The weight-loss drug Wegovy is now available in Australia.

Wegovy is administered as a once-weekly injection and is approved specifically for weight management. It’s intended to be used in combination with a reduced-energy diet and increased physical activity.

So how does Wegovy work and how much weight can you expect to lose while taking it? And what are the potential risks – and costs – for those who use it?

Let’s look at what the science says.

What is Wegovy?

Wegovy is a brand name for the medication semaglutide. Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA). This means it makes your body’s own glucagon-like peptide-1 hormone, called GLP-1 for short, work better.

Normally when you eat, the body releases the GLP-1 hormone which helps signal to your brain that you are full. Semaglutides enhance this effect, leading to a feeling of fullness, even when you haven’t eaten.

Another role of GLP-1 is to stimulate the body to produce more insulin, a hormone which helps lower the level of glucose (sugar) in the blood. That’s why semaglutides have been used for several years to treat type 2 diabetes.

How does Wegovy differ from Ozempic?

Like Wegovy, Ozempic is a semaglutide. The way Wegovy and Ozempic work in the body are essentially the same. They’re made by the same pharmaceutical company, Novo Nordisk.

But there are two differences:

1) They are approved for two different (but related) reasons.

In Australia (and the United States), Ozempic is approved for use to improve blood glucose levels in adults with type 2 diabetes. By managing blood glucose levels effectively, the medication aims to reduce the risk of major complications, such as heart disease.

Wegovy is approved for use alongside diet and exercise for people with a body mass index (BMI) of 30 or greater, or 27 or greater but with other conditions such as high blood pressure.

Wegovy can also be used in people aged 12 years and older. Like Ozempic, Wegovy aims to reduce the risk of future health complications, including heart disease.

2) They are both injected but come in different strengths.

Ozempic is available in pre-loaded single-dose pens with varying dosages of 0.25 mg, 0.5 mg, 1 mg, or 2 mg per injection. The dose can be slowly increased, up to a maximum of 2 mg per week, if needed.

Wegovy is available in prefilled single-dose pens with doses of 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, or 2.4 mg. The treatment starts with a dose of 0.25 mg once weekly for four weeks, after which the dose is gradually increased until reaching a maintenance dose of 2.4 mg weekly.

While it’s unknown what the impact of Wegovy’s introduction will be on Ozempic’s availability, Ozempic is still anticipated to be in low supply for the remainder of 2024.

Is Wegovy effective for weight loss?

Given Wegovy is a semaglutide, there is very strong evidence it can help people lose weight and maintain this weight loss.

A recent study found that over four years, participants taking Wevovy as indicated experienced an average weight loss of 10.2% body weight and a reduction in waist circumference of 7.7cm.

For those who stop taking the medication, analyses have shown that about two-thirds of weight lost is regained.

What are the side effects of Wegovy?

The most common side effects are nausea and vomiting.

However, other serious side effects are also possible because of the whole-of-body impact of the medication. Thyroid tumours and cancer have been detected as a risk in animal studies, yet are rarely seen in human scientific literature.

In the four-year Wegovy trial, 16.6% of participants who received Wegovy (1,461 people) experienced an adverse event that led to them permanently discontinuing their use of the medication. This was higher than the 8.2% of participants (718 people) who received the placebo (with no active ingredient).

Side effects included gastrointestinal disorders (including nausea and vomiting), which affected 10% of people who used Wegovy compared to 2% of people who used the placebo.

Gallbladder-related disorders occurred in 2.8% of people who used Wegovy, and 2.3% of people who received the placebo.

Recently, concerns about suicidal thoughts and behaviours have been raised, after a global analysis reviewed more than 36 million reports of adverse events from semaglutide (Ozempic or Wegovy) since 2000.

There were 107 reports of suicidal thoughts and self-harm among people taking semaglutide, sadly including six actual deaths. When people stopped the medication, 62.5% found the thoughts went away. What we don’t know is whether dose, weight loss, or previous mental health status or use of antidepressants had a role to play.

Finally, concerns are growing about the negative effect of semaglutides on our social and emotional connection with food. Anecdotal and scientific evidence suggests people who use semaglutides significantly reduce their daily dietary intake (as anticipated) by skipping meals and avoiding social occasions – not very enjoyable for people and their loved ones.

