With an endorsement from Derek Lowe, my opinion is superfluous, but yes, this study looks legit. Semaglutide causes weight loss in a large, rigorous controlled trial. 🧵follows.
https://twitter.com/Jess_Riedel/status/1359667454348197888
1961 participants, randomized 2:1 to semaglutide or placebo, plus a 500-calorie deficit and exercise program. Mostly white and Asian, mean BMI 38.
Over 68 weeks, the treatment group lost a mean of 16% of their body weight, or 37 pounds. The control group only lost a mean of 3% or 7 pounds.
This is about half a pound a week of weight loss. That's comparable to the effect size of topiramate, the drug that causes the largest amount of weight loss per week I've previously found in the literature. onlinelibrary.wiley.com/doi/pdf/10.111…
(Nobody takes topiramate just for weight loss, though; it's an epilepsy drug with some funky side effects, including seriously impaired cognition. The hope of obesity-drug researchers is to find something that healthy people can take safely.)
Back to semaglutide. It does some other nice things: mean reduction of waist circumference by 5 inches, and significant reductions in fasting glucose, blood pressure, cholesterol, triglycerides, and CRP.
Side effects are common but mild. 74% of semaglutide patients had some kind of gastrointestinal problem, like nausea, diarrhea, constipation, or vomiting. Increased risk of gallstones in the treatment group, in 1.8% of participants.
So what is semaglutide, anyway? It's a diabetes drug that stimulates the production of insulin by binding to the glucagon-like peptide (GLP1) receptors.
GLP-1 also reduces appetite, possibly by slowing gastric emptying (food remains in the stomach longer) and maybe also by doing something to the hypothalamus, where it's expressed. en.wikipedia.org/wiki/Glucagon-…
Animal experiments on GLP-1 show that the central nervous system effect works to reduce appetite even in the absence of the peripheral/gastric effect, and lesions to the hypothalamus-brainstem connections reduce the satiety effect. ncbi.nlm.nih.gov/pmc/articles/P…
(In other words, the hypothalamus effect is both necessary and sufficient to the appetite-suppression effect of GLP-1. God, I love the hypothalamus.)
Anyhow. Somebody once asked me to research DNP, the supposedly "super extreme" weight loss drug that makes ATP production less efficient and can make you go blind or die. en.wikipedia.org/wiki/2,4-Dinit…
Well, semaglutide causes more weight loss than DNP, and doesn't kill you.
Well, semaglutide causes more weight loss than DNP, and doesn't kill you.
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