2024-05-14 08:28:19
Two major studies based on the largest and most extensive clinical trial on the effects of semaglutide (wegovy) in more than 17,000 adults with overweight and obesity, but without diabetes, reveal that patients lost an average of 10% of their body weight and more than 7 cm waist circumference after 4 years. Furthermore, the findings also indicate that semaglutide offers cardiovascular benefits regardless of starting weight and the amount of weight lost, suggesting that even mildly obese patients or those who do not lose weight will likely gain some advantage.
Weight loss was maintained in men and women of all races, ages, and body sizes, with a lower incidence of serious adverse events compared to placebo. More than half of adults taking semaglutide dropped at least one body mass index (BMI) category after two years, compared with 16% who received placebo. Additionally, 12% achieved a healthy BMI (25 kg/m² or less) compared to 1% of the placebo group.
Semaglutide, a GLP-1 medication initially prescribed for adults with type 2 diabetes, is also approved for weight loss in people who are obese or overweight who face at least one other health problem. This class of drugs mimics the functions of the body’s natural incretin hormones, helping to reduce blood sugar levels after meals and controlling daily caloric intake.
Between October 2018 and June 2023, 17,604 adults (aged 45 years or older; 72% men) from 804 regions in 41 countries with overweight or obesity (BMI 27 kg/m² or more) participated in the SELECT trial. These people were treated with semaglutide (2.4 mg) or placebo for an average of 40 months. Participants had previously experienced a heart attack, stroke, and/or peripheral arterial disease, but did not have type 1 or type 2 diabetes at the start of the study.
The researchers analyzed markers of obesity such as body composition and fat distribution, including waist circumference and waist-to-height ratio, to evaluate the effect of semaglutide on central abdominal fat, which is associated with increased cardiovascular risk.
The first study, led by Donna Ryan of the Pennington Biomedical Research Center in New Orleans (USA), and published in ‘Nature Medicine’, shows that weekly treatment with semaglutide can produce significant and sustained weight loss, reducing waist size for at least four years. In the semaglutide group, weight loss continued through week 65 and was maintained throughout the four years of the study, with an average loss of 10.2% of body weight and 7.7 cm of waist circumference.
Cardiovascular health
The second, led by John Deanfield of University College London (United Kingdom), examined the relationship between baseline weight measurements and weight change with cardiovascular outcomes. The findings showed that semaglutide offered cardiovascular benefits regardless of starting weight and the amount of weight lost, suggesting improvements in cardiovascular outcomes even for those with mild obesity or who lost weight moderately.
These results have important clinical implications according to the researchers. “About half of the patients in my cardiovascular practice have weight levels similar to those in the SELECT trial and are likely to benefit from taking semaglutide in addition to their usual treatment,” Deanfield says.
Furthermore, the findings suggest that the benefits of semaglutide in reducing cardiovascular risk They may be due to other effects beyond weight loss, such as positive impacts on blood sugar, blood pressure or inflammation, and direct effects on the heart muscle and blood vessels.
Despite these significant findings, the authors caution that the SELECT trial is not a primary prevention trial, so the data cannot be extrapolated to all overweight and obese adults to prevent major adverse cardiovascular events. Additionally, although the study was large and diverse, it did not include enough individuals from different racial groups to fully understand the potential effects on these populations.
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