What is the drug originally? From diabetes aid to weight management tool
Semaglutide was originally developed by the Danish pharmaceutical company Novo Nordisk and belongs to the class of GLP-1 receptor agonists, initially used for blood sugar control in patients with type 2 diabetes. Its mechanisms of action mainly include: promoting insulin secretion, inhibiting glucagon release, slowing gastric emptying, and enhancing satiety.
These mechanisms not only help stabilize blood sugar but also bring additional effects—reduced appetite and decreased food intake, leading to gradual weight loss. In 2021, the U.S. FDA officially approved high-dose semaglutide for long-term weight management in the "overweight or obese" population, marketed under the brand name Wegovy, attracting global attention.
However, it is worth noting that this indication is strictly limited to obese patients with a BMI ≥ 30, or those with a BMI ≥ 27 accompanied by hypertension, hyperlipidemia, and other metabolic syndromes. In other words, semaglutide is essentially part of a chronic disease treatment plan, not a "quick weight loss secret" for healthy individuals.
The pharmacological effects are indeed significant. A clinical study showed that after 68 weeks of use, participants had an average weight loss of 14.9%, with some individuals losing over 20%. However, the premise behind this is medical intervention under professional assessment and strict control, which should not be underestimated.
Behind the online craze: Why has the weight loss demand shifted to "drug dependence"?
The speed of dissemination on social media far exceeds that of medical literature. Short video platforms, celebrity interviews, and personal experience sharing all mention "losing 10 pounds in a month after using semaglutide," "not hungry, not craving, can lose weight while lying down," quickly igniting the public's impulse to use medication under weight loss anxiety.
Especially the word-of-mouth descriptions like "takeout is no longer appealing," "can't drink milk tea," and "only eat one meal a day" lead many to mistakenly believe this is a safe and magical "diet shortcut." Pharmacies have also seized the opportunity to launch "semaglutide injection pens," and even gray market transactions have emerged with sales without prescriptions and "one pen delivered to your home."
Why do people crave "drug-induced weight loss"? There are three main reasons:
First, the psychological fatigue from long-term weight loss failures. Difficulty in maintaining diets and slow results from exercise have led many into a vicious cycle of "weight fluctuations + self-denial," prompting them to seek external help.
Second, a blind spot in the awareness of "health side effects." People see the significant weight loss effects but overlook the systemic impacts of the drug on the gastrointestinal, endocrine, and emotional systems.
Third, distortion of information on social media. Many videos of "successful weight loss" do not disclose the real background, such as whether there are underlying diseases, whether there is professional guidance, or whether there has been a rebound, leading the public to mistakenly believe in the myth of "easy weight loss."
However, semaglutide is essentially a potent agonist that intervenes in human metabolism and appetite regulation, not a mild solution like weight loss coffee or health tea, and its risks should not be underestimated.
Adverse reactions emerge: What risks are hidden beyond weight loss?
Although the market research on semaglutide has confirmed its effectiveness in weight control, a series of potential adverse reactions have increasingly drawn the attention of the medical community.
1. Gastrointestinal discomfort is the most common side effect
Users often experience symptoms such as nausea, vomiting, diarrhea, and constipation. Although these reactions are mild to moderate, they significantly impact quality of life. Some individuals even experience electrolyte imbalances or decreased physical strength due to an inability to eat.
2. Increased risk of gallbladder disease
Studies have shown a positive correlation between GLP-1 agonist drugs and the incidence of gallstones and cholecystitis. Rapid weight loss itself can also increase the risk of cholesterol deposition in the bile ducts.
3. Hypoglycemia and insulin interference
Although it does not directly induce hypoglycemia, it may exacerbate hypoglycemic reactions in patients using insulin or sulfonylurea hypoglycemic agents, especially in the elderly population who need to be more vigilant.
4. Potential for thyroid C-cell lesions
Animal studies have shown a certain link between semaglutide and the risk of thyroid C-cell tumors, although there is no conclusive evidence in humans, some guidelines have listed it as a contraindication.
5. Psychological dependence and risk of eating disorders
Some individuals rebound immediately after stopping the medication, developing a "behavioral dependence" on the drug; others may develop a fear of eating, leading to mild anorexia or emotional eating disorders.
