Liraglutide and semaglutide: antidiabetics for weight loss are a dangerous fad

For months, Instagram and TikTok have not talked about anything else: liraglutide and semaglutide , new drugs for weight loss with which stars and ordinary people lose tens of kilos in a few months. These are antidiabetics , medicines developed to combat hyperglycemia which have revealed, unexpectedly, a welcome bonus: they make you lose weight effortlessly, and quickly. After all, we are always looking for the miracle pill . And despite the fact that disappointments are almost a constant , we don’t stop hoping for it. Not all that glitters is gold, of course. Because contrary to what joyful videos and carefree tiktok challenges seem to think, we are talking about drugs in all respects, with their long list of side effects , which should not be taken lightly or left to do it yourself. And that they can easily disappoint those who decide to use them without a real medical need. In fact, they also seem to have a dark side: among those who have tried them there are those who claim that their effect is, neither more nor less, that of causing nausea and a feeling of disgust for food .

What drugs?

The drugs in question have different trade names , also linked to the different therapeutic indications (antidiabetics or anti-obesity). Regardless of the branding, they are analogues of the Glp-1 hormone , a substance normally produced by our body which has various effects, the main of which are promoting the production of insulin after meals, and inhibiting that of glutadione , one of its antagonist. In a diabetic patient they are therefore very effective in counteracting hyperglycemia caused by resistance to the action of insulin, because they increase its availability within the body.

However, they also have other effects, equally beneficial in a person suffering from type 2 diabetes. They are in fact able to slow down gastric emptying , thus increasing the sense of satiety when eating. And they reduce appetite by acting directly on the central nervous system . For people who have developed diabetes, usually over the years and with excessive body weight, this is an additional benefit , given that weight loss is one of the first weapons with which the progression of the disease can be slowed down, and avoid the need for insulin injections.

However, the slimming effectiveness was considered so high that attention has also shifted to the possible use as anti-obesity drugs tout court. For the first of the two drugs to enter the market, liraglutide , we are talking about an average loss of between 5 and 7 kilos in weight , if used by obese patients in association with physical activity and a healthy diet. For semaglutide, the most optimistic estimates come in at an average 15% loss of body weight over about a year of use. Tirzepatide would seem even better, a drug recently approved for diabetes in America, and still pending approval in Europe, which when tested on obese (non-diabetic) patients demonstrated an average weight loss of more than 20% at the highest dose tested , and an efficacy in losing at least 5% of body mass in 95% of people who experimented with the drug.

From drug to panacea

Clearly, these are medicines that may have their uses in the fight against obesity , one of the great silent epidemics of our age. They are not miraculous pills (or rather, in most cases, injections), seen on average they help to lose 10, 15 kilos, people who weigh a hundred, and only if you pay attention to reduce sedentary lifestyle and improve nutrition . But in the very obese, people with other important risk factors, and perhaps older, the cost-benefit profile is probably favourable. In fact, their approval as anti-obesity drugs is subject to a BMI greater than 30 (i.e. clinical obesity ) or overweight (BMI greater than 27) associated with risk factors such as hypertension and high cholesterol , which make weight loss important to prevent serious pathologies

The problem is that a different message seems to have passed, namely that they are harmless medicines, with which losing weight finally becomes a piece of cake. Credit (or fault) to celebrities such as the Kardashian sisters and Elon Musk , who apparently used semaglutide injections to quickly get back in shape, thus turning the drug into a real fad. The trend is unearthed on TikTok , where the hashtag #Ozempic (trade name of the anti-diabetic formulation of semaglutide) has surpassed 273 millionof views, and things quickly spiraled out of control. Specialists have been warning for months that these are molecules that have never been tested on healthy people of normal weight, and that it is therefore impossible to know what risks there are by using them lightly. But the temptation to lose a few sizes without struggling seems to have often gotten the better of it.

Getting liraglutide (which is also available in Italy) or semaglutide (approved in America, but not in Italy, for weight loss) without a prescription, or perhaps with an off-lable prescription is relatively simple. And in a short time, consumption has skyrocketed (at least in the US), even beyond the rosiest expectations of their producer. As a result, drugs have become scarce for those who need them most: patients with type 2 diabetes.

Problems and side effects

In the United States, the past few months have seen supply issues of various kinds, all related to increased demand for semaglutide . In Australia , the drug will not be available until next March , again due to skyrocketing demand, which has prompted the country’s health authorities to review the guidelines, to prioritize use by diabetic patients who really need it. of the drug. In Italy the phenomenon still appears to be extremely limited, and certainly has not reached such proportions as to endanger supplies. And that’s a good thing, because as a recent Guardian article points out , many people are realizing the effects side effects of these drugs only when it is already too late.

In fact, scrolling through the list, it is easy to realize that these are problems that are difficult to ignore, if you have decided to take the drug simply to lose a few pounds faster. The most common are nausea (affecting 15-20% of patients), vomiting , diarrhea , abdominal pain , constipation . But there are more serious effects, even if clearly very rare: hypoglycemia (whose prevalence in non-diabetic and non-obese people is not known, and could be much higher than what emerged from clinical trials ), fatigue , mental fog , increased heart rate , hair loss , dysgeusia . There has also been talk in the past of the possibility that Glp-1 analogues could increase the risk of developing thyroid cancer , although these are mainly concerns based on tests performed on laboratory animals.

Another aspect that seems to emerge in recent months is that relating to the changes that these drugs induce not only in appetite , but more generally in the relationship with food . Nausea, for example, is an extremely common side effect and in many cases of practically debilitating intensity, and some are starting to wonder if it shouldn’t rather be considered an effect of the drug: that is, if nausea is a contributing factor substantially reduce the daily food intake, and thus have a palpable effect on weight loss .

It’s not all. The use of these drugs is known to reduce cravings and cravings for food, especially fatty and sugary foods. But many people begin to describe the change in perception of food as so drastic as to be traumatic . Some say they regret the possibility of occasionally going out to eat, made impossible by medicines. And who complains that they can no longer drink coffee when they wake up , or that they feel sick just thinking about fatty foods such as hamburgers , steaks or chips .