Anyone use a T2 Diabetes med that helps weight loss?

Agree with gist of above posts - but just pointing out that the way some of the newer diabetic drugs work for weight loss is not by reducing your appetite - it is by enabling more glucose to be excreted renally.

This of course helps lower your blood sugar levels - and has a 'side effect' of assisting in weight loss.

Be aware on these MFP forums, there is a lot of negative judgment of people who have used weight loss medications, and some blatant misinformation.
There is no point arguing on an internet forum with people who have closed minds. Have a good talk with a doctor who is experienced in using these medications for weight loss.
The Canadian Obesity Foundation now recommends the use of these meds for patients who are BMi >30 with associated health conditions (things like heart disease, high blood pressure, arthritis, etc)

Of course, careful dietary control and if possible, moderate exercise, are recommended as well, making MFP an ideal accompaniment for medication use when appropriate.

In Canada, there are several medications approved and used for weight loss that are having as good success as surgery.

Use of the medication semaglutide (weekly injectable) has great success (average weight loss 15 kg over 68 weeks) and is cardioprotective. The medication liraglutide (daily injectable) has pretty good success (average weight loss 9 kg over 55 weeks) but is said to have a lower incidence of side effects.
New studies published in the last few months have also shown that the medications are effective for many people even when lower than recommended doses are used. If side effects are a problem, a lower dose can be used and although weight loss will be slower, it will still work.

The medications work in several ways, by delaying gastric emptying to increase feeling full, by reducing central signals of hunger, by increasing production and sensitivity to insulin, and perhaps other ways. Many patients have reported a remarkable freedom from the constant gnawing and distracting hunger that they usually feel on calorie reduced diet.

My story is atypical but successful. I do not have diabetes and my HbA1C has always been normal. Last September I had a BMI over 30 and high blood pressure. Due to an unrelated medical problem a few months after I started, I was only able to use Ozempic for 12 weeks. During that time, I followed the same 1200-1400 cal diet I had been following for a year without any weight loss, and I was unable to exercise due to a knee problem. Once I started on Ozempic, due to nausea, I was only able to tolerate the starting dose of 0.25 mg weekly, which gradually abated over the 3 months. The recommended weight loss dose is nearly 10 times that, but some of us are very sensitive to it. I lost a total of 15 lbs over 12 weeks. (197 down to 182) The most dramatic effect was the reduction of the constant torturous hunger I used to feel 24/7, even after eating, which my endocrinologist attributed to insulin resistance (I made insulin, but it pushed every calorie into fat storage before my tissues could use it for energy.) since stopping the Ozempic, the torturous hunger did not return, and I kept the weight off for over a year, continuing to follow a “moderate calorie reduce diet” of around 1400 cals. This fall, I started back on MFP and am able to do about 1-2 hours of mild to moderate exercise daily (walking and gardening). I have lost about 7 lbs over 10 weeks now (182 down to 175) , and have plateaued, but I am down 22 lbs since Sept 2021, and I am sure the plateau will resolve sooner or later. My BMI is now below 28, so I am not using the Ozempic currently.

I had previously used metformin about 10 years ago, without any success at all, in fact it made me vomit several times a day, so I might not have been getting a decent dosage. I actually gained weight while taking it, which stabilized and gradually returned to my pre-metformin weight in about a year after. During this entire time (since about 2013), I have followed a doctor monitored calorie reduced diet. At times I have been able to exercise as much as 3 hours a day, until I blew out my ACLs, one after another. I did not lose weight despite these efforts. When I tried for 6 months to reduce daily calories below 1000, I did lose weight, about a pound a month, then plateaued, becoming iron deficient in the process. When I went back up to 1400 cals, I gradually regained all the weight I had lost, about 4-5 lbs a year, until I reached nearly 200 lbs. that is when my doctor agreed to try the Ozempic with me.

Talk to an experienced weight loss physician if your doctor is not one. Many MDs harbour the same negative judgment against the use of these meds

So, I did a bit of research on the pharmaceutical application of semaglutide as a weight reduction medication. The side effect of weight loss for it's original diabetic medication which is approved for use in the US has not been lost as a potential profit center considering almost 50% of the population would qualify if there was FDA approval and which as we know it was approved.