The medical community does not oppose the use of semaglutide to treat obesity, but the premise is professional assessment and continuous monitoring. If one only sees "losing weight" while ignoring the "cost," it is easy to fall into the trap of drug harm.
Not everyone can use it: Which populations should be cautious or even avoid it?
Not everyone is suitable for using semaglutide for weight loss. According to relevant drug instructions and medical consensus, the following populations need special attention:
Pregnant and breastfeeding women
There is not enough research to assess its effects on fetuses or infants, and it is recommended to stop the medication at least two months before pregnancy and to avoid use during breastfeeding.
Patients with a family history of medullary thyroid carcinoma
Due to the potential impact on C-cells, it is recommended that individuals with such a medical history completely avoid use.
Patients with a history of pancreatitis
Semaglutide may induce pancreatitis or exacerbate existing conditions, and use should be approached with caution.
Patients with severe gastrointestinal diseases
Patients with conditions such as gastroparesis or active gastric ulcers may experience exacerbated conditions due to the drug's impact on gastric emptying.
Patients with mental disorders and eating disorders
The drug may affect mood and appetite control, increasing the risk of disordered eating behaviors.
Additionally, young women with a normal BMI but simply wishing to "slim their face" or "thin their legs" should also understand: this drug is not a "weight loss beauty product," but a medical tool for those with metabolic abnormalities; use outside of medical indications may lead to long-term hidden dangers.
Successful weight loss, but health raises red flags
Ms. Wang, 29, from Shanghai, works in an office, stands 160 cm tall, weighs 62 kg, and developed the idea of "rapid weight loss" as she is about to take wedding photos. She purchased a semaglutide injection pen through a social platform, injected herself for 8 weeks without medical evaluation, and lost 7 kg.
Initially, she said, "I had no appetite and felt light," but starting from the fifth week, she frequently experienced nausea and stomach pain, which later developed into persistent bloating and jaundice, leading to an emergency hospital visit where she was diagnosed with drug-induced cholecystitis and mild pancreatitis. The doctor pointed out that her physical condition did not meet the medication indications, and the dosage was increased too quickly, causing her gastrointestinal system to be unable to adapt.
After being discharged, Ms. Wang admitted: "I lost weight, but I lost my quality of life and paid too high a price." She began to adjust her diet structure and, with the guidance of a nutritionist, restored her intestinal function, gradually overcoming the side effects.
This case is not uncommon. Currently, many people, driven by weight loss anxiety, are "over-medicalizing" their body management, forgetting that medication has never been a cost-free universal key.
The bottom line of rational medication: Standardized weight loss must return to the medical track
The World Health Organization emphasizes that weight loss is a long-term behavioral intervention project that should include nutritional adjustments, exercise plans, behavioral cognitive corrections, and, when necessary, medication assistance. As a drug, semaglutide must return to clinical scenarios and be used strictly according to regulations.
1. It must be assessed by a professional doctor to determine if it is suitable for use
Including body mass index (BMI), blood sugar status, underlying diseases, and any drug contraindications.
2. Must undergo gradual dosage adjustment and periodic management
Clinical recommendations suggest an initial dose of 0.25 mg per week, gradually increasing to a maximum of 2.4 mg, adjusted according to tolerance.
3. Must be combined with dietary and exercise interventions; otherwise, the effects are difficult to maintain
The drug can only "assist in appetite control" and cannot replace core processes such as energy expenditure and muscle maintenance.
4. Stopping the medication must be planned to avoid rebound and metabolic disorders
Abrupt cessation may lead to a rapid rebound in appetite, and it is recommended to combine behavioral interventions for a smooth transition.
5. Clearly define the weight loss goal as "healthy weight" rather than "extreme thinness"
The goal of medical intervention is to improve metabolic indicators and reduce the risk of chronic diseases, not to pursue a gaunt appearance.
Weight loss has never been a shortcut; it is a reconciliation with the threefold relationship of body, diet, and psychology. Semaglutide can serve as an "auxiliary piece" in this battle, but it is by no means a "universal winning move." Recognizing the essence of health is the only way to go further.