Of course, Matthias Blüher has known for a long time that being overweight causes problems for people and that there is a great desire to lose it. As an expert in the metabolism of excess weight, the doctor from Leipzig University Hospital deals every day with patients who weigh too much. But since the “weight loss injection” Wegovy was approved in Germany in July, Blüher has hardly been able to avoid inquiries. “In the beginning there were 50 to 60 inquiries per week, now there are over 100,” he told the health forum South German newspaper, which was dedicated to weight loss injections. Wegovy has achieved great popularity through aggressive marketing by the manufacturer, but also through influencers and celebrities such as Kim Kardashian and Elon Musk, who have used the product to lose weight.
On average, people lose 10 to 15 percent of their body weight when they take the drug for several months. No wonder there is so much interest – not only among severely overweight people, for whom Wegovy has been approved, but also among people who want help on the way to a bikini figure, as Blüher reported. The problem is that the drug is currently difficult to obtain due to the high demand. Some people also use a similar preparation called Ozempic, which contains the same active ingredient in a lower dose and is actually intended to help people with diabetes against their high blood sugar and high blood pressure; Diabetics sometimes no longer have access to the medicine that is so important to them.
According to Blüher, the new drug is a real step forward for severely overweight people – because such a large amount of weight loss could not previously be achieved with any other means other than a radical reduction in eating or stomach surgery. “Wegovy is very helpful for people who have an enormous amount of suffering because of their obesity and who have additional illnesses such as diabetes, heart disease, high blood pressure and perhaps also psychological impairments that significantly affect everyday life,” says Blüher.
Effortless weight loss? It sounds like humanity’s dream come true, where you can eat as much as you want and still look good on the beach. Does that really work? “To a certain extent yes,” said Blüher. “But it works much better if you also make sure to incorporate healthy eating and activity into your daily routine.” The often stated possible weight loss of ten to 15 percent of body weight is just an average, says Blüher: “People respond very differently to the medication.” About one in ten patients do not lose weight at all with Wegovy, others manage 20 to 30 percent.
However, such a high weight loss is not the upper end, but the rule when Beate Herbig gets to work. The surgeon performs stomach reductions and gastric bypass operations on people with obesity at the Bielefeld Clinic. She doesn’t think that the weight loss injection will mean she’ll have less to do soon. “We are dedicated to a group of people who have such an exceptionally high body weight that they still weigh far too much, even if they lose 20 percent through a medication,” she said at the SZ Health Forum. “With the injection we don’t yet achieve what we can achieve through the operation. But it can be a support for our patients if they gain weight again after the operation.”
Compared to weight loss injections, the operation has another huge advantage: It usually leads to permanent weight loss because patients can no longer eat as much because of the smaller stomach and because the gastric bypass means that the duodenum is bypassed during digestion also contributes to long-term hormonal weight control. However, those who use the weight loss injection usually gain weight again as soon as they stop using it. The drug doesn’t change behavior, it simply curbs the appetite by controlling the brain’s sense of hunger and satiety – making it easier to eat less. Many experts therefore fear that people who want to maintain their lower body weight will have to rely on the injection for the rest of their lives.
“There are now other reports,” said metabolism expert Timo Müller from the Helmholtz Center in Munich, who researches active ingredients that help you lose weight. Sometimes weight loss is sustainable. However, other patients quickly gain significant weight again. How strong the yo-yo effect is, which is also known from diets, also depends on the individual patient. “Overall, the clinical data now shows that patients who stopped taking the drug after 44 weeks still weigh ten percent less after 88 weeks than a comparison group that only received a placebo in the first 44 weeks,” says Müller. However, they had previously lost 20 percent weight, so they had gained weight again – but not all of it.
As with all medications, the effect is not given to you for free. The weight loss injection also has side effects: users often suffer from nausea, bloating, diarrhea or constipation. There are also reports of dangerous inflammation of the pancreas or thyroid diseases. “It is therefore important to examine carefully which patients really benefit from such therapy,” emphasized Matthias Blüher.
According to medical guidelines, the weight loss injection is currently recommended for people with a BMI of 30 or from a BMI of 27 if other illnesses such as diabetes, high blood pressure or sleep apnea are present. For the group of people who simply want to lose a few kilos, there is no study data on the benefits and risks. “The weight loss injection can be particularly dangerous if a patient or their family has or has had special types of thyroid cancer,” says Blüher. “I would also be careful if the pancreas had already become inflamed.” However, other thyroid diseases, such as Hashimoto’s, are not a contraindication.
Reports of psychological side effects are also worrying. There have been reports of suicides in connection with the weight loss injection. The drug itself probably does not have a depressive effect, said Matthias Blüher. However, drastic weight loss is a warning signal for the brain. Despite the joy of losing weight, the loss of weight can lead to people developing depression. “The brain perceives: I’m losing weight, I’m coming to an end,” says Blüher. There is another mechanism, added Timo Müller: the drugs intervene in the reward system in the brain, which is linked to appetite. “If I no longer feel like rewarding myself with food, then that can also lead to me developing depression.” Unfortunately, it cannot be predicted which patients this will affect, said Blüher. However, there is no risk of an undesirable interaction with medications used to treat mental illnesses.
Sometimes people who can no longer eat as much because of the injection or a stomach reduction also lack food to compensate for their emotions, says Beate Herbig. It is therefore important to accompany them and offer psychological help if necessary.
According to the experts at the SZ Health Forum, it is important that patients seek care from an experienced doctor, not only because of the side effects, but also in order to set the correct dosage. Under no circumstances should you order the products on the Internet, where counterfeits are already circulating in abundance.
The weight loss injection not only has undesirable side effects, but apparently also positive side effects – namely on the heart. “We see that these active ingredients have a beneficial effect on the cardiovascular system – regardless of their direct effect on obesity,” says Müller. Weight loss is good for the heart, but the effect of the weight loss injection goes beyond that. This is apparently because the active ingredient increases blood flow in the heart in the event of a heart attack and thus minimizes the spread of the heart attack.
All experts criticized the fact that the medication has not yet been reimbursed by statutory health insurance companies. The health insurance companies could ultimately save a lot of money if timely weight control prevented or delayed serious secondary illnesses, said Matthias Blüher. “Nevertheless, the legislature has equated obesity medications with hair growth products and sexual enhancers.” Beate Herbig emphasized that obesity is not simply the result of overeating, but a serious illness that is still stigmatized – including by health insurance companies.