New trials show an oral form of a popular weight loss drug matches the injectable’s effectiveness, but as access expands, doctors advise it must still be used as a chronic disease treatment, not a quick cosmetic fix.
Novo Nordisk, a leading global pharmaceutical company, recently presented findings from the OASIS 4 phase 3 trial showing that their Wegovy weight-loss pill can potentially be used as an effective alternative to the injectable form.
The trial found that people taking 25mg of oral semaglutide — marketed as Wegovy in South Africa, and with the same active ingredient as Ozempic — saw larger improvements in blood sugar, blood pressure, and heart-related risk factors than those on a placebo, with the strongest benefits seen in those who lost at least 15% of their body weight.
Domenica Rubino, trial investigator and director at the Washington Centre for Weight Management and Research in Virginia, noted that the trial results demonstrated the weight loss efficacy of oral semaglutide as a potential therapeutic option for people with obesity and those overweight.
Ankia Coetzee, an endocrinologist at Stellenbosch University, said semaglutide works by mimicking a natural hormone called GLP-1 (glucagon-like peptide-1 receptor agonist), which helps regulate metabolism. The drug slows the stomach’s emptying, helping people feel full longer.
It also reduces food cravings by acting on the brain’s appetite centres, calming so-called “food noise”, and improves blood sugar control by increasing insulin secretion from the pancreas and lowering glucagon. She said the combination of these effects supports weight loss and helps manage cravings.
According to the World Health Organisation, GLP-1 weight loss drugs like semaglutide are now approved for treating obesity and weight loss, but were originally used for managing type 2 diabetes.
If someone’s got a normal BMI and they want to lose weight because they want to look better, the risk-benefit ratio sort of changes, and we’re potentially going to see problems with these drugs
— Ankia Coetzee, endocrinologist at Stellenbosch University
Particularly in the US, GLP-1 medications have surged in popularity. According to The BMJ, the number of non-diabetic patients starting GLP-1 treatment increased by 700% between 2019 and 2023. The Aesthetic Surgery Journal reports that this rise has been driven in part by social media and celebrity influencers promoting the off-label use of these drugs for cosmetic weight loss.
“If someone’s got a normal BMI and they want to lose weight because they want to look better, the risk-benefit ratio sort of changes, and we’re potentially going to see problems with these drugs,” Coetzee cautioned.
She said the medication was intended for individuals with a BMI above 27 who have at least one weight-related comorbidity, or for those with a BMI of 30 or higher, regardless of additional health conditions. “If you use it for the right person at the right time, the benefits, by far, outweigh the potential risks.”
She noted that the main risks include gastrointestinal side effects such as nausea, vomiting, diarrhoea, constipation, and bloating, with dehydration a concern in cases of severe vomiting.
Coetzee said older weight loss drugs often worked by artificially boosting metabolism or energy, which could cause serious side effects like heart problems and high blood pressure.
In contrast, newer GLP-1 medications work by enhancing the body’s natural hormonal system, improving appetite control, cardiovascular health, and kidney function, making them safer and more effective for managing metabolic health. “I think the problem is that for a long time, we didn’t realise that being overweight and obesity are also chronic diseases.”
Coetzee said medical professionals used to put people with these conditions into a corner by instructing them to “just eat less, and move more”.
Sara Norcross, general manager at Novo Nordisk South Africa, said the results “build on existing clinical trial evidence for semaglutide, and extend findings beyond weight loss to suggested improvements in overall health”.
This pill is not yet approved by the South African Health Products Regulatory Authority, but in February, Novo Nordisk made an application for the formulation in the US for review, which is anticipated to be completed by the end of the year.
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