Learn how the weekly semaglutide injection works, a new strategy in the treatment of obesity.

By Fernanda Bassette, from the Einstein Agency - Earlier this year, obesity treatment gained another tool: the Brazilian National Health Surveillance Agency (Anvisa) approved the use of the drug Wegovy (semaglutide 2,4 mg) for overweight and obesity in the country. Data from the National Health Survey, conducted by the Brazilian Institute of Geography and Statistics (IBGE), indicate that about 20% of Brazilians are overweight, making obesity a chronic public health problem. A study conducted with Wegovy showed very promising results. But how does this medication work in the body?

Semaglutide is a familiar medication to some people. It was approved by Anvisa (Brazilian Health Regulatory Agency) in 2018 for the treatment of type 2 diabetes (Ozempic), but in lower doses (maximum of 1 mg). Because of the good results observed in weight loss, this medication had been used "off-label" for people with obesity. The results of a large international study, conducted with more than 2.000 patients and published in the New England Journal of Medicine, showed a weight loss of around 17% in patients who received a weekly injection of semaglutide (in addition to guidance on diet and physical exercise) - something considered exceptional for a pharmacological treatment, since with other available medications the patient usually reaches a plateau when they lose about 10% of their weight.

It acts similarly to a hormone produced in the intestine, which is GLP-1. Every time a person eats, this hormone signals to the brain that it's time to reduce hunger and slow down stomach emptying. In addition, it improves insulin function in the body, leading to a greater feeling of satiety after a large meal. Its effects last for a week in the body. 

“Semaglutide has a similar action to liraglutide (Saxenda), with the difference that semaglutide is administered weekly and liraglutide is administered daily. It is a medication that does not take away the pleasure of eating, but it leads to greater satiety,” explained endocrinologist Márcio Mancini, head of the Obesity Group at the Hospital das Clínicas of the Faculty of Medicine of USP. “Along with nutritional changes and physical activity, it makes the treatment of obesity more effective,” he stressed.

According to Mancini, the fact that the dosage indicated for obesity is higher may imply slightly more side effects, such as nausea, possibly vomiting, and delayed gastric emptying. “But these are manageable effects. This is a medication that has a dose escalation, which is increased over the weeks only when the patient tolerates that dose. That's why self-medication is bad,” the doctor emphasized. The semaglutide injection in the treatment of obesity is administered weekly, which is important for adherence to treatment. 

Thus, semaglutide joins other medications currently available to combat obesity (sibutramine, orlistat, and liraglutide), with the difference being the monthly cost of treatment – ​​the price of the medication has not yet been defined, it still depends on the Chamber for the Regulation of the Medicines Market, but it should be around R$ 1.000 per month. “Sibutramine also leads to greater satiety, but studies don't show such great effectiveness in weight loss. But it is quite useful because the monthly treatment with sibutramine costs around R$ 50,” Mancini noted. 

The Brazilian public health system (SUS) has no medication.

Mancini further emphasized that although semaglutide has excellent results for obese patients, its practical application is likely limited to a small number of people, as the Brazilian public health system (SUS) currently lacks any medication to treat obesity. “Within the SUS, we occasionally offer nutritional guidance to the population. The SUS only offers bariatric surgery, with waiting lists that stretch for years. Getting semaglutide available through the SUS is a dream. It's unlikely to arrive even in the long term,” he stated.

Semaglutide is indicated for people with obesity. It can be a first-line medication, but, according to Mancini, the main filter for the patient is the cost, and this is a very expensive medication. "It's a good medication for patients who have contraindications to sibutramine, for example, or who haven't responded to orlistat," he concluded.

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