Is this drug just too good to be true?
1. Counselling Conundrum: a real question from a patient
2. Concise Conclusion: a straight-forward patient-friendly answer
3. Quick Wrap-up
Clearly, there are nuances that may not be captured in this format. The goal here is to provide you with helpful counselling tips which often draw from multiple sources or those which are not commonly accessed by busy healthcare providers serving the community.
Counselling Conundrum: "I am considering asking my doctor to try this new diabetes injection all my friends are using for weight loss, as I am travelling and want my bikini body to be ready! I am not technically considered overweight or diabetic (I am generally healthy), but is there a downside to this medication if I just want to shed a few pounds? I am wondering especially because I am a senior."
Concise Conclusion: This is actually a very important question that does not seem to be asked often enough. For overweight type-2 diabetics this medication really is a miracle drug; it causes weight loss (which can reduce insulin resistance, minimizing the amount of diabetes medication someone needs), it reduces sugars, it protects against cardiovascular disease, and it's also generally very safe. The main downside here is that losing weight usually means losing muscle in addition to fat, and this is more likely to happen the older and the less weight you have to lose. It's important for those taking semaglutide to start or intensify strength training and eat adequate protein to prevent this from happening. So in someone that does not need to lose weight for health reasons like yourself, there is a very real risk that you would lose muscle, which is very dangerous particularly as we age (it gets harder to maintain muscle, and muscle is in part what keeps us from falling and what keeps us living longer in general). You also would gain very little benefit from the weight loss and cardiovascular protection as you are already quite healthy. In your case this downside would almost certainly outweigh any benefits you may get from this medication.
Quick Wrap-up: There is currently a firestorm around semaglutide, and for good reason; it's the most potent medication for weight loss currently on the market with a good safety profile. However, as with any means of losing weight, one should not always be willing to sacrifice muscle to lose fat (particularly simply for aesthetics). Sarcopenia sets in quite quickly as we age, and we need to be doing everything we can to protect ourselves, which includes resistance exercises such as lifting weights/rucking, and consuming about 1 gram of protein per pound of body weight (and this number increases as we age as our body's response to protein declines). Of course, weight loss is decidedly not the only benefit of resistance training; there is the improved bone mineral density, increased insulin sensitivity, improved mood, as well as a long list of other benefits that would take hours to list. Unfortunately, exercise is also one of the most involved things you can do for your health (it takes time, effort, and can be exhausting), which is why it's important to start somewhere and slowly build from there, particularly if your patient is averse to exercise.
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Dive Deeper
1. Once-Weekly Semaglutide in Adults with Overweight or Obesity | NEJM (Go to Supplementary Appendix, table S2. Patients lost only 1.6 kg of fat for every 1 kg of lean mass.)
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