Happy Fall, everyone. I thought we could take a look at the latest developments on what’s driving weight gain and two new medications that may revolutionize its treatment.
Roughly 40% of the U.S. adults have obesity. Another 30% are overweight. Extra pounds raise the risk of type 2 diabetes, heart disease, stroke, several cancers and more.
How many healthcare professionals and patients consider obesity to be a lifestyle disease, that they lack will power, if they can push food away they wouldn’t have a problem. However, obesity is a really complex disease. There have also been many myths about obesity, and it’s not about an absence of will power or an in ability to count calories and it’s probably not about carbs or fats.
We need to recognize obesity as a disease takes the onus away from personal responsibility and places it on the conditions that are driving the problem.
The brain plays a key role in food intake and in what weight our bodies are defending.
Genes also play a role in part by making some people more or less susceptible to what many call a toxic food environment. Portion size and availability of highly processed, high caloric food have grown. In the past people ate 3 meals a day and maybe a snack, now people eat all day long and the nature of our food changed. There are psychological changes on long term obesity that counteract weight loss no matter what someone does.
Game-Changing drugs
New drug called tirzepatide (sold by Eli Lilly as Mounjaro) to people with T 2 diabetes. The drug was approved by the FDA in May. Patient inject under the skin weekly to treat Type 2 diabetes. In clinical trials it reduced A1c levels even more than taking insulin. It is not approved for weight loss but this may happen soon. Recent SURMOUNT-1 trail roughly 18 months, the average participant injecting 10-15 mg per week roughly lost 20% of their initial weight. (Participants were advised to cut 500 calories a day and exercise 150 minutes each week)
That was 45 pounds for average participant who started the trial at around 230 pounds. The magnitude of weight loss was similar to what patients can expect with gastric bypass surgery. The drug also lowered bloods pressure, LDL cholesterol, Fasting insulin, and A1c.
In 2021, the FDA approved semaglutide (sold as Wegovy by Novo) for weight loss. It’s also sold as Ozempic to treat Type 2 diabetes.
In the clinical trials participants lost an average of 15% of their initial weight or about 35 pounds after 68 weeks. (Participants were advised to cut 500 calories a day and exercise 150 minutes each week).
The drug is costly, $1,350 per month- not many insurances cover the cost.
Both drugs are versions of GLP-1 - naturally occurring hormone that is released by cells in the small intestine when food, carbohydrates hits the stomach.
GLP-1 follow 3 pathways-
- Signals the pancreas to release insulin to pick up the glucose that’s coming in.
- It slows gastric emptying which leads to greater feeling of fullness.
- It hits a part of the brain that stimulates fullness earlier
Naturally occurring GLP-1 is active for only two – three minutes after eating. Half of the semaglutide injecton is still in your system after a week.
Tirzepatide.
It combines longer acting versions of both GLP-1 and glucose-dependent insulinotropic peptide (GIP), another natural occurring hormone.
GIP stimulates insulin release when blood sugar levels are high, so it improves glucose tolerance. It also acts on the brain and seem to regulate fat tissue storage.
It leads to more weight loss that semaglutide, in the SURPRASS 2 trail, it was superior to semaglutide at lowering long term blood sugar levels.
Precautions:
Thyroid cancer- thyroid tumors seen in rat studies.
GI symptoms- 45-50% experience nausea, 25% vomiting
Gallestones – GLP-1 drugs make the gallbladder empty more slowly
Weight loss is not permanent. Stop the drug and weight starts to come back.
No one knows what being on the drugs for 5-10 years will be like. Will there be severe side effects that was seen with weight loss drugs that were pulled off the market. Pondimin and Redux damaged heart valves, Belviq raised the risk of cancer, and Meridia increased risk for stroke. Researchers are optimistic about the new drugs potential. If long term studies show that these drugs are effective and concerning adverse events don’t emerge over time, they could be game changers in weight loss management.
Sharon Brecosky