By Robert P. Belin, M.D. Chairperson, Health and Wellness Breckenridge, Golf and Tennis Club, and member of Engage Estero’s Health Council
For the first time, the FDA has approved medication for weight loss! So, why is this important and in the news non-stop? It’s important because, with obesity, there are 1) many associated medical problems, 2) emotional image problems, and 3) an economic impact.
Approximately 42% of our U.S. adult population is obese, and predicted to continue to increase! It’s even greater for the Black community, although for Asians, it’s only 16%! Obesity is defined as having a BMI between 18.5 and 24.9. BMI is a calculated ratio between your height and weight and is non-gender specific. A BMI calculator is readily available online by googling- BMI Calculator.
Why do we even care? We care because almost every illness that can afflict us is significantly increased with obesity. A couple of examples of obesity complications – heart failure is 33% more likely, cancer 10% more likely, especially colon and breast, and 50% of the obese will become diabetic! In addition, the economics of obesity is huge – the U.S. spends on health issues almost $4,000 per obese individual per year! And the personal cost of medication, currently, is $1,200 – $1,500 per month for life. If medication is discontinued, the weight returns. Therefore, the suggested use is forever once it’s initiated.
The two major drugs that the FDA currently approves are these:
1) Zepbound (brand) Tirzepatide (scientific) – Eli Lilly and
2) Wegovy (brand) Semagentide (scientific) – Novo Nordisk.
In addition, each company has an approved drug for diabetes – both for control and weight loss. Mounjaro (Lilly’s) and Ozempic (Novo’s) and, interestingly, they are chemically identical to their respective weight loss drug. The fact that they are identical has led to significant confusion and even abuse! This class of drugs is called GLPs (glucagon like peptide).
Even though these drugs have been tested extensively worldwide over the years, there are complications, as there are with all medications, even aspirin! Fortunately, most complications are not major and not common. Probably the most common to varying degrees is gastric reflux (GERD) due to the slow emptying of the stomach, which ironically is one of the very desirable effects!
To appreciate the benefits of GLPs, a brief non-scientific explanation of how the GLPs function is necessary. They improve the integration, efficiency, and output of the body’s systems, including the stomach (slows emptying), brain, liver, heart, blood vessels, kidneys, pancreas, and intestines!
Some benefits are decreasing body weight, blood pressure, plasma glucose (blood sugar), sleep apnea, markedly reducing the incidence of heart attacks, and markedly slowing stomach emptying while improving lipid numbers and decreasing diabetic neuropathy! It’s been reported that even sleep apnea was improved or cured!
It has recently been reported that GLPs have demonstrated, in clinical studies, numerous cardiovascular protective effects for those with or without diabetes, which is an important added benefit.
It’s important to appreciate that obesity has multiple and varied causal factors. It is NOT a social problem—while diet, exercise, and lifestyle are still important ingredients to management, effective medication is now available for the first time.
Summary, Trip Wires and the Future:Beware of knockoffs, fakes, and compounded products, as abuse can easily occur. These new medications should NOT be used for cosmetic weight loss. Who should pay – insurance, government, individuals? For now, the GLPs are only available as injectables. Will there be an oral preparation? Yes, that seems highly likely, as several companies are already conducting clinical trials on oral preparation. Should there be a minimum age for use, and who is eligible? Who should mandate the control?
Although currently only available for type II diabetes, will it be appropriate and approved for type I diabetes in the future? Will the fast food and snack industry be affected? Will it significantly impact the insurance industry? And finally, will the word obesity become unacceptable and eventually be replaced by something more PC (politically correct)?
But remember, patients who take new medications to reduce their weight need to appreciate the need to involve lifestyle modification with their treatment for several reasons. Firstly, healthy eating patterns and physical activity offer important additional benefits, enhancing a patient’s health and well-being. In addition, regular specialist counselling in lifestyle modification will help patients maintain their motivation levels and develop specific skills for addressing obstacles during the lengthy process of weight loss and maintenance and improving outcomes in the long term. Taking weight loss medication while continuing to eat excessively, including fast-foods, fatty foods and a high meat intake will be counter-productive!