How can people access Wegovy?

Wegovy is available for purchase at pharmacists with a prescription from a doctor.

But there is a hefty price tag. Wegovy is not currently subsidised through the Pharmaceutical Benefits Scheme, leaving patients to cover the cost. The current cost is estimated at around A$460 per month dose.

If you’re considering Wegovy, make an appointment with your doctor for individual advice.

Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Emily Burch, Accredited Practising Dietitian and Lecturer, Southern Cross University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Rice is a culinary staple in Australia and around the world.

It might seem like a given that brown rice is healthier than white and official public health resources often recommend brown rice instead of white as a “healthy swap”.

But Australians definitely prefer white rice over brown. So, what’s the difference, and what do we need to know when choosing rice?

What makes rice white or brown?

Rice “grains” are technically seeds. A complete, whole rice seed is called a “paddy”, which has multiple parts:

1. the “hull” is the hard outer layer which protects the seed
2. the “bran”, which is a softer protective layer containing the seed coat
3. the “germ” or the embryo, which is the part of the seed that would develop into a new plant if was germinated
4. the “endosperm”, which makes up most of the seed and is essentially the store of nutrients that feeds the developing plant as a seed grows into a plant.

Rice needs to be processed for humans to eat it.

Along with cleaning and drying, the hard hulls are removed since we can’t digest them. This is how brown rice is made, with the other three parts of the rice remaining intact. This means brown rice is regarded as a “wholegrain”.

White rice, however, is a “refined” grain, as it is further polished to remove the bran and germ, leaving just the endosperm. This is a mechanical and not a chemical process.

What’s the difference, nutritionally?

Keeping the bran and the germ means brown rice has more magnesium, phosphorus, potassium B vitamins (niacin, folate, riboflavin and pyridoxine), iron, zinc and fibre.

The germ and the bran also contain more bioactives (compounds in foods that aren’t essential nutrients but have health benefits), like oryzanols and phenolic compounds which have antioxidant effects.

But that doesn’t mean white rice is just empty calories. It still contains vitamins, minerals and some fibre, and is low in fat and salt, and is naturally gluten-free.

White and brown rice actually have similar amounts of calories (or kilojoules) and total carbohydrates.

There are studies that show eating more white rice is linked to a higher risk of type 2 diabetes. But it is difficult to know if this is down to the rice itself, or other related factors such as socioeconomic variables or other dietary patterns.

What about the glycaemic index?

The higher fibre means brown rice has a lower glycaemic index (GI), meaning it raises blood sugar levels more slowly. But this is highly variable between different rices within the white and brown categories.

The GI system uses low (less than 55), medium (55–70) and high (above 70) categories. Brown rices fall into the low and medium categories. White rices fall in the medium and high.

There are specific low-GI types available for both white and brown types. You can also lower the GI of rice by heating and then cooling it. This process converts some of the “available carbohydrates” into “resistant starch”, which then functions like dietary fibre.

Are there any benefits to white rice?

The taste and textural qualities of white and brown rices differ. White rice tends to have a softer texture and more mild or neutral flavour. Brown rice has a chewier texture and nuttier flavour.

So, while you can technically substitute brown rice into most recipes, the experience will be different. Or other ingredients may need to be added or changed to create the desired texture.

Removing more of the outer layers may also reduce the levels of contaminants such as pesticides.

We don’t just eat rice

Comparing white and brown rice seems like an easy way to boost nutritional value. But just because one food (brown rice) is more nutrient-dense doesn’t make the other food (white rice) “bad”.

Ultimately, it’s not often that we eat just rice, so we don’t need the rice we choose to be the perfect one. Rice is typically the staple base of a more complex dish. So, it’s probably more important to think about what we eat with rice.

Adding vegetables and lean proteins to rice-based dishes can easily add the micronutrients, bioactives and fibre that white rice is comparatively lacking, and this can likely do more to contribute to diet quality than eating brown rice instead.

Emma Beckett, Adjunct Senior Lecturer, Nutrition, Dietetics & Food Innovation – School of Health Sciences, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.