FDA approves game-changing weight-loss drug semaglutide

Game changer," but not a "magic pill

Although Garvey calls the approval of semaglutide for weight loss a "game changer," he warns that its use is not a quick and easy solution. "It helps patients stick to a reduced-calorie diet; it's not a magic pill. You still have to pay attention to lifestyle choices and maintain physical activity," he says. What it does do is make it much easier to stick to the diet and exercise needed to lose weight, which can otherwise be extremely difficult for overweight and obese people."

"It's not their fault," Garvey says. "The mechanism of the disease [obesity] makes them feel more hungry," so even if they manage to lose weight, they usually gain it back.

To avoid side effects, slowly increase the dosage

According to Kirby, the side effects of semaglutide are usually mild, although many newcomers experience gastrointestinal problems such as nausea. Some also experience diarrhea, vomiting, constipation, or abdominal pain. To avoid or mitigate such problems, anyone starting semaglutide should start at a lower dose and slowly bring it up to 2.4 mg.

Semaglutide contains a warning that it is associated with medullary thyroid cancer, but this adverse effect has only been reported in animal studies (not in humans). Nevertheless, anyone with a history of this rare thyroid cancer should avoid taking the drug. People who have the rare disease multiple endocrine neoplasia syndrome type 2 (MEN2) should also avoid taking this drug, as should those with pancreatitis or gallbladder disease.

Adults of any age can use semaglutide, but older adults should definitely consult their doctor before embarking on any weight-loss efforts, Garvey warns. The reason: If you already have thinning bones (osteopenia or osteoporosis) or significant loss of muscle mass, losing weight can exacerbate these problems-especially if you don't incorporate adequate aerobic and strength training into your regime.

And now the bad news: the current cost of the drug

For most people, the biggest disadvantage of using semaglutide for weight loss will probably be the cost. Medicare currently doesn't cover obesity drugs, and most private health insurance plans don't cover them either. "It's interesting because Medicare will cover bariatric surgery," Kirby says. "Right now, patients who want to take a weight-loss drug like Wegovy are likely to pay $1,200 to $1,300 a month out of pocket for as long as they need it (probably the rest of their lives).

Kirby and other obesity experts hope to make a difference by supporting the Obesity Treatment and Reduction Act. "It would provide Medicare coverage for overweight and obesity drugs, which would likely lead to better coverage in the commercial marketplace," she notes.

"We know that being overweight and obese can worsen more than 200 diseases, including joint disease, heart disease and many cancers," Kirby says. "I see patients who have struggled with their weight for a long time and have been told repeatedly, 'All you have to do is eat less and exercise.' But these measures [by themselves] produce only modest results for most patients. The rest really need more help."

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