What's with the Wegovy Pill - Part 1

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Wow did I get a lot of requests to write about this! We’ll start with some basic information today and then break down the actual trial data in the rest of this series.

Summary

The FDA has approved a pill form of Novo Nordisk’s weight loss medication Wegovy Like the injection form, this pill is a larger dose of the Type 2 Diabetes pill (brand name Rybelsus.) The maximum T2D dose is 14mg while the recommended weight loss dose is 25mg. In part 1 we look how Novo Nordisk is discussing this on their webpage dedicated to this pill which, despite claiming to show “full study detail” shows only select study details without context and does not include specific adverse event information. What we can find out from the page is that in the 64 week study that included 307 adults , 24% of the participants failed to lose even 5% of their body weight, 40% failed to lose 10%, 53% failed to lose 15%, and 72% failed to lose 20%. In Part 2 we will look at the actual full study details.

Deeper Dive

The FDA has approved a pill form of Wegovy, the brand name of semaglutide for weight loss (for clarity, the brand name of semaglutide for Type 2 Diabetes is Ozempic for the injection and Rybelsus for the pill.)

Quick history: Semaglutide was first approved as a Type 2 Diabetes medication. It had a side effect of a small amount of weight loss. Novo Nordisk, the controversy-heavy company who manufactured it, tested to see if larger doses produced more weight loss. They did and it got FDA approval as a weight loss medication. Because the goal of the weight loss application is to increase the side effect of weight loss, it also increases the risk of all of the other dose-dependent side effects, some of which are severe and some of which can be fatal.

Originally semaglutide for Type 2 Diabetes (Ozempic) was only offered by a once-a-week injection (improving upon previous iterations in the GLP-1 drug class requiring daily injection.) Still, injections don’t work for everyone for lots of reasons and so Rybelsus, a pill form, was created.

Now a pill form of semaglutide for weight loss (Wegovy) has been FDA approved. Unlike Rybelsus, it is not getting another name. It’s just being called “The Wegovy Pill” as far as I have seen.

I thought for this study it might be interesting to start on Novo Nordisk’s Wegovy website to see what they were claiming. (As always I’ll indent direct quotes from the drug manufacturer, you can skip them, avoid weight stigma, and still get the gist of the piece.)

Novo says:

“In a 64-week medical study of 307 adults living with ob*sity, or with overw*ight and at least one weight-related medical problem, adults lost on average with Wegovy® pill about 33lbs, 14% weight loss Based on an average starting weight of 234 lb, With placebo about 6lbs, 2.4% weight loss, based on an average starting weight of 231lb”

They are using the weight-loss industry person-first marketing language that Novo Nordisk put a ton of money into as part of their effort to pathologize body size regardless of actual health status to increase their market. Also, of course the idea of “weight-related” medical problems is seriously questionable since these are medical problems that people of all sizes get that get called “weight-related” when higher-weight people have them and/or it helps the weight loss industry. I wrote about that in detail here.

They continue:

Let’s break down the study results

In addition to a reduced calorie diet and increased physical activity, based on an average starting weight of 235 lb for Wegovy® pill and 231 lb for placebo:

76% of adults taking Wegovy® lost 5% or more weight vs 31% of adults taking placebo

60% of adults taking Wegovy® lost 10% or more weight vs 14% of adults taking placebo

47% of adults taking Wegovy® lost 15% or more weight vs 6% of adults taking placebo
28% of adults taking Wegovy® pill lost 20% or more

Let’s say this another way:

24% of the sample failed to lose even 5%
40% failed to lose 10%
53% failed to lose 15%
72% failed to lose 20%

As I’ve said before, it is critical that these numbers are part of an informed consent conversation, including and especially for patients who are being manipulated into taking these medications because their healthcare is being held hostage for a weight loss ransom.

Also, their “placebo” is the same eat less and exercise more “intervention” that’s been failing for a century so it’s not impressive that they’ve bested (at least in the short-term) it with a megadose of a Type 2 Diabetes medication whose side effects interrupt normal hunger and digestion.

Finally I saw a tab to click that said “See full study details” This was exactly what I was looking for. I clicked it and all it said was:

“Results are from a 64-week medical study of 307 adults with ob*sity (BMI ≥30 kg/m2), or with overw*ight (BMI ≥27 kg/m2) and at least one weight-related medical problem, including high blood pressure or high cholesterol. Adults with type 2 diabetes were excluded. Patients were taking either Wegovy® pill or placebo. During the trial, 18% of adults in the Wegovy® group discontinued treatment compared with 26% of adults in the placebo group.”

For the record, I would not remotely describe this as “full study details.” I would charitably describe this as very few study details with absolutely no context. In fact, they don’t cite the study on the page or even give the name of the study or the authors. You would think that’s the least they could do so that it would be easy to look up and I’m curious why they didn’t..

Note that in these trials dropouts in the placebo group may be high because people know that they are in a trial for a weight loss drug and what the likely side effects are, and when they don’t experience the side effects or lose much weight, they quit.

They go on to explain that you have to take the pill first thing in the morning with a “sip of water (up to 4 ounces) on an empty stomach.” Then “wait at least 30 minutes before eating or drinking or taking other oral medications” and to “Take Wegovy® the same way, every day, for it to work as intended.” Again, this is important information for an informed consent conversation.

Finally are the dosages. Like with the injection, the medication is begun at what is considered a subtherapeutic level, in this case 3mg, and then titrated up every four weeks until the patient reaches the “maintenance dose” of 25mg. Remember that weight loss is actually just a side effect of this medication which means that to create the most weight loss, the goal is to get the patient to the highest dose they can stand as fast as possible.

At the bottom of the page they discuss the side effects but without any of the numbers or information that the trial would have had to create.

We will begin our discussion of the actual “full study details” starting in part 2.

The first online workshop of the year will be Weight-Neutral Blood Sugar Management with Dr. Gregory Dodell. There is a pay-what-you-can option to make sure money isn’t a barrier and a video in case you can’t make it live. Details and registration are here!

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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.