In recent years, medications initially developed for managing type 2 diabetes have gained popularity as weight-loss solutions. Drugs like semaglutide, marketed under brand names such as Ozempic and Wegovy, have been leading this trend. Although these medications have shown effectiveness in reducing body weight, their off-label use for weight loss has raised significant concerns among healthcare professionals.
Semaglutide is a GLP-1 receptor agonist originally approved for type 2 diabetes treatment. It works by mimicking the naturally occurring hormone glucagon-like peptide 1 (GLP-1). GLP-1 helps the body produce more insulin after eating, aiding in lowering post-meal blood sugar levels. Moreover, GLP-1 slows stomach emptying, making people feel full faster and longer, and affects the brain to reduce hunger. These effects have led to weight loss as a secondary benefit.
The popularity of semaglutide as a weight-loss drug has surged, with people without diabetes seeking prescriptions for its appetite-suppressing effects. In Singapore, both Ozempic and Wegovy are approved. Ozempic is prescribed for patients with type 2 diabetes, while Wegovy is approved for patients with obesity or a BMI of 27 or higher who have weight-related medical issues such as high blood pressure or heart disease.
However, using these medications off-label for weight loss in non-diabetic individuals has raised concerns. Dr. Khoo Chin Meng, head and senior consultant at National University Hospital’s endocrinology division, noted that semaglutide is more effective than current obesity drugs and generally well-tolerated, but its cost is high—around $300 per weekly dose. Additionally, he emphasized that semaglutide does not change eating behaviors or address root causes of obesity, resulting in a high risk of weight regain once the medication is stopped.
Singapore's Health Sciences Authority (HSA) has also expressed concerns about misuse of prescription-only drugs. In response to increasing demand for drugs like Ozempic and Wegovy for weight loss, the Ministry of Health (MOH) has taken steps to ensure these medications are purchased only for prescribed medical uses. The MOH collaborates with healthcare institutions and drug companies to monitor usage patterns locally and internationally to minimize treatment disruptions and maintain drug supply resilience.
Furthermore, the HSA has previously suspended sales of certain weight-loss products due to safety concerns. For example, in 2010, sales of sibutramine products were suspended after a benefit-risk assessment indicated that increased cardiovascular risks outweighed the modest weight loss achieved. This decision followed findings from the Sibutramine Cardiovascular Outcomes (SCOUT) study, which showed modest and not clearly maintained weight loss after stopping the drug.
The off-label use of diabetes medications for weight loss highlights the need for careful consideration and regulation. While these drugs show promise for weight reduction, their use should be limited to those for whom they are approved and prescribed. Healthcare professionals and regulators continue to monitor this trend to ensure patient safety and appropriate medical treatment use.