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The Straits Time Highlights Worrisome TikTok Videos on Diabetes Medicine

Recently, a weight loss injection, commonly identified as Ozempic, has been going viral on Tik Tok with multiple users digitally documenting their journey. At approximately 400 SGD, the rave for this “miracle drug” inevitably drew criticism as people without relevant health conditions are exploiting the drug for weight loss purposes– subsequently leading to global shortages. 

diabetes medication
Diabetes drugs are the new “off-label” medication used for weight loss. Source: https://www.straitstimes.com/world/europe/tiktok-videos-on-use-of-diabetes-drug-for-weight-loss-worry-doctors 

The quest of pursuing a miracle weight loss drug never ends. The idea of popping pills and not having any food restrictions is enticing. Over the years, there have been various weight loss supplements and medications that have surfaced on the market, this includes orlistat, phentermine-topiramate, tirzepatide, naltrexone-bupropion, and many various food supplements and probiotics that claim to have weight loss effects. This phenomenon is also known as off-label drug use (OLDU).

Elon Musk
Elon Musk’s confession of using Ozempic to achieve his figure increased the popularity of OLDU. 

An eerily similar trend followed suit with liraglutide, sold as Saxenda in Singapore. Recently Saxenda was praised for its efficiency in aiding and improving the health and lifestyle of obese and diabetic patients in Singapore. However, a search on Tik Tok also shows a repetition in trend, specifically in the Southeast Asia region. Users are not just digitally documenting their journey, but also sharing their “successes” with the medication, alluring many to go down the same path. 

So what is my stance as a medical professional on Saxenda?

Whilst the misuse of these diabetes/obesity drugs does make me uncomfortable, the innovation of medical sciences is one to be celebrated not criticised. Particularly, in Singapore, Saxenda requires a doctor’s prescription to access. I place faith in the integrity of doctors in Singapore to responsibly prescribe these injections and to make them accessible to the demographic that truly needs them. This brings me to the main question; can we still consider weight loss medication safely? My answer is a firm yes. 

Managing Obesity with Saxenda in Singapore

Weight loss medication works when paired with diet modification and physical activity.

The prevalence of obesity in Singapore is uptrending. Globally, 30% of the population is overweight, with 10% being obese. In Singapore, with the stability of the country’s economy and socioeconomic conditions, we are fortunate enough to be able to enjoy a better lifestyle which includes better food options and nutrition alternatives. However, there is always a flip side to the coin as this means we could also be predisposed towards overeating, and food indulgence, leading to an increased risk of obesity.

Weight loss medication is not a substitute for diet modification and exercise. However, when used appropriately, it can complement lifestyle measures to improve a person’s weight. While regular exercises and looking after your diet are quintessential for the management of a healthy weight, it is often easier said than done. Commonly, lack of motivation and the inability to sustain a healthy long-term exercise regimen and diet plans are pitfalls of weight management. 

Less commonly, an underlying medical condition that has not been addressed can be causative of recalcitrant weight. You are encouraged to discuss your weight concern with your doctor, often medical intervention with Saxenda or other options may be suggested as an adjuvant/add-on treatment for chronic weight issues.

What is Saxenda (Liraglutide) injection actually used for?

Liraglutide has been used as a medication to control type 2 diabetes mellitus and manage chronic obesity. In type 2 diabetes mellitus, aside from controlling the blood glucose level, liraglutide also has been proven to reduce the risk of cardiovascular conditions such as stroke and heart attack.

In recent years, liraglutide has been approved and shown clinically effectively to be used as an adjuvant with diet control and exercise in the management of chronic obesity in patients.

Saxenda Singapore
Saxenda has been clinically proven for its efficiency.

How does Saxenda work? 

Saxenda, also known as Liraglutide, is under the category of GLP-1 receptor agonist (glucagon-like peptide-1 receptor agonist) medication. GLP-1 receptor agonist works by increasing the release of insulin from the beta cells of the pancreas and reducing the release of glucagon into the body. 

In a way, GLP-1 receptor agonist mimics incretin hormones in our body to encourage insulin production, reduces glucagon release, and slows down the absorption rate of nutrients into the bloodstream by reducing gastric emptying. Simply put, this creates satiety and reduces food appetite.

What are the side effects of Saxenda (Liraglutide) injection?

Most patients who are on Saxenda tolerate the medication well.

