More than one-third of the United States’ population qualifies as “obese.”
That means the pursuit for a pharmaceutical weight loss drug has only become more intense.
And there’s some encouraging news on this front.
A recently published study from the Mayo Clinic reports that a pharmaceutical weight loss drug already exists and has proven to be effective, even in those who are obese.
Liraglutide is a prescription medication that is self-administered via injection once per day.
It was originally created to treat type 2 diabetes under the brand name Victoza, manufactured by Novo Nordisk.
“Our paper shows that liraglutide, administered for 3 months at the approved dose of 3 milligrams per day, was associated with an average weight loss of 12 pounds compared to an average 6.6-pound weight loss for patients receiving a placebo,” explained Dr. Michael Camilleri, a gastroenterologist at Mayo Clinic and a senior author of the study.
In order to prescribe this medication specifically for weight loss, healthcare providers encountered an obstacle.
Insurance companies would only cover Victoza for people with an indication of diabetes or prediabetes.
Being obese does not necessarily mean a person has diabetes, so there’s a hurdle to jump in order to prescribe the drug for weight loss.
Consequently, Novo Nordisk rebranded liraglutide as Saxenda and categorized it as a weight loss drug, resulting in the same drug with two different names and with two primary purposes.
And for many patients, it works.
“Liraglutide appears to be very effective in inducing weight loss over three months of treatment,” Camilleri told Healthline.
How drug helps you lose weight
Essentially, liraglutide works like the hormone GLP-1, which is released from the small intestine during and after meals.
This is the framework for many other diabetes medications, such as exenatide (Byetta/Bydureon), lixisenatide (Lyxumia), albiglutide (Tanzeum), and dulaglutide (Trulicity).
However, these other medications have not yet proven in research to aid in weight loss as effectively as liraglutide.
For patients on the drug for its original purpose — improving blood sugar levels —liraglutide works in three specific ways:
- It slows down the rate at which food leaves your stomach and empties into your small intestine for further digestion, which helps to prevent blood sugar spikes after eating.
- It helps to prevent your liver from producing and releasing too much sugar (glycogen).
- It helps your pancreas produce more insulin.
The aspect of the stomach emptying more slowly is what leads to weight loss in people who do not have diabetes.
“In clinical practice,” explained Camilleri, “measurement of stomach emptying at five weeks may serve as a biomarker to determine which patients should continue on the treatment and which patients might be better candidates for other weight loss treatments.”
The most notable side effect reported by patients is nausea, but this is also what helps people lose weight due to the nausea’s reducing effect on appetite.
“It is essential to titrate the dose up slowly, over five weeks,” said Camilleri, “and to ‘pause’ for patients to become less nauseated with treatment dose before escalating by 0.6 milligrams every week.”
Camilleri adds that taking liraglutide if you don’t have diabetes doesn’t seem to result in hypoglycemia (low blood sugar).
Besides their names, the only true difference between Saxenda and Victoza is in the dosages — both of which are delivered via injection with Novo Nordisk’s Flexpen device.
For patients prescribed the drug under the name Victoza for diabetes management, doses in a Flexpen can be adjusted gradually up to as high as 1.8 milligrams per day. When prescribed specifically for weight loss, Saxenda can be adjusted up 3 milligrams per day.
Some insurance coverage may require a note from the doctor, says Camilleri, explaining that all other weight loss approaches to achieve “clinically meaningful weight loss” have failed, especially when other obesity-related comorbidities are present.
Can drug help non-obese patients?
The company’s clients include patients with type 2 diabetes and prediabetes.
“I’ve been using liraglutide with my patients since 2005,” Robinson told Healthline. “In terms of the GLP-1 drugs, it’s become the ‘go-to’ for weight loss.”
In her practice, Robinson says she sees success when using liraglutide in patients with prediabetes who need to lose a little weight, reduce their HbA1c (glycated hemoglobin test), and in a sense, “re-set themselves.”
“It’s not a miracle drug, but it does make it easier for people to lose weight because they aren’t as hungry between meals. And they feel full more quickly, to the point that if they do overeat they will feel sick,” explains Robinson.
If a patient is experiencing strong symptoms of nausea, Robinson continues their current dose for at least two weeks, giving their body time to adjust to the medication before making another increase.
Another important part of preventing nausea is simply eating less. Robinson instructs all her patients to begin by putting two to three fewer tablespoons of food on their plate in order to avoid any gastrointestinal distress.
“For weight loss, it works,” said Robinson.
But that weight loss comes not without effort.
Both Robinson and Camilleri emphasize that liraglutide should be used in conjunction with behavioral changes around nutrition and exercise.
Due to how expensive liraglutide is, whether prescribed as Saxenda or Victoza, many insurance providers will not cover the drug unless the patient is enrolled in a weight loss program.
Certain people, particularly men, seem to be able to eat through that “fullness” feeling, preventing them from successfully losing weight.
Robinson recalls a male patient who only lost three or four pounds on the drug and eventually gained it back.
“But I see other patients where it completely changes their metabolism, and they’re able to eat less, cut their calories, and lose weight,” she said. “I had a patient who was diagnosed with prediabetes; then she was diagnosed with type 2. She was drinking a half or full bottle of wine nearly every night, eating a lot of junk food, a very unhealthy lifestyle. When she started taking Victoza, she stopped drinking, changed her diet, started exercising. She lost 40 pounds in 6 months.”
Unfortunately, for those who just want to “drop a few pounds,” getting insurance coverage may be nearly impossible.
“Some insurance policies will require that you have an indication for weight loss with a BMI [body mass index] greater than 30 to be prescribed Saxenda, or greater than 28 with comorbidity diagnoses,” explained Robinson.
This insurance obstacle means a percentage of the U.S. population will have to rely on good old-fashioned willpower, nutritional changes, and exercise in order to slim down.