Here's the original study:
https://nejm.org/doi/full/10.1056/NEJMoa2032183

Novo Nordisk the pharmaceutical company that conducted the study basically upped the dosage to 2.4mg from it's diabetic medication of 1mg so basically a 240% increase. On the surface this looks to be a great study as well. This was a phase 3 randomized, controlled trial comparing semaglutide with placebo in overweight and obese people with diabetes. The study had 1961 participants given a dose of 2.4mg and the trial ran for 68 weeks, so lots of people and a decent amount of time considering the considerable expense to run a controlled trial these days. The results were amazing where participants lost on average 15% of their body weight when compared with placebo or basically -15.3 kg in the semaglutide group as compared with −2.6 kg in the placebo group.

Ok, so here are my concerns. First and foremost this study was conducted by the company who would profit from a positive outcome and all the Doctors involved and I do mean all were employed by Novo Nordisk. I'm sure no bias or manipulation took place considering no pharmaceutical companies have ever been involved in this type of activity and have ever been taken to court, right, so I'm sure we got a legitimate study, but just to make sure maybe an independent university could undertake a similar study. Who would pay for it, not Novo Nordisk I would presume, anyway that is my first concern. Next is, when you look at the graph (figure1) from the 60th to the 68th week a slight weight gain was realized which begs the question, is it effective over longer time frames.

Another problem I have with this drug is the black box warning which is the most serious warning the FDA can give a medication and this one is for thyroid C-cell tumor risk and in rodents for example, not humans there is a dose and duration related increase in C-cell tumors and it's recommended that for human's, people should be monitored considering these trials haven't been done, for obvious reasons and mostly because it can be caught early and be treated.

My other concerns are the side effects reported, and trust me they probably did a run up trial to disqualify people that had any adverse effects initially. Regardless 44% had nausea, 32% diarrhea, 25% had vomiting, 23% constipation, 15% abdominal pains and headaches. A large amount had random symptoms of fatigue, indigestion, dizziness, bloating, burping, low blood sugar and flatulence along with a case of pancreatitis, which brings up the point that anyone with pancreatitis or kidney problems to be aware of semaglutide's effects. This medication is not recommended for pregnant persons, thinking about getting pregnant or under 18. Also, this isn't cheap. 1200 a month and that's if insurance companies cover it, which could be like jumping through hoops I'd imagine.

Is it the "magic Pill" for weight loss? Somehow, I think not. I do think that it could be a good initial buffer or incentive to start a lifestyle intervention. Cheers.

autobahn66 wrote: »

@middlehaitch

Canadian obesity guidelines are published by Obesity Canada, here.

And the associated publication can be seen here.

And the recommendations are to consider pharmacological management in anyone with BMI >30 or people with adiposity-related conditions and BMI >27. All of this should be in conjunction with other interventions. There is no national formulary in Canada, so there is no clear guide that I can look into that shows how these guidelines are implemented in practice. In the UK the pharmaceutical options tend to be reserved in local formularies until after sustained attempts at medically managed weight loss have been partially successful, but varies geographically.

The study linked by neanderthin here includes a comparison with a few outcomes after bariatric surgery. The claim is that the numbers are similar, and it is expected that the route to weight loss is not important in the reduction of cardiovascular risk. This is a large study and includes lots of the information stated by Lori. In terms of dose - that's a bit more difficult: there have been studies of semaglutide using a range of doses and little published about the variances in administered dose. For liraglutide, it is well recognised practice to settle on the highest tolerated dose if there are minor adverse effects at max dose. I am not aware of a study which demonstrates the efficacy of this.

This meta-analysis examines studies looking at GLP-1 agonists (particularly liraglutide and semaglutide) and cardiovascular events in adults with obesity without diabetes: it showed a significant reduction in cardiovascular events.
There is another large trial ongoing (SELECT - including 17000 participants!) but this hasn't published yet as far as I can see.


This meta-analysis showed that there was a substantial reduction in mortality, cardiovascular events and renal impairment in patients with diabetes (relevant to the OP, but not necessarily generalisable to people without diabetes due to the concomitant improved control of HbA1c as a confounding factor).

I think it's important to recognize that a reduction in cardiovascular events within the obese population is largely ameliorated through weight loss and other dietary interventions and additionally with a focus on reducing highly refined and highly glycemic carbohydrates. Saying that, GLP-1 agonists do produce weigh loss on their own, which would by default, reduce cardiovascular events and when compared to placebo offer better outcomes considering the difference in weight loss between these two groups, regardless of the person having diabetes or not. Just thought I'd mention this.