Answer
May 29, 2024 - 03:11 PM
Semaglutide can be worth it for weight loss when the goal is medical weight management, not cosmetic weight loss. The best-approved weight-loss version is Wegovy, while Ozempic is primarily a type 2 diabetes drug and weight-loss-only use is usually off-label.
It is most likely to be “worth it” for someone with obesity or overweight plus a weight-related condition such as high blood pressure, sleep apnea, abnormal cholesterol, or diabetes. Health Canada’s Wegovy monograph lists chronic weight management use for adults with BMI 30+, or BMI 27+ with at least one weight-related comorbidity, alongside reduced calories and increased physical activity.
The upside is real: in the STEP 1 trial, adults with overweight or obesity taking semaglutide 2.4 mg lost an average of 14.9% of body weight after 68 weeks, compared with 2.4% on placebo; about 69% lost at least 10% of body weight, and about 50% lost at least 15%. For people with obesity/overweight and established cardiovascular disease but no diabetes, the SELECT trial found fewer major cardiovascular events with semaglutide: 6.5% vs 8.0%, hazard ratio 0.80.
The catch is that it often works like a long-term treatment. In an extension of STEP 1, people regained much of the lost weight after stopping semaglutide: after losing 17.3% during treatment, they regained 11.6 percentage points by one year after withdrawal. So it may be worth it only if you are prepared for ongoing treatment or a serious maintenance plan.
The downsides are also real. Common side effects include nausea, vomiting, diarrhea, constipation, abdominal pain, reflux, fatigue, and appetite suppression that can go too far. Serious warnings include pancreatitis, gallbladder problems, kidney injury from dehydration, severe GI problems, allergic reactions, and contraindications for people with personal/family history of medullary thyroid cancer or MEN2.
My practical take: worth considering if you have obesity or a weight-related health risk, have struggled with sustainable weight loss, can access legitimate prescribed medication, and can pair it with protein intake, resistance training, and follow-up care. Probably not worth it if you only want to lose a small amount of weight, cannot tolerate GI side effects, are using an unregulated/compounded source, are planning pregnancy soon, or are not ready for the possibility that stopping may lead to regain.
