Why 'Just Anyone' Can't Take Slimming Injections: The Surprising Risks & Regulations You Need to Know

The emergence of a celebrated weight-loss injection claiming to be safe, side-effect-free, and suitable for anyone without the need for dieting or exercise has captured public attention. Promising rapid weight loss of up to 10 kilograms in a single month with just one weekly injection, this seemingly miraculous solution raises questions about its authenticity and suitability for all individuals. The spotlight falls on semaglutide, a long-acting glucagon-like peptide-1 (GLP-1) receptor agonist initially developed for treating type 2 diabetes but later found to have significant weight-loss properties.

Approval Status and Intended Use

While semaglutide has been approved by the US FDA for subcutaneous injection (2.4mg once a week) for weight loss since June 2021, its regulatory status in China diverges. In China, semaglutide is solely authorized for use in patients with type 2 diabetes, functioning as a hypoglycemic agent and demonstrating efficacy in reducing major cardiovascular adverse events in this population. Its application for weight loss remains unapproved.

Accidental Discovery and Mechanisms of Action

The weight-loss effect of semaglutide was serendipitously uncovered during its investigation as a hypoglycemic drug. While the exact mechanisms are not fully understood, current research points to three primary pathways:

1. Appetite suppression and reduced energy intake: By elevating satiety signals in the hypothalamus' arcuate nucleus, semaglutide curbs the rise in hunger signals, enhancing feelings of fullness and decreasing caloric consumption.
2. Gastrointestinal influence: The drug slows gastric emptying and gastrointestinal motility, decreases gastric acid secretion, and enhances satiety, ultimately reducing food intake.
3. Altered food preferences: Acting on central GLP-1 receptors, semaglutide significantly diminishes the preference and intake of high-fat or sweet foods, primarily by suppressing appetite and promoting reduced eating.

Illicit Usage and Counterfeiting Concerns

The allure of semaglutide's weight-loss potential has led to the proliferation of counterfeit products masquerading as internet celebrity medical beauty items. In January 2023, Chinese authorities in Zhuji, Zhejiang, uncovered three cases involving the sale of fake medicines labeled as "AB Light Combination" containing "semaglutide." These illegal products have infiltrated the medical aesthetics industry, causing considerable societal harm.

An organized criminal group, led by Tang Mouqiao, manufactured and sold "Qingqingsu" slimming injections containing "semaglutide" under the guise of a cosmetics company. Law enforcement seized over 16,000 bottles of "Qingqingsu" products, along with 20-plus machines and equipment valued at nearly one million yuan. The group dissolved powdered "semaglutide" in mannitol, freeze-dried it, and distributed it to beauty salons and agents nationwide as a cosmetic product.

The investigation revealed that the gang's online store in Jiangsu had sold more than 6,000 bottles of "Lightness Su," with the illicit merchandise reaching over 20 provinces across China. The case remains under active investigation as authorities continue to compile and analyze production and sales data.

Clinical Trials and International Recognition

In China, semaglutide oral preparation is undergoing a Phase III clinical trial targeting overweight or obese adults, aiming to assess the efficacy and safety of a once-daily 50mg dose. Internationally, semaglutide's recognition for weight management continues to grow. On March 30, the European Medicines Agency's Committee for Medicinal Products for Human Use recommended and approved Novo Nordisk's marketing application for semaglutide for weight control in adolescents aged 12 years and older.

Realities of Side Effects and Appropriate Usage

Contrary to online claims, semaglutide is not devoid of side effects. Gastrointestinal discomfort, such as nausea, vomiting, diarrhea, abdominal pain, indigestion, constipation, decreased appetite, and more, are the most prevalent adverse reactions. Other possible side effects include constipation, nasopharyngitis, headache, indigestion, abdominal pain, upper respiratory tract infections, hepatobiliary disorders, gallstones, injection site reactions, and, in severe cases, pancreatitis.

Usage of semaglutide for weight loss is not advised for pregnant or breastfeeding individuals, those with a history of medullary thyroid cancer, multiple endocrine neoplasms, or a family history of these diseases. Moreover, a 2022 study published in "Diabetes, Obesity and Metabolism" revealed that obese patients regain weight after discontinuing semaglutide. Mental health implications and the importance of long-term diet control and health management cannot be overlooked.

In summary, while semaglutide demonstrates promise as a weight-loss aid, its unauthorized use for this purpose in China, the proliferation of counterfeit products, and the reality of side effects and potential weight regain post-treatment emphasize the need for cautious consideration and adherence to regulatory guidelines. Proper patient selection, close monitoring, and a holistic approach to weight management are crucial for ensuring the safe and effective use of semaglutide or any weight-loss intervention.