Maybe the most magical bullet of all for weight loss


By John DiTraglia - Contributing Columnist



The use of semaglutide for weight loss has been proclaimed a game changer. The dose of semaglutide for weight loss is 2.4 mg by injection once weekly and is brand named Wegovy. Wegovy was only recently FDA approved. Semaglutide had been used for treatment of type 2 diabetes at the dose of 1mg and is brand named Ozempic.

Semaglutide is one of several drugs in this class that works by mimicking a hormone called glucagon-like peptide-1 (GLP-1) that targets areas of the brain that regulate appetite and food intake among other things like stimulating insulin secretion when your blood sugar is high. It can lower body weight by 15% on average but in studies of treatment of obesity lasting up to a year, the bodyweight of treated subjects had not plateaued and was still going down. So that is getting into the neighborhood of the 25% weight loss you get from gastric bypass surgery.

GLP-1 is an incretin. Incretins are small protein hormones that are rapidly secreted by the gut in response to a meal. The other main incretin in humans is called a glucose-dependent insulinotropic polypeptide, and it works in some ways like GLP-1 and does some things differently from GLP-1.

Tirzepatide is a new small protein drug made by Eli Lilly that somehow combines the actions of both of these incretins in one molecule. Tirezepatide in 3 different doses 5, 10 and 15mg, was compared to the 1mg dose of semaglutide a study of the treatment of type 2 diabetes that is reported in this week’s New England Journal of Medicine. (1)

It performed better at every dose than the 1mg semaglutide for treatment of diabetes but more potentially blockbusting is that it caused way more weight loss, 13% on average that did not plateau at the end of the 40 weeks of observations in this study.

Now before you get as excited as I did, this may not be better than the 2.4 mg dose of semaglutide that is Wegovy and maybe higher doses of tirzepatide may not be tolerated as well as that higher dose of semaglutide. Also, Wegovy is presently costing about $1000 a month and you will probably have to keep taking it forever. But still…

1. Frias JP et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. N Engl J Med 2021;385:503-15.

2. Tuttle KR. Breaking new ground with incretin therapy in diabetes. N Engl J Med 2021;385:560-1.

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By John DiTraglia

Contributing Columnist

This writer’s opinion is their own and not the opinion of this newspaper

John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- jditrag@zoomnet.net or phone-354-6605.

This writer’s opinion is their own and not the opinion of this newspaper

John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- jditrag@zoomnet.net or phone-354-6605.