While individual results may vary, those results are remarkable.

The question then is not whether Semaglutide is effective, but rather if weight-loss drugs are the future of fitness. Why work hard in the gym and/or struggle with a diet when you can just pop a pill once a day or inject once a week?

Where did Semaglutide come from?

Semaglutide falls under a class of drugs used to treat type 2 diabetes. When food hits the stomach, the intestine releases GLP-1, which sends a signal to your body to make insulin and suppress your appetite. However, this state and satiety don't last long.

Over the years, GLP-1 has been mimicked into drugs, and Semaglutide is one of them. Its effect is relatively potent, it's 50% as effective as GLP-1, and it maintains the sensation of satiety for a longer period.

Its medical and (rising) cosmetic use

In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese (World Health Organization). Obesity has reached pandemic levels, necessitating medical interventions aimed at controlling its rapid spread.

Doctors are allowed to prescribe Semaglutide for weight loss. While the guidelines differ between countries, they generally recommend Semaglutide for use if a patient's BMI is >30 (or >27 with related medical conditions). For patients with a BMI outside a healthy range, there are significant health benefits associated with them getting a pharmacological "helping hand" with weight loss.

However, it's becoming more common for people to request Semaglutide for cosmetic purposes, even when their BMI is within a healthy range. And, honestly, who can blame them? Would you truthfully say no to a "magic pill" for weight loss?

The problem is that doctors don't prescribe Semaglutide to improve aesthetics, they prescribe it to improve patients' health and quality of life. So, healthy individuals may choose to seek the drug elsewhere, no doubt motivated by the glorification of its benefits on social media (similar to anabolic steroids, growth hormones, and fad diets).

Semaglutide's pros (weight loss and treating type 2 diabetes) and cons (decreased muscle mass, nausea, and elevated resting heart rate).

The side effects

Semaglutide is a relatively new drug, and there are still uncertainties about its safety. However, most side effects are manageable if dosed correctly, which emphasises the importance of getting it from a doctor.

Nonetheless, it carries more risks than simply living a healthier lifestyle and, when it comes to cosmetic use, the risks commonly outweigh the benefits. Using Semaglutide can lead to a decrease in muscle mass, chronic nausea, elevated resting heart rate, and in rare cases, pancreatitis. There's also a significant rebound effect, meaning that if you start using it, you may be tempted to stay on it for a long period.

When should it be used?

Semaglutide is a useful tool for people with a high BMI who have exhausted all other weight loss options. It can help them lose a significant amount of weight and kickstart their weight-loss journey. I also think it's beneficial when you look at it from a mental health perspective. It may help those struggling with depression caused by weight gain, but it's tricky when there are people with body dysmorphia who may seek the drug for less helpful reasons.

However, Semaglutide should not be used for cosmetic purposes, it's not a long-term or permanent solution. Individuals with a BMI within a healthy range are better off pursuing a holistic approach to health, including a better diet, increased activity, and, if necessary, mental health support.

The bottom line (a blended approach)

Regardless of what I've said in this blog, there will be individuals who will pursue the use of Semaglutide and for them, I recommend a blended approach to weight loss.

Using Semaglutide for a short period can be effective but don't plan to be on it for a long period. Use the drug together with healthier habits and behaviours to facilitate and maintain weight loss. Consider seeking out the extrinsic motivation of a personal trainer, the guidance of a registered dietician, or the support of a psychotherapist. Perhaps most importantly, work with a doctor to determine the best course of action to transition off the drug correctly.

Ultimately, living a healthier lifestyle that is sustainable should be your goal, not relying on a drug with side effects as well as a hefty price tag (~$420 per weekly injection pen).

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