Common side effects include:

  • Abdominal bloatedness
  • Nausea or vomiting
  • Reduced appetite
  • Change of bowel habits such as constipation
  • Low blood glucose– especially if you are taking diabetic medication concurrently
  • Symptoms of low blood glucose include dizziness, weakness, hunger pangs, tremor, sweating, increased heart rate, and blurry vision.
Side effects Saxenda
Nausea is one of the common side effects of Saxenda.

Thankfully, most of the side effects improve over time when the medication is taken continuously. You can also discuss with your doctor if you experience any of the side effects, as your physician may facilitate titrating or lowering the dose or switching to another medication depending on your symptoms and concerns.

Rarely, patients may develop pancreatitis symptoms such as severe abdominal cramps, fever, severe nausea, and vomiting. Your doctor will counsel you and go into depth about the red flags and symptoms to monitor for pancreatitis when you are on Saxenda. You are encouraged to discuss with your doctor the potential side effects of Saxenda.

Who is not suitable for Saxenda (Liraglutide)? What are the contraindications for taking Saxenda (Liraglutide)?

You are not suitable for Saxenda medication if:

  • You have a drug allergy, or allergic reaction towards liraglutide, or ingredients in Saxenda.
  • You are pregnant or planning to conceive.
  • You or your family have a history of thyroid cancer, or endocrine conditions such as Multiple Endocrine Neoplasia Syndrome (MEN) type 2.

What is the difference between Saxenda (Liraglutide)  and Ozempic (Semaglutide). Which is better?

Both Saxenda and Ozempic medication fall under the GLP-1 receptor agonist category.  The pharmacological fundamental function is similar for both of the medications. 

Below are some key differences between the medications.

BrandOzempic Saxenda 
Active ingredient SemaglutideLiraglutide
DurationLong-acting Short-acting 
Conditions prescribed forType II Diabetes with cardiovascular disease Obesity 
Age suitability Adults only Adults and children (12 years and older) 
Dosing Weekly basis Daily basis 
Efficiency Studies have indicated higher efficiency 
AdministrationMedical professionalSelf-administered
Accessibility in SingaporeNot approved for weight loss or in patients without diabetes. Approved for weight loss and with patients without diabetes. 
Differences between Ozempic and Saxenda

Frequently asked questions: 

Will I get Ozempic Face with Saxenda (Liraglutide)?

Ozempic face
Ozempic face from drastic weight loss

Ozempic face is a newly coined medical term for patients who are on Ozempic medication and notice the appearance of a haggard, sunken, aged face over time. This is due to a rapid weight loss secondary to the medication, leading to loss of volume/facial tissue causing an appearance of ‘gaunt, aged’. This side effect is not solely occurring with Ozempic medication. Any rapid weight loss regimen can have a  noticeable undesirable effect. 

Do I need to take Saxenda (Liraglutide)  for life?

There is no particular time frame for the use of Saxenda for the management of obesity. Obesity can be a chronic long-term condition, hence you are encouraged to work with your physician to come up with a sustainable treatment regimen plan with Saxenda, lifestyle management with healthy eating, and regular exercise.

Is Saxenda (Liraglutide) an alternative to exercise and overeating?

Saxenda medication is not a substitute for exercise and overeating. It should be used as an additional aid together with lifestyle changes to help lower a person’s weight.

How fast does Saxenda (Liraglutide)  work?

With the treatment of Saxenda, you may notice a weight loss of at least 5% or more when the medication is used together with healthy eating habits and regular exercise over a period of 3 months. If you do not achieve such weight changes over time, your doctor may review with you the medication and weight loss regimen and advise accordingly. 

Can I stop my Saxenda (Liraglutide)  and restart subsequently?

You can stop your Saxenda if you develop any undesirable side effects or any concerns that warrant you’re unsuitable for Saxenda. Depending on your individual condition and response to the medication, your doctor may advise you to restart the medication over time.

How much weight loss should I expect when I am on Saxenda (Liraglutide)?

You are encouraged to follow up with your doctor regularly when you are on Saxenda injection medication. Upon 4 months of medication, your doctor will review your weight and clinical findings, if you have lost 5% of your weight or even more, this is a good indication that you are responding to the medication and you can consider continuing the medication. However, if there is less than a 5% loss of weight after 16 weeks of use of Saxenda medication, your doctor may discuss with you to consider other medication options.

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