Anti-obesity Drugs - Do they work??

?New types of medicines have been life-changing for many people who have struggled with weight. They are anti-obesity medications, and what makes them unique is how they are prescribed: They are used to treat obesity as a chronic metabolic disorder.

?Tirzepatide, which has been used under the brand name Mounjaro? for type 2 diabetes. In November 2023, it was approved by the Food and Drug Administration (FDA) under the name Zepbound? for chronic weight loss management. According to a study published in The New England Journal of Medicine, use of tirzepatide in the trial resulted in more than a 20% weight reduction in those with obesity—an average of 52 pounds per person.

Another medication, semaglutide, was approved for weight loss as Wegovy? in 2021. Semaglutide is given once a week by self-injection. It doesn’t work for everyone, but when it’s successful, it can help someone shed 15% of their body weight. (If you weigh 200 pounds, for example, that would be 30 pounds.)

It mimics a hormone called glucagon-like peptide-1 (GLP-1), which is secreted in the gut and targets receptors throughout the body, including the brain. When an individual is eating, GLP-1 sends the brain the “I’m full” signal, Dr. Jastreboff says. Semaglutide also decreases “gastric emptying,” the process by which stomach contents are moved into the first part of the small intestine as part of the digestive process. “But this effect wanes over time,” says Dr. Jastreboff. “The main way semaglutide helps treat obesity is through its action in the brain.”

How effective are they and how long does it take for the effect to appear?

It can take more than a year for the drug to reach full effectiveness, although some patients hit their plateau earlier. Meanwhile, doctors say patients will need to take the medications for years—and probably for life—to avoid having the weight come back. “We talk about diabetes remission, and, in the same way, patients have obesity remission,” Dr. Jastreboff says.

“Patients are not ‘cured’ once they lose the weight," Dr. Jastreboff adds. "They need to continue treatment with anti-obesity medications in order to maintain the weight they lost, just as they would need to continue taking diabetes medication to maintain blood sugar levels.”

Who is eligible for these medicines??

But not everyone is eligible for treatment with semaglutide. Doctors can prescribe it for people who have obesity, with a body mass index (BMI) of greater than 30, or those who are overweight, with a BMI greater than 27, accompanied by weight-related medical problems such as high blood pressure, type 2 diabetes, or high cholesterol. (BMI is a measure used to determine weight categories. The medication is not recommended for those with a personal or family history of certain endocrine or thyroid tumors, specifically, medullary thyroid cancer.

Which drug works for whom??

Researchers are still studying which medications are best for which patients. Until they learn more, doctors gather information about such factors as a patient’s eating behavior and other components and may need to try more than one medication to find the one that works best for an individual. All anti-obesity medications are prescribed along with a lifestyle program that addresses eating and exercise for a particular patient.

What about side-effects??

The most common side effects of medications such as semaglutide and tirzepatide are gastrointestinal. Most of the time, these side effects are mild to moderate, and most commonly occur during medication initiation and dose escalation. Not everyone has these gastrointestinal side effects, but if they occur, the most common ones include nausea, diarrhea, constipation, and, rarely, vomiting.

So, obesity should choose which path - Anti obesity drugs or traditional approaches??

Obesity is a complex metabolic disease with a clear biological basis, and we can treat it with targeted therapy aimed at the biology. There can be physiological reasons why extreme diet control, weight loss fails to give the desired results, anti-obesity drugs may help to overcome such barriers.

Traditional approaches to weight loss, balanced diet, personalized work out regimens can be fortified with these drugs and not be replaced by them entirely. Future research and studies might help in creating tailor made approaches for personalized body types with selective use of these drugs.

References

https://medicine.yale.edu/news/yale-medicine-magazine/article/new-anti-obesity-medications/#:~:text=Treatment%20options%20for%20