Unprecedented Weight Loss With Semaglutide

Semaglutide is a medication that is used to treat type 2 diabetes (trade name Ozempic).  Not only does it improve blood sugars more than any other medication that it has been compared to (so far) in the diabetes world, but it is also very effective to help with weight loss.  Thus, semaglutide is currently under study as a medication to treat obesity in people without diabetes.

We have now completed the first study of semaglutide as an obesity treatment.  The study, published in The Lancet, in which I was an investigator and also an author of this paper, randomized 957 people to receive various doses of once daily semaglutide, with liraglutide 3mg and placebo as controls. (Liraglutide 3mg is also called Saxenda, which is a medication already in use for treatment of obesity.)

At 1 year, 93% of patients were retained in the trial, which is much better than most studies of weight loss medication, which tend to have much less follow up data. Overall, 81% of patients completed the full year of treatment. A higher percent of the placebo group (24%) stopped treatment than did those on semaglutide (18%).

The weight loss after one year on semaglutide was impressive, ranging from -6.0% weight loss on the lowest tested dose of semaglutide (0.05mg per day) to an impressive -13.8% weight loss on the highest dose tested (0.4mg per day), compared to -2.3% weight loss on placebo and -7.8% on liraglutide 3mg per day.

The weight loss had not plateaued by one year on the highest doses of semaglutide, suggesting that if the study had been longer than a year, even more weight loss may have been seen.

In terms of side effects, gastrointestinal were most common (e.g. nausea), in keeping with what we already know about this class of medication; these side effects increased with higher doses of semaglutide, and were a little higher on the highest semaglutide dose than on liraglutide 3mg.  There was also a higher risk of gallbladder side effects (e.g. gallstones), which was a little more common on the highest dose of semaglutide compared to placebo.

The weight loss seen in this study is more than has been seen with any other existing weight loss medication.  The next phase of studies of semaglutide for weight loss is underway.


Disclaimer: I was a principal investigator in this research trial and an author of the paper discussed. I am/have been involved in other trials of semaglutide and liraglutide as an obesity treatment.  I receive honoraria as a continuing medical education speaker and consultant from the makers of semaglutide and liraglutide (Novo Nordisk). 

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2018

Read more...

Could Intermittent Fasting Benefit Our Metabolism?

(this figure is from the study discussed below)

Intermittent fasting (IF) is a popular dietary strategy these days amongst people who are looking to shed pounds.  While IF has not been shown to be any better than daily calorie restriction for weight loss, many have speculated that IF may improve cardiometabolic health, with conflicting data as to whether this is actually the case.

A new study suggests that IF at the right time of day may actually improve metabolic health.

The study was small but elegant - 8 men with pre diabetes, who were assigned to intermittently fast using a new technique called 'time restricted feeding' by eating during only 6 hours per day (with dinner before 3pm), or to eat over a more typical 12 hour period each day.  They followed this eating pattern for 5 weeks, and later crossed over to the opposite eating assignment for another 5 weeks.
All meals were supervised, and were geared towards keeping body weight the same (i.e. this was not a weight loss study).

They found that eating only 6 hours per day resulted in improved insulin sensitivity, blood pressure, appetite, and markers of oxidative stress.

How does this work?  Well, there is a hypothesis that after 12 hours or more without food, our bodies flip a 'metabolic switch' of sorts, turning to fat as a fuel source once liver glycogen (sugar) stores have run out (there is an interesting review from the journal Obesity on this).

Interestingly, the time of day when food is eaten seems to be important - while this study showed a metabolic benefit to restricting food intake to 6 hours earlier in the day, other studies restricting food intake to the late afternoon or evening have shown either no benefit or worsening of metabolic parameters (these studies are referenced in the article).  This may be because eating earlier in the day fits better with our circadian rhythm of hormones, as our insulin sensitivity, and also the calories we burn while digesting food are higher in the morning.

We often recommend: "Eat breakfast like a king, lunch like a prince, and dinner like a pauper."  While this principle was founded on the idea of avoiding overeating in the evening due to not eating enough during the day, it seems that there may be a physiologic basis for eating earlier in the day to promote metabolic health.

Perhaps our new slogan should be: Eat breakfast like a king, lunch like a prince... and have your dinner early.

Stay tuned to www.drsue.ca for discussion of a brand new study on intermittent fasting in people with type 2 diabetes, coming soon!

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2018

Read more...