Semaglutide is an injectable drug for diabetes in the class called GLP-1 analogues. Click for my overview of the class. Semaglutide is sold in the U.S. as brand name Ozempic.
Folks with diabetes taking Ozempic found that it promoted fat weight loss. Facial fat tends to fill in wrinkles, hence, younger-looking skin. Loss of fat on the face can make your skin sag and older-looking, more wrinkled, gaunt. That’s so-called Ozempic face.
Semaglutide and others in it’s class are increasingly being used by non-diabetics for weight loss, either as an injection or a pill.
To restore volume in a patient’s face, doctors will often perform noninvasive, but expensive, procedures such as injecting Radiesse and hyaluronic acid-based fillers or Sculptra injections, which stimulates collagen production. Doctors can also restore volume with a face lift or by transferring fat from other body parts to the face.
At baseline, the mean body weight was 104.8 kg, the mean BMI was 38.0, and 94.5% of participants had a BMI of 30 or higher. The mean percentage change in weight at week 72 was −15.0% (95% confidence interval [CI], −15.9 to −14.2) with 5-mg weekly doses of tirzepatide, −19.5% (95% CI, −20.4 to −18.5) with 10-mg doses, and −20.9% (95% CI, −21.8 to −19.9) with 15-mg doses and −3.1% (95% CI, −4.3 to −1.9) with placebo (P<0.001 for all comparisons with placebo). The percentage of participants who had weight reduction of 5% or more was 85% (95% CI, 82 to 89), 89% (95% CI, 86 to 92), and 91% (95% CI, 88 to 94) with 5 mg, 10 mg, and 15 mg of tirzepatide, respectively, and 35% (95% CI, 30 to 39) with placebo; 50% (95% CI, 46 to 54) and 57% (95% CI, 53 to 61) of participants in the 10-mg and 15-mg groups had a reduction in body weight of 20% or more, as compared with 3% (95% CI, 1 to 5) in the placebo group (P<0.001 for all comparisons with placebo).
Three to 7% of users stopped the drug due to side effects.
So far, effectiveness has been shown in only one placebo-controlled trial. Diet and exercise must be continued. It doesn’t work well for everyone: 6 out of 10 users lost at least 5% of their body weight; the other 4 didn’t. It appears to have fewer side effects than other weight loss products. Not a way to achieve ideal weight, but probably worth trying for patients who understand that it is only an aid and not a final solution. I hope they will be encouraged enough by a 22-pound weight loss to continue losing weight with or without Plenity.
Overweight and obese folks with diabetes also tend to lose weight with the new once-weekly injection therapy called tirzepatide, brand name Moujaro. (Where do they get these names?!) And remember that bariatric surgery is often very effective at weight loss and controlling diabetes…if you survive the operation.
Right off the bat, I don’t like that they studied both diabetics and prediabetics. There were only 40 original study participants, with complete data on only 33. Why lump the two together?
Participants followed each diet for 12 weeks then lab data and body weight were assessed.
The researchers conclusions:
HbA1c [a measure of blood sugar control] was not different between diet phases after 12-weeks, but improved from baseline on both diets, likely due to several shared dietary aspects. WFKD [ketogenic diet] was beneficial for greater decrease in triglycerides, but also had potential untoward risks from elevated LDL-C, and lower nutrient intakes from avoiding legumes, fruits, and whole intact grains, as well as being less sustainable.
Triglycerides dropped more on the keto diet, no surprise. Body weight dropped the same for both diets, 7-8%. HDL-cholesterol (the “good cholesterol”) rose 11% on keto and 7% on Mediterranean diet. HgbA1c dropped the same on both diets, about 8% from baseline. Both diets lead to eating ~300 calories less per day than baseline consumption.
The authors reported that LDL “dangerously” rose 10% on the keto diet. But was it really a dangerous change? Triglycerides went down on the keto diet, as we would expect. And as we saw in 2018 with the Virta Health trial, on average, LDL went up 10%. However, the calculated cardiac risk score went down 12%.
