Oral Weight Loss Medication Similar to Ozempic Coming to South Africa

Recent trials indicate that an oral formulation of a widely used weight loss drug exhibits effectiveness comparable to the injectable version. However, as accessibility increases, medical professionals advise that it should be regarded as a treatment for a chronic condition, rather than a quick cosmetic solution.

Novo Nordisk, a leading global pharmaceutical firm, recently shared findings from the OASIS 4 phase 3 trial. The results suggest their Wegovy weight-loss pill has the potential to act as an effective substitute for the injectable form.

The trial discovered that individuals taking 25mg of oral semaglutide – marketed as Wegovy in South Africa, and containing the same active ingredient as Ozempic – experienced greater enhancements in blood sugar levels, blood pressure, and cardiovascular risk factors compared to those receiving a placebo. The most significant benefits were observed in participants who achieved a minimum of 15% reduction in body weight. Health tracking apps like Shotlee can help monitor such changes and improvements in overall health.

Domenica Rubino, a trial investigator and director at the Washington Centre for Weight Management and Research in Virginia, pointed out that the trial's outcomes highlight the efficacy of oral semaglutide as a possible therapeutic option for individuals with obesity and those who are overweight.

Ankia Coetzee, an endocrinologist from Stellenbosch University, explained that semaglutide functions by mimicking a natural hormone known as GLP-1 (glucagon-like peptide-1 receptor agonist), which plays a role in regulating metabolism. The medication slows down the emptying of the stomach, which helps individuals maintain a feeling of fullness for a longer period.

Furthermore, it diminishes food cravings by influencing the brain's appetite centers, thereby reducing "food noise." It also enhances blood sugar regulation by boosting insulin secretion from the pancreas and decreasing glucagon levels. According to Coetzee, the combination of these effects promotes weight loss and aids in controlling cravings.

The World Health Organisation notes that GLP-1 weight loss medications such as semaglutide are currently approved for the treatment of obesity and weight loss, but were initially employed for managing type 2 diabetes.

"If someone's got a normal BMI and they want to lose weight because they want to look better, the risk-benefit ratio sort of changes, and we're potentially going to see problems with these drugs"

-- Ankia Coetzee, endocrinologist at Stellenbosch University

GLP-1 drugs have become increasingly popular, particularly in the United States. According to data, the number of non-diabetic patients initiating GLP-1 treatment saw a 700% increase between 2019 and 2023. The rise is partially attributed to social media and celebrity influencers advocating for the off-label application of these medications for cosmetic weight reduction.

Coetzee cautioned that "if someone has a normal BMI and desires to lose weight to enhance their appearance, the risk-benefit ratio shifts, potentially leading to issues with these drugs."

She clarified that the medication is intended for individuals with a BMI exceeding 27 who have at least one weight-related comorbidity, or for those with a BMI of 30 or higher, regardless of any additional health conditions. "If administered to the appropriate individual at the appropriate time, the benefits significantly outweigh the potential risks."

She mentioned that the primary risks involve gastrointestinal side effects, including nausea, vomiting, diarrhoea, constipation, and bloating, with dehydration being a concern in cases of severe vomiting.

Coetzee also noted that older weight loss medications frequently functioned by artificially stimulating metabolism or energy levels, which could result in severe side effects such as heart complications and elevated blood pressure.

Conversely, newer GLP-1 medications operate by augmenting the body's inherent hormonal system, thereby enhancing appetite regulation, cardiovascular health, and kidney function. This makes them safer and more effective for managing metabolic health. "I think the problem is that for a long time, we didn't realise that being overweight and obesity are also chronic diseases."

Coetzee explained that healthcare professionals previously placed individuals with these conditions in a difficult position by simply advising them to "eat less, and move more".

The pill has not yet received approval from the South African Health Products Regulatory Authority. However, in February, Novo Nordisk submitted an application for the formulation in the US for review, with completion expected by the end of the year.