What is it? 

Ozempic/Wegovy is the brand name for a drug called semaglutide. It's not your typical pill – it's an injection that you can get only if a doctor prescribes it. Back in 2017, it was first approved in the U.S. to help with type-2 diabetes. Now, Ozempic is the brand name used to treat diabetes, and Wegovy is the one for obesity, but both use the same semaglutide. It wasn't until recently, in 2021, that this drug got the green light to be used specifically for obesity, under the name Wegovy. 

How does it work? 

Semaglutide acts like something your body naturally produces, called glucagon-like peptide 1 (GLP-1).¹ This drug connects with the GLP-1 receptors in your body, making you feel less hungry and fuller. It also helps lower blood sugar levels. For people with type-2 diabetes, it helps manage their blood sugar, and for those looking to shed some pounds, it aids in weight loss. However, like any medication, there can be side effects, including nausea, diarrhea, vomiting, constipation, headaches, low blood sugar, and more. 

What does the research say? 

Scientists conducted a big study called the STEP (Semaglutide Treatment Effect in People with obesity) clinical trials to see if semaglutide could really help people lose weight and keep it off. In STEP 1, those taking semaglutide lost around 14.9% of their weight, way more than the 2.4% lost by those on a placebo during the 68-week trial. In STEP 3, people got therapy to help with weight loss, and those on semaglutide lost 16.0% of their weight, while those on the placebo lost 5.7%. For STEP 4, everyone in the trial started semaglutide for the first 20 weeks, then some people continued with semaglutide for 48 more weeks and lost more weight, while others switched to a placebo and gained weight. The results showed that continuing with semaglutide helped lose an extra 7.9%, while those who switched to a placebo gained 6.9%. It is this last trial that has generated a lot of interest in doctors because of metabolic adaptation. 

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Metabolic Adaptation to Weight Loss 

Metabolic adaptation refers to the body's ability to adjust its metabolic rate in response to changes in energy intake, particularly during weight loss.² As individuals reduce their calorie intake to lose weight, the body undergoes various changes to preserve energy and maintain itself. These physical changes can determine how much weight a patient loses and whether they will gain it back later. There are four main components to metabolic adaptation. 

• Basal Metabolic Rate (BMR) Adjustment: When a person reduces their calorie intake to create a calorie deficit, the body may respond by lowering its basal metabolic rate (BMR). BMR is  the amount of energy the body uses at rest to maintain essential bodily functions like breathing, heartbeat, and cell production. Studies have shown that as individuals lose weight, their BMR can decrease. The body needs to use more energy to lose weight, and BMR is one subtle way that the body burns calories. So, when BMR decreases and the body burns less calories than usual, it becomes more challenging to continue losing weight and easier to regain weight once normal eating resumes. 
• Changes in Hormonal Regulation: Hormones play a crucial role in regulating metabolism. During weight loss, hormonal changes occur to tell the body to conserve more energy. Leptin, a hormone produced by fat cells that regulates appetite and energy expenditure, decreases during weight loss. This reduction in leptin levels can stimulate hunger and slow down metabolism, which can lead to regaining weight. 
• Muscle Mass Loss: Consuming less calories, especially in the absence of resistance training, can lead to the loss of lean body mass, including muscle tissue. Muscle tissue burns more calories when put to use, so when you lose muscle mass it becomes more difficult to burn calories and lose weight. Preserving muscle mass through resistance training is important to avoid this issue. 
• Energy Efficiency Improvement: The body becomes more efficient in using energy as individuals lose weight. This increased efficiency means that the body can perform the same activities with fewer calories. While efficiency is beneficial for survival in times of food scarcity, it can hinder weight loss efforts and can make you regain weight. 

Semaglutide does not directly affect metabolic adaptation to weight loss, but it may indirectly influence metabolic processes by changing appetite, blood sugar, and body composition. This possibility of weight loss that can be maintained is what has made semaglutide such a hot topic with some doctors and the media. No matter what weight loss method you choose, it is important to consult a doctor before starting any kind of weight loss program. They are the most qualified people to discuss the risks, benefits, and any possible negative outcomes of a specific program or method.