Is Semaglutide, the Antidiabetic Drug, Really a 'Weight-Loss Wonder'? Key Facts and Product Information

In China, semaglutide has been approved for the treatment of adult type 2 diabetes and for reducing the risk of cardiovascular adverse events in patients with type 2 diabetes and cardiovascular disease; however, its weight loss indication has not yet been approved. In addition, there are many adverse reactions and contraindications associated with the use of semaglutide. Patients need to obtain the drug through official hospital channels and use it under the guidance of a doctor. Whether in China or abroad, there are many precautions and restrictions on the use of semaglutide, and it is not a "weight loss miracle drug" that everyone can use.

◎Trainee Reporter Shen Wei

As summer approaches, weight loss is on the minds of many beauty-conscious individuals, with numerous people sharing various weight loss methods on social media, such as exercising, dieting, and eating low-fat meals. Recently, some netizens shared a so-called "weight loss miracle" they purchased online, which reportedly requires no dieting or exercise and helps users "lose 16 pounds after one injection." It was revealed that this "weight loss miracle" is called "semaglutide injection," a prescription drug used to treat type 2 diabetes.

Can Semaglutide be used for weight loss? Can people with weight loss needs buy related products online by themselves? With these questions, the reporter of Science and Technology Daily interviewed relevant experts.

Effectively control blood sugar and improve multiple cardiovascular metabolic indicators

Semaglutide is a new type of long-acting glucagon-like peptide-1 (GLP-1) analog, which not only enhances insulin secretion but also effectively inhibits glucagon secretion, thereby reducing blood sugar. In addition to effective blood sugar control, semaglutide can also improve multiple cardiovascular metabolic indicators, providing better comprehensive control of various cardiovascular risk factors including blood pressure, blood lipids, and weight.

In fact, semaglutide was first widely known as a "once-a-week" hypoglycemic drug.

As early as December 2017, semaglutide was approved by the U.S. Food and Drug Administration (FDA) for glycemic control in adult patients with type 2 diabetes; in January 2020, the FDA again approved semaglutide to reduce related disease risks in adult patients with type 2 diabetes who also have cardiovascular disease; in June 2021, the drug was approved in the United States for long-term weight management. The FDA has approved semaglutide for use in adult patients with a body mass index (BMI) of 30 or higher, as well as overweight adults (BMI of 27 or higher) with at least one weight-related condition such as hypertension, type 2 diabetes, or high cholesterol.

"Semaglutide does have a certain effect on weight loss. On one hand, it suppresses the feeding center in the hypothalamus, making people feel less hungry and reducing their appetite; on the other hand, it acts on the gastrointestinal tract, delaying gastric emptying and increasing the feeling of fullness." Dr. Fang Hongjuan, Deputy Chief Physician of the Endocrinology Department at Beijing Tiantan Hospital, told reporters that semaglutide essentially works by suppressing the patient's appetite, making them feel full after eating a small amount and uncomfortable if they eat too much, thereby reducing calorie intake and achieving weight loss.

In China, the weight loss indication for semaglutide has not yet been approved.

In April 2021, semaglutide was approved in China for the treatment of adult type 2 diabetes and to reduce the risk of cardiovascular adverse events in patients with type 2 diabetes and cardiovascular disease; in December of the same year, the drug was included in the national medical insurance, reducing the burden on diabetes patients.

Professor Houdé Zhou, Deputy Director of the National Clinical Research Center for Metabolic Diseases at Xiangya Second Hospital of Central South University, introduced: "Although semaglutide can currently be used for lowering blood sugar in some European and American countries, it can also be used for weight loss in patients with severe obesity or obesity-related complications. However, in China, the weight loss indication for semaglutide has not yet been approved." Moreover, semaglutide is a prescription drug that needs to be managed strictly according to the current national regulations for prescription drugs. Patients need to obtain the drug through official hospital channels and use it under the guidance of a doctor.

"Currently, the approved dosage of semaglutide in China is 1.0 mg, which is used for treating type 2 diabetes and differs from the dosage required for physiological weight loss," said Ji Lirong, Director of the Endocrinology Department at Peking University People's Hospital. The off-label use of semaglutide injections in clinical practice requires hospital approval, doctor-prescribed guidance, and follow-up. Purchasing medication online or through third parties may pose significant risks. In addition to the potential dangers of blindly using the drug, quality changes that may occur during transportation and storage are equally concerning. Illegal 'weight loss' injectables entering the market, if not stored under strict conditions, could not only reduce effectiveness but also exacerbate side effects, causing harm to the body.

Whether in China or abroad, the use of semaglutide comes with many precautions and conditions, and it is not a "weight-loss miracle drug" suitable for everyone. For instance, individuals with a history of medullary thyroid carcinoma, acute pancreatitis, or multiple endocrine neoplasia, as well as those with very high blood lipids who are heavy drinkers, people with type 1 diabetes, and pregnant women, are either not allowed or are temporarily not recommended to use semaglutide.

The use of Semaglutide also has many adverse reactions and contraindications. Zhou Houdé stated that the most significant adverse reaction after using Semaglutide is gastrointestinal reactions, including bloating, nausea, vomiting, diarrhea, etc. "Semaglutide also has many rare and severe side effects. Some studies have found that Semaglutide may exacerbate symptoms in patients with diabetic retinopathy and could also affect the gallbladder, leading to conditions such as cholecystitis and bile stasis in users," added Fang Hongjuan.

"In addition to physical discomfort, the mental health of semaglutide users may also be affected, such as the potential emergence of psychological issues like depression, anxiety, and bipolar disorder." Fang Hongjuan reminded.

Not only that, but a study published in April 2022 in the journal Diabetes, Obesity and Metabolism showed that after discontinuing medications like Wegovy and Ozempic (semaglutide), weight regain occurs, with two-thirds of the lost weight returning within a year.

Scientific Weight Loss Also Requires Cultivating a Healthy Lifestyle

In March 2023, the latest edition of the "World Obesity Map" report published by the World Obesity Federation revealed that the prevalence of overweight/obesity will increase from 38% in 2020 to 51% in 2035, with the number of people rising from 2.6 billion in 2020 to over 4 billion by 2035.

"In fact, no matter which drug is used for weight loss, lifestyle intervention must be combined. Therefore, weight loss requires setting long-term goals, combining diet control with exercise; lifestyle intervention will always be the best method for weight loss." Zhou Houde stated that drug-based weight loss should be scientifically and reasonably approached, requiring a precise diagnosis based on one’s obesity condition. Even when mandatory interventions such as medication or surgery are considered for weight loss, it is essential to first evaluate which drugs are suitable, and only after an accurate assessment should medications be taken under a doctor's guidance.

Fang Hongjuan also pointed out that semaglutide cannot replace diet and exercise, and long-term health management is still necessary to combat obesity. "For overweight and obese individuals, we certainly hope they can adopt a low-calorie diet, combined with exercise, to achieve balanced nutrition and energy equilibrium, forming a healthy lifestyle. However, at the beginning, when they are unable to control their diet through willpower alone, medication can be used as an aid for a period of time. Afterward, without the assistance of medication, many people may experience some weight regain due to difficulties in maintaining a healthy lifestyle. But if they can sustain a good lifestyle, they will benefit in the long term."

Fang Hongjuan emphasized that relying solely on medication for weight loss is not feasible, and ultimately, self-discipline is key. Lifestyle interventions are the most cost-effective approach. "Moreover, people should have a relatively healthy standard for body weight and avoid body image anxiety. Everyone’s body shape is different, so it’s not appropriate to judge based simply on BMI or personal perception," said Fang Hongjuan.