Key Takeaways:

• Lifestyle modifications, bariatric surgery, and medications are some of the main options for individuals to lose weight.

• Medications currently approved in Singapore include phentermine, orlistat, and naltrexone-buproprion. The most recently approved was semaglutide (Wegovy). Like liraglutide (Saxenda), this is a type of medication known as a GLP-1 receptor agonist, or GLP-1RA.

• GLP-1RAs help to reduce the amount that you eat, which leads to weight loss.

Obesity is known to be a major risk factor for a number of different chronic diseases, including diabetes. However, many people struggle to lose excess weight. Factors like genetics play a significant role in determining a person’s body weight, and some people find it much harder to lose weight than others do.

For years, physicians had little to offer people who were struggling with obesity, beyond simply telling them that losing weight would improve their health. That’s changed in recent years, with the development of new methods that can help people who are struggling to lose excess weight. There are now both surgical and medical options that can be useful.

What are the options for obesity treatment?

For a person trying to lose weight, there are a few main options:

• Lifestyle modifications, such as dietary changes and increased exercise. Health coaching may help some people to achieve weight loss through these methods.

• Bariatric surgery. There are a few different types of surgery that can be used for weight loss. These include less invasive options like intragastric balloons and gastric sleeves, as well as more invasive gastric bypass surgery. Serious complications of these procedures can occur, and some procedures have permanent side effects. 

• Medications. Several different types of medications are currently approved in Singapore for weight loss. The most recently approved was semaglutide (Wegovy). Like liraglutide (Saxenda), this is a type of medication known as a GLP-1 receptor agonist, or GLP-1RA. Other medication options include phentermine, orlistat, and naltrexone-buproprion.

Semaglutide (in the form of Wegovy) is the most recently approved medication for weight loss in Singapore

Until recently, semaglutide  in the form of (Ozempic and /Rybelsus) was only approved in Singapore for treating diabetes. However, weight loss was known to be a common effect of this medication. In 2021, a form of semaglutide called Wegovy was approved specifically for weight loss in the US. Wegovy is made by the same manufacturer that also produces Ozempic, and contains the same active ingredient (semaglutide). The difference is primarily in the dose – the target dose of Wegovy is somewhat higher than that of Ozempic.

In Singapore, until very recently, we only had two versions of semaglutide available. Ozempic is given by injection once per week, while Rybelsus is a tablet that’s taken daily. Both of these are intended to treat diabetes, and while they may cause weight loss as a side effect, they’re not prescribed specifically for weight loss. With the approval of Wegovy, we can now use semaglutide specifically for weight loss, with the effects on blood sugar control being seen as a beneficial side effect.

Another GLP-1RA called liraglutide (Saxenda) was approved for weight loss in Singapore in mid-2022. This is given as a daily injection.

How do GLP-1RAs work for weight loss?

GLP-1RAs mimic a natural hormone called glucagon-like peptide 1, or GLP-1. This has a few different effects in the body. GLP-1RAs:

• Slow down emptying of the stomach after a meal, helping you to feel full for longer.

• Reduce cravings and emotional eating.

• Stimulate the pancreas to secrete insulin.

• Block the release of sugar from the liver.

Ultimately, GLP-1RAs help to reduce the amount that you eat, which leads to weight loss. In addition, they help to control blood sugar. Many people who are significantly overweight also have type 2 diabetes, and this class of medications can be useful for treating both problems.

What other drugs are available for weight loss?

Although GLP-1RAs like semaglutide and liraglutide are effective for weight loss, there are also other medication options that are approved for weight loss in Singapore. 

Most medications for weight loss work by suppressing appetite. Phentermine is a stimulant, which works by a mechanism similar to that of amphetamines. Although it is effective for weight loss, it tends to cause side effects, and carries a potential for addiction. Phentermine is usually only used for the short term, because long-term use can lead to serious issues such as heart problems. 

Another approved option is a combination of two medications, bupropion and naltrexone. Bupropion is an antidepressant, and naltrexone blocks certain receptors in the nervous system. It’s believed that the combination works by acting in the brain to reduce hunger and to alter the brain’s perception of reward related to food, which makes you less motivated to eat unhealthy foods.

Another medication, known as orlistat, works differently. This medication reduces the absorption of fat in the digestive tract, by blocking the action of an enzyme that breaks down dietary fat. This can lead to unpleasant digestive side effects related to the undigested fat passing through your intestines. Orlistat requires people to adhere to a low-fat diet to avoid these side effects, and many people find this difficult to stick to for the long term. In addition, it can lead to deficiencies of certain fat-soluble vitamins.

FAQs about semaglutide (Wegovy)

What are the advantages of semaglutide?

Although there are other medical and surgical weight loss options, semaglutide’s biggest advantage is that in addition to stimulating weight loss, it also helps to control blood sugar. Besides this, it’s considered to be a very safe medication, with a low risk of serious side effects. Studies have shown that semaglutide is better tolerated than other options, including liraglutide and bupropion-naltrexone.

Weight loss effects of semaglutide

Semaglutide is effective for weight loss, but it’s not a “magic bullet” that will immediately remove all excess weight. It’s important to be realistic about what to expect on semaglutide. A study published in 2022 showed that people taking semaglutide lost an average of 5.9% of their body weight at three months, and 10.9% at six months. If you currently weigh 100kg, this means that you can expect to lose approximately 11kg after six months on semaglutide.

How to get the most benefit out of semaglutide?

Semaglutide is most effective when it’s used alongside lifestyle changes, such as increased exercise and eating a healthy diet. Many people struggle to create and stick to a healthy lifestyle plan. It may be helpful to have the support of a dietitian and/or health coach to assist with this.

What are the potential side effects of semaglutide?

Although semaglutide is considered to be a very safe medication overall, side effects certainly can occur. Most are mild, such as digestive effects, headaches, and weakness during exercise. The majority of people can manage these effects through small tweaks to their lifestyle, and these effects also tend to resolve over time. More serious side effects are rare, but it’s important to be aware that they are possible.

Where can I get semaglutide in Singapore?

Not all clinics in Singapore are currently offering Wegovy. If you’re interested in this weight loss option, then you’ll need to ensure that you choose a clinic that offers it. It’s always important to receive a medical evaluation prior to starting semaglutide, to ensure that it’s a safe and appropriate option for you.

Who is eligible?

To be considered a candidate for semaglutide in Singapore, you need to have a body mass index (BMI) of at least 30, meaning that you’re obese. Alternatively, you can have a BMI of at least 27, along with at least one weight-related medical condition (such as type 2 diabetes, high blood pressure, or high cholesterol). Wegovy is approved for weight loss in conjunction with healthy lifestyle changes, so if you’re prescribed this medication, you should also receive support in creating and maintaining a healthy lifestyle plan.

Our NOVI Optimum Plus program is designed to help people achieve weight loss through a combination of medications and lifestyle changes.