In short Article

Semaglutide for weight loss in obesity

As a consequence of the publication of a number of randomised studies, Semaglutide has recently received much publicity as a possible treatment of obesity. In the Netherlands, semaglutide had been authorised as a monotherapy for type 2 diabetes mellitus, when metformine is not suitable, or in addition to existing glucose-lowering medication. The recently published studies STEP 1, 3 and 4 have shown that semaglutide is able to induce a 10–15% weight loss, compared to placebo, in individuals who are overweight or obese but do not have type 2 diabetes mellitus. These studies did not, however, investigate whether the weight loss was associated with a favourable effect on relevant cardiovascular endpoints. This is one reason why the clinical relevance of the weight losses found in the studies remains unclear. In any case, it does appear that maintenance of the weight loss achieved will require semaglutide to be taken for life. Another disadvantage is the high price of semaglutide. Adverse effects are mostly gastro-intestinal in nature and their severity is mild to moderate. Premature termination of treatment due to adverse effects was rarely seen in the studies.

  • Subcutaneous administration of 0.5 to 1 mg semaglutide a week can induce improved glycaemic control, weight loss and possibly fewer cardiovascular complications in individuals  who are overweight or (morbidly) obese and have type 2 diabetes mellitus.
  • Subcutaneous administration of 2.4 mg semaglutide a week can induce an average weight loss of 10–15% in individuals who are overweight or (morbidly) obese and do not have type 2 diabetes.
  • Although achieving a normal weight in people who are overweight or (morbidly) obese is important to reduce the rate of overweight-related disorders, it remains unclear whether the weight loss induced by semaglutide is associated with long-term health gains.
  • On the basis of the available evidence, it seems likely that maintaining the weight loss achieved will require semaglutide to be taken for life.
  • In view of the major uncertainties about possible health gains, the probably very prolonged treatment and the high price, it is currently not advisable to use semaglutide in the treatment of overweight or (morbid) obesity.

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  • Rutger A. Middelburg