One Sunday afternoon, you’re going through your social media feed. Suddenly, you come across another viral video, but this one looks like a confession. Someone looks straight into the camera and swears they’ve lost weight with a miraculous injection, the same one the most famous technology magnate tweeted about as his secret to slimming. They’re talking about Ozempic, a drug designed to treat type 2 diabetes that has been irresponsibly and trivially promoted as a way for weight loss. What they call a miracle and say is no trick includes serious warnings that few are aware of.

Obesity drugs have been around since the 1950s. These were eventually taken off the market because they didn’t pass safety tests and had severe side effects such as heart damage, insomnia, and addiction. Decades later, their replacements have arrived. Mauricio Vera, an internist at ABC Hospital and an endocrinologist who is highly specialized in lipids, cardiovascular risk, and obesity, explains that some of these drugs are aimed at the brain’s reward system and others at metabolic control or appetite reduction.

The Origin of a Treatment That Imitates Hormones

In 2017, the Food and Drug Administration (FDA) approved the sale of a semaglutide injection from Novo Nordisk called Ozempic as a treatment for type 2 diabetes. Four years later, after detecting weight loss in patients, the pharmaceutical company asked the agency to authorize Wegovy, which is a larger dose of the active ingredient. This was authorized for chronic weight control in adults with obesity or overweight and at least one condition related to this. They instructed that its use must be accompanied by a low-calorie diet and an increase in physical activity.

Biochemist and Tecnológico de Monterrey researcher Hugo Alves Figueiredo explains that medication such as Ozempic is formulated from Glucagon-like peptide-1 (GLP-1) analogs. This is a hormone that is found naturally in our bodies and has a regulatory effect.

When we eat, our bodies produce several hormones to help digestion, one of which is GLP-1. This reaches different organs and tissues that have receptors for GLP-1, such as the tongue, muscles, brain, heart, stomach, liver, and pancreas. Different cells and functions activate when it arrives. In the pancreas, GLP-1 receptors promote the production of insulin, the hormone that reduces blood sugar levels and suppresses the production of glucagon, which elevates sugar levels. They delay gastric emptying of the intestinal tract, controlling appetite.

The natural hormone has a short lifetime. Medication based on GLP-1 for weekly use was designed to imitate and amplify the hormone’s effects. Semaglutide makes insulin work better in the body and slows down gastric movement to prolong the feeling of satiety. Its effect on the brain is to suppress the urge to eat.

People Need to Learn How to Use the Drug

Novo Nordisk says that 25,000 new patients in the United States start using Wegovy every week. Alves, who also coordinates strategic research projects at TecSalud, the Institute for Obesity Research, and the School of Medicine, points out that these drugs should be considered part of personalized medicine and that people need to learn how to use them, which involves understanding the limitations of a medicine that reaches different organs and knowing when not to use it.

Some exclusion factors are already known, such as having a clinical history of pancreatitis, because it has a strong effect on this organ. It is also contraindicated in cancer patients because a negative effect on their therapies has been observed. Nor is it recommended in people with personal or family histories of medullary thyroid carcinoma or multiple endocrine neoplasia type 2 syndrome.

Studies in mice show that prolonged use of liraglutide, another GLP-1 analog, could harm the pancreas’s capacity to produce insulin. What’s more, most people recover lost weight when suspending the use of these medicines.

Obesity is not an aesthetic problem. It’s a public health problem. Thinking that you have to solve it on your own leads to risky behavior such as the use of non-prescribed medicines and inequality in how public policy addresses these due to their high cost, which ranges from 968 to 1,349 dollars per month.

Alves says society needs to realize that it is not a miracle drug and it has a general effect due to the GLP-1 receptors spread all over the body. Some of the side effects for Wegovy mentioned by the FDA include nausea, diarrhea, vomiting, constipation, abdominal pains, headaches, fatigue, indigestion, dizziness, abdominal distension, belching, hypoglycemia in patients with type 2 diabetes, flatulence, gastroenteritis, and gastroesophageal reflux disease.

It can even cause gall bladder problems, increased heart rate, retinal damage, and suicidal behavior or thoughts. What’s more, it warns about its potential to develop thyroid T-cell tumors.

Treatment Requires Definitions

Obesity is not just a number on the scale. It causes 2.8 million deaths per year and is preventable. Estefanía Espitia, a postdoctoral researcher at the Ramón de la Fuente Muñoz National Institute of Psychiatry, explains that while Body Mass Index (BMI), which is defined as weight divided by the square of height in meters, is used as a rule for detecting obesity, it is full of exceptions that oblige us to rethink how we classify it.

Espitia points out that as a disease, weight increase is studied due to the accumulation of fat or adipose tissue and metabolic changes.

Helen Lorenzo, a member of the Bioengineering and Medical Devices Unit at Tecnológico de Monterrey’s Institute for Obesity Research (IOR), says that a strong sign of obesity is bulging of adipose tissue in the abdomen, when adipocytes accumulate more fatty acids or divide in an accelerated fashion. This causes the release of lipids into the blood, an excess of which modifies how the organs work and produces a state of chronic inflammation that leads to metabolic syndrome (conditions that precede chronic and degenerative diseases such as diabetes and hypertension).

Solutions Should Be Integral to Succeed

Obesity drugs have previously been developed focusing on absorbing sugar or liquids in the gastrointestinal system. Products have also been created that seek to degrade deposits of fat. Many of these drugs are still on the market. “GLP-1 analogs are going to fit within that model. They’re going to be one more option, but the ways in which they should be applied need to be more limited,” adds Alves Figueiredo.

Other strategies for treating obesity are on the way. Helen Lorenzo is researching plant molecules and peptides derived from snake and scorpion venoms. These are expected to change the expression of fat cells, something she calls adipocyte browning, which is about allowing one type of cell to behave like those that burn fat. The unit’s goal is to deliver these compounds directly to the target cells via nanoparticles.

Vera says that the use of these new drugs is not for everyone. “It’s not worth making your body sick to achieve the ideal figure without a health goal.” Instead, specific criteria are required, such as having attempted to make lifestyle changes, having a high Body Mass Index, and suffering from diseases related to obesity. He emphasizes not harming your body to achieve an ideal figure without considering your health. What’s more, he stresses the lack of studies on people who are not obese and the risk of scarcity for those who need them.

Although the goal is to have medicines that are increasingly more specific, Espitia, Vera, Alves, and Lorenzo agree that the treatment of obesity should be integral, which means exercise, nutritional guidance, psychotherapy, and drugs under suitable medical supervision when necessary.

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