In terms of answering the headline question, Keto Versus Mediterranean Diet: Which Is Best for T2 Diabetics and Prediabetics?, the answer really depends on long-term data concerning longevity and various diseases. This study doesn’t answer the question.
Tomorrow is March 5th and it is five years since I began my personal health and weight recovery journey that I’ve dubbed “A Dietitian’s Journey“. While it began in 2017, in a way it still continues today and that is the point behind this post.
Five years ago, I was obese, had type 2 diabetes for the previous 8 years, and had developed dangerously high blood pressure.
Recommended. You’ll find out if low-carb eating put her diabetes into remission.
Judicious wine consumption is one component of the traditional healthy Mediterranean diet
Researchers compared three low-calorie diets and concluded that the Mediterranean option was the healthiest. The study at hand today is way too small to be considered anything but a pilot study. So results may not be replicable on a larger scale. I’d like to know how compliant study subjects were with the protocol, because 700 calories a day for six weeks is quite a challenge.
Comparison of short-term hypocaloric high-protein diets with a hypocaloric Mediterranean diet: Effect on body composition and health-related blood markers in overweight and sedentary young participants
Highlights
A hypocaloric Mediterranean diet provides all the necessary nutrients.
The hypocaloric Mediterranean diet reduces body mass and fat mass and maintains fat-free mass.
The hypocaloric Mediterranean diet is beneficial on metabolic and inflammation/muscle- damage indices.
Hypocaloric high-protein diets with and without whey supplementation reduce body mass and fat-free mass but not fat mass.
Hypocaloric high-protein diets with and without whey supplementation are adverse on metabolic and inflammation/muscle-damage indices
Abstract
Objectives
The aim of the present study was to compare the short-term effects of a hypocaloric Mediterranean diet and two high protein diets, with and without whey protein supplementation, on body composition, lipidemic profile, and inflammation and muscle-damage blood indices in overweight, sedentary, young participants.
Methods
Thirty-three young, overweight, male and female participants (mean ± SD age: 22.8 ± 4.8 y; body mass: 85.5 ± 10.2 kg; body fat percentage: 34.3% ± 8.1%) were randomly allocated to three different hypocaloric (−700 kcal/d) diets: a Mediterranean diet (MD; n = 10), a high-protein diet (HP; n = 10) diet, and a high-protein diet with whey supplementation (n = 10). The intervention lasted 6 wk. Body composition and biochemical indices were evaluated 1 wk before and after the nutritional interventions.
Results
Body and fat mass were decreased in the MD and HP groups (−3.5% ± 1.1% and −5.9% ± 4.2% for body and fat mass respectively in MD, and −1.7% ± 1.2% and −2.0% ± 1.8% for body and fat mass respectively in HP;P < 0.05), with no significant decline of fat-free mass observed in the MD group. The MD group’s diet beneficially altered the lipid profile (P < 0.05), but the HP and HPW groups’ diets did not induce significant changes. Subclinical inflammation and muscle-damage indices significantly increased in the HP and HPW groups (7.4% ± 3.5% and 66.6% ± 40.1% for neutrophils and CRP respectively in HP, and 14.3% ± 6.4% and 266.6% ± 55.1% for neutrophils and CRP respectively in HPW; P < 0.05) but decreased in the MD group (1.8% ± 1.2% and −33.3% ± 10.1% for neutrophils and CRP respectivelyc; P < 0.05). Energy intake of carbohydrates and proteins were significantly related to the changes in body composition and biochemical blood markers (r = −0.389 and −0.889; P < 0.05).
Conclusions
Among the three hypocaloric diets, only the Mediterranean diet induced positive changes in body composition and metabolic profile in overweight, sedentary individuals.
Steve Parker, M.D.
PS: I haven’t read the full report and don’t plan to any time soon.
Semaglutide and liraglutide are drugs that were developed to treat diabetes and are FDA-approved for that. They are given by subcutaneous injection. Semaglutide is also FDA-approved for weight loss in non-diabetics if certain conditions are met.
Once-weekly semaglutide outperformed daily liraglutide in overweight and obese non-diabetics.
