Last updated on January 8th, 2024 at 10:06 am
John R.H. Wilding et al. N Eng. J Med, 2021.
Review of Semaglutide weight loss drugs by Les Ruthven, Ph.D.
In this study 1961 adults, none with diabetes, were randomly assigned in a 2 to 1 ratio to 2.4 mg of once weekly Semaglutide or placebo injections plus “lifestyle” intervention for 68 weeks. The average weight loss from baseline to 68-weeks was -14.9% weight for the drug group and -2.4% weight loss for the placebo group; this translates to a net superiority of 12.4% weight loss in favor of the drug. Serious adverse effects were 9.8% vs. 6.4% for the placebo group.
On the positive side it has been generally accepted that even a 10 pound weight loss in an overweight/obese person will generate a decided improvement of health in the overweight person.
For the above positive effects of the drug injections for weight loss an important negative is the cost, which in one drug is $ 19, 200.00 yearly. In order to maintain the weight loss, however, the patient must continue the injections for the rest of their life! In one study one year after stopping the drug participants regained two-thirds of their prior weight loss including the prior cardio metabolic improvements!
In the Wielding study after 68-weeks of treatment the group average loss (net of the placebo loss) was 28 pounds but to maintain the loss patients must stay on the drug for the rest of their lives! To the investigators the findings confirm the chronicity of obesity and suggest ongoing treatment is required to maintain improvements in weight and health! However, is the chronicity due to the “disease” itself or is it due to ineffective treatment? We know the basic cause of overweight/obesity is eating more calories than one burns in one’s daily activity and the cure of the eating problem is to eat less. For 75 years or more the medical profession and the pharmaceutical industry have been addressing obesity by a host of drugs to manipulate brain chemistry (including the latest iteration) and the result has been in my mind a complete failure. For an average weight loss of approximately 28 pounds requiring lifetime treatment what are the Semaglutide side effects and costs.
Common side effects of these drugs are nausea, vomiting, diarrhea, abdominal pain or discomfort and constipation. Some serious side effects include inflammation of the pancreas and tumors in humans, of which the degree is unknown. Some patients have reported gallbladder disease, thyroid c cell tumors and kidney damage.
With regard to costs, if all beneficiaries with obesity took Semaglutide drugs the cost would top $13.5 billion annually according to a recent analysis by the New England J. of Medicine. If all adults on Medicare took these weight loss drugs the costs would exceed the total spent on Medicare’s total pharmacy bill, which was $145 billion in 2019! In Medicare that year the bill was $66.00 for each week’s injection which translates to $15,000.00 per patient per year! From past history I suspect that in a year or two physicians for obese patients on Semaglutide drugs will begin to refer these obese patients for a surgical solution! From prior experience with some other drugs this will probably happen but should it?
The only way to stop what is nothing short of nonsense is to stop paying for weight loss treatment in the form of drugs in any health plan. However, the only entity that could stop paying for such inappropriate treatment are the government and private employer self-insured health plans, the latter particularly because these employer sponsored health plans have the power of what treatments are and are not reimbursable. Physicians do not like behavioral treatment of health problems but after 75 years of failure I believe it is time to consider behavioral treatment of overweight/obesity by experts in human behavior such as psychologists.
