Slimming pens are used as allies against obesity

​The search for the ideal weight has always been a recurring debate among Brazilians, especially after the coronavirus pandemic, when life happened at home. During this period, the number of overweight and obese people increased. In 2019, 55.4% of Brazilians were overweight, while in 2021, this number rose to 57.25%, according to the Vigitel 2021 survey by the Ministry of Health.

To aid in weight loss, medicines with “pen” formats have been used as allies. With prices ranging from around BRL 600 to BRL 1,000, the substances semaglutide and liraglutide, sold under the trade names of Ozempic and Saxenda respectively, produce hormones similar to those of the human body, acting to control appetite. They were initially developed, however, for the management of type 2 diabetes.

“They act by sensitizing the pancreas to produce more insulin according to the level of glucose in the blood. For this reason it helps in controlling diabetes, but they also act on the hypothalamus – the region of the brain that regulates appetite – and, therefore, increases the satiety helping to lose weight”, explained endocrinologist Cintia Cercato, member of SBEM (Brazilian Society of Endocrinology and Metabology).

The endocrinologist says that the drug does not cause diabetes in those who do not have the disease.

In the United States, both substances have been approved for the treatment of obesity. In Brazil, liraglutide was released for the treatment of diabetes and obesity, while semaglutide is authorized only in the case of diabetes and is under evaluation by Anvisa (Brazilian Health Surveillance Agency) to assist in weight loss.

In a note, the agency informed that “the indications of the drugs are approved from the requested indication” and that “the laboratory requested the indication of Ozempic for the treatment of obesity, and the request is under analysis by Anvisa”.

​According to a study by IQVIA, between April 2020 and April 2021, Saxenda ranked second among the best-selling drugs in Brazilian pharmacies, while Ozempic ranked sixth. Although the substances belong to the same family, there are differences between them, such as the frequency of application, according to endocrinologist Fernanda Braga Albuquerque.

“Saxenda needs to be applied every day, subcutaneously (under the skin) and Ozempic already allows a weekly application, also subcutaneously, which facilitates patient adherence,” said Albuquerque.

Why are diabetes medications used for weight loss?

The two substances also act on the brain, which causes the feeling of satiety and decreases the desire to eat, according to Cercato, from SBEM.

Both work on the pancreas, making insulin-producing cells more sensitive to blood sugar, releasing more insulin if glucose levels are high, he says.

“But if the person has normal glucose, these cells do not need to produce more insulin and that is the reason why they do not cause hypoglycemia in those who are not diabetic. These drugs cause weight loss, as they can reach regions in our brain that regulate hunger, satiety and the desire to eat. Thus, the drug helps people with obesity to eat less, causing a negative energy balance”, he says.​

What is the effect of medications?

A randomized study published in the International Journal of Obesity, by the Nature group, observed that the daily application of 3.0 mg of liraglutide, associated with diet and exercise, over 56 weeks in people with overweight and comorbidities causes a decrease in weight of on average 6%. The placebo group lost an average of 0.2%

In relation to semaglutide, another research published in the scientific journal New England Journal of Medicine indicated that the substance reduced the weight of obese people, in addition to preventing aggravations such as diabetes. For the test, about 2,000 members received a weekly dose of 2.4 mg. They lost an average of 14.9% of their body weight at the end of 68 weeks, while the placebo group lost an average of 2.4%.

“In overweight or obese participants, 2.4 mg of semaglutide once weekly plus lifestyle intervention was associated with sustained and clinically relevant reduction in body weight,” the study says.

All studies indicated that the most common adverse effects among participants were gastrointestinal, such as nausea.

Is it necessary to have a medical prescription?

Not. The fact that they are sold freely, without a prescription, is a matter of concern for experts, as each body acts in a way.

“Although these medications do not need a prescription to be purchased, it is important to consult a doctor beforehand. Because no medicine that is good for one person will be good for everyone, in addition to evaluating the need to start treatment with these substances and guide how it should be used”, says endocrinologist Albuquerque.

What are the contraindications?

The drugs are contraindicated for those who are sensitive to the components of the formula, pregnant women or those who intend to become pregnant, and lactating women according to the package insert.

“They should be used with caution in patients with severe gastroesophageal reflux or in people with a history of pancreatitis,” says Cercato.

What are the side effects?

According to studies, the most felt effects are gastrointestinal.

“The main thing is nausea. But the patient can have diarrhea, constipation and vomiting. That’s why medical follow-up is important, to see how the person will react to the treatment”, emphasizes Albuquerque.

How long should I take it?

The endocrinologist says that the period of treatment varies between patients, which means that the drugs can be for months, years or for a lifetime, she says.

“All obesity treatment has phases. The first is rapid weight loss, then slower weight loss, and then the patient maintains that weight. There is also a phase where there can be weight regain. This with or without medication. What we notice is that Ozempic and Saxenda help with weight maintenance as long as they continue to be used”, he says.

“If we look at obesity as a chronic health condition like hypertension, diabetes, in which medications are well accepted and without stigma, obesity is a chronic disease like them. So, the medication may be necessary for life. .”

Can medications be used to lose little weight?

Not. According to the package insert for Saxenda (liraglutide), it should only be used by people with a BMI above 27.

“These drugs are not for those who want to lose, for example, 3 kilos. Although many people use it that way. They are indicated for the treatment of obesity. That is why a medical evaluation is important”, concludes Albuquerque.