Question Among adults with overweight or obesity without diabetes, what is the effect of once-weekly subcutaneous semaglutide, 2.4 mg, vs once-daily subcutaneous liraglutide, 3.0 mg, on weight loss when each is added to counseling for diet and physical activity?
Findings In this randomized clinical trial that included 338 participants, mean body weight change from baseline to 68 weeks was –15.8% with semaglutide vs –6.4% with liraglutide, a statistically significant difference.
Meaning Among adults with overweight or obesity without diabetes, once-weekly subcutaneous semaglutide, compared with once-daily subcutaneous liraglutide, added to counseling for diet and physical activity resulted in significantly greater weight loss at 68 weeks.
For prevention or improvement of overweight- and obesity-related illnesses, aim for loss of at least 5 to 10% of body weight. Assuming you’re overweight or obese in the first place. 16% body weight change is significant. 16% of 300 pounds (136 kg) would be 48 pounds (22 kg).
Steve Parker, M.D.
PS: My book’s less expensive than those drugs. And no needles!
…according to U.S. News & World Report. Click through if interested in the two runners-up. I think a low-carb version of Mediterranean is better for most folks.
Olives, olive oil, and vinegar: classic Mediterranean foods
I’m surprised they ranked Atkins as the “Best Fast Weight-Loss Diet.” Looks like we’re getting over our collective phobia about saturated fat. “Keto Diet” ranked #4 in that category.
I met a patient at the hospital recently who was taking semaglutide. I asked how long he had diabetes and he told me he didn’t have diabetes: his PCP (primary care physician) was prescribing it for weight loss.
A recent study enrolled 1,961 obese non-diabetics and found a very significant weight loss difference compared to the placebo group. I expect Novo Nordisc will be asking for FDA approval to market semaglutide, originally for diabetes, as a weight-loss drug. But what happens after you quit taking the drug? I bet you know.
In participants with overweight or obesity, 2.4 mg of semaglutide [injected] once weekly plus lifestyle intervention was associated with sustained, clinically relevant reduction in body weight.
The title above sums it up. If you’re eating pasta frequently and trying to lose weight, you do have to be careful not to over-eat. In other words, you generally have to restrict calories. In the study at hand, I don’t know how many daily calories were allowed since I haven’t read the full report. Here’s the abstract:
Background & aims
The effect of pasta consumption within a low-energy [read: calorie-restricted] Mediterranean diet on body weight regulation has been scarcely explored. This paper investigates the effect of two Mediterranean diets, which differed for lower or higher pasta intake, on body weight change in individuals with obesity.
Methods & Results
Forty-nine volunteers finished a quasi-experimental 6-month two–parallel group dietary intervention. Participants were assigned to a low-energy high pasta (HP) or to a low-energy low Pasta (LP) group on the basis of their pasta intake (HP ≥ 5 or LP ≤ 3 times/week). Anthropometrics, blood pressure and heart rate were measured every month. Weight maintenance was checked at month 12. Body composition (bioelectrical impedance analysis, BIA), food intake (24-h recall plus a 7-day carbohydrate record) and the perceived quality of life (36-item short-form health survey, SF-36) were assessed at baseline, 3 and 6 months. Blood samples were collected at baseline and month 6 to assess glucose and lipid metabolism. After 6-month intervention, body weight reduction was −10 ± 8% and −7 ± 4% in HP and LP diet, respectively, and it remained similar at month 12. Both dietary interventions improved anthropometric parameters, body composition, glucose and lipid metabolism, but no significant differences were observed between treatment groups. No differences were observed for blood pressure and heart rate between treatments and among times. HP diet significantly improved perception of quality of life for the physical component.
Conclusions
Independent of pasta consumption frequency, low-energy Mediterranean diets were successful in improving anthropometrics, physiological parameters and dietary habits after a 6-month weight-loss intervention.
“[The Armor of God] Finally, be strong in the Lord and in his mighty power. Put on the full armor of God, so that you can take your stand against the devil’s schemes.”
Diabetic Mediterranean Diet 