Managing excess weight: How much is there? The role of the Ozempic drug in overcoming the stigma of overweightness and obeseness

Ozempic, a drug used to treat diabetes, has gained attention recently as celebrities, a tech mogul and TikTok influencers have described taking it to lose weight in short time frames.

There’s been such an increase in demand that an FDA database lists the medication’s active ingredient, semaglutide, as “currently in shortage.” Its manufacturer, Novo Nordisk, says keeping supplies stable is a priority. Ozempic is a lower dose of semaglutide that is marketed to treat diabetes.

According to the co- director of the Office of Obesity Research at the US National Institute of Diabetes and Digestive and Kidney Diseases, the presentation concluded like nothing else in the conference. Sustained applause echoed through the room “like you were at a Broadway show”, she says.

Soon, there will be a new weight loss medication on the block—and it’s even more potent than its peers. It took the FDA less than six months to review the weight loss drug, after a clinical trial showed that people with overweight or obese lifestyles lost 22% of their body weight on the highest dose. If all goes according to plan, that will make Mounjaro the latest in a fast-growing biomedical sector—spanning everything from bariatric surgery to deep brain stimulation for binge-eating—that aims to combat, if not cure, the problem of “excess” weight.

The ability to melt weight away by tweaking biology gives credence to the idea that obesity is a disease. In the past, scientists and the public often thought that those with obesity simply lacked the willpower to lose weight. But evidence is growing that most people’s bodies have a natural size that can be hard to change. Richard DiMarchi is a chemist at Indiana University Bloomington.

These treatments could be used to escape the stigma associated with being overweight, rather than serve a true health need.

The injection costs upwards of US$1,000 per month, and there are lots of research questions regarding who will respond to treatment and whether they’ll have to take these drugs for life.

Scientific discovery of a molecule that mimics the GIP gene but does not interfere with appetite: Jeffrey Friedman, Eli Lilly, and many others

It was decades ago that Jeffrey Friedman began to research the cause of the mice becoming obese. In 1994, Friedman, a molecular geneticist at The Rockefeller University in New York City, discovered that the faulty gene encoded leptin, a hormone that is produced by fat tissue and induces a feeling of fullness4. Giving leptin supplements to mice that lacked it reduced their hunger and body weight.

Scientists were intrigued by a new drug that was being investigated in a phase III trial. The molecule, a modified version of liraglutide, acts on the same pathways but remains intact and active in the body for longer, says DiMarchi. It might also have better access to brain regions that regulate appetite, he adds.

The new class of drugs are more effective than the old ones. There was a clinical trial published in The New England Journal of Medicine in 2021 that showed that the drug led to a 15% reduction in body weight.

It can also mimic GIP, “but it doesn’t really matter in patients with diabetes and obesity, because the GIP part doesn’t really do anything,” says Holst. Eli Lilly is conducting early-stage clinical trials with drugs that target GSIP alone,which will resolve the debate.

The levels of weight loss from treatment approach those that can only be accomplished through surgery. After six months, this procedure reduces body weight by 30% or more, which means that the weight loss will continue for a year or two.

The history of the weight loss industry is more like prospecting for gold or investing in cognizance than a story of scientific advancement, where boom inevitably gives way to bust. Fen-Phen was linked to heart valve damage. Intermittent fasting was going to fix something until researchers showed they produce exactly the same results. There is a complicated case of surgical weight loss.

Mller says that they were the first to come up with the crazy idea. We were criticized a lot in the field.

The easy way out of obesity: Cost-effective treatment of type 2 diabetes medications with a focus on muscle mass and fat around the organs

Other approaches include ‘triple agonists’ that mimic the actions of GLP-1, GIP and a third hormone, glucagon, which also stimulates insulin secretion9. Other gut hormones, like peptide YY, are also being explored. And some researchers are investigating the monoclonal antibody bimagrumab, which increases muscle mass while decreasing fat.

Another unknown is who will respond to these drugs — and who won’t. The drugs are less effective for weight loss in people with type 2 Diabetes than they are for people without it. Conditions such as fatty liver disease and having fat around the organs, known as visceral body fat, might also affect how people respond to different drugs, Tschöp says.

Others worry about the idea that these drugs offer a quick fix. This is a common misconception about bariatric surgery, says Leslie Heinberg, a clinical psychologist at the Cleveland Clinic in Ohio who specializes in bariatric behavioural health and body image. “Some people who still hold on to those mistaken beliefs will say, ‘Oh, now people can just take this pill and that’s the easy way out of obesity,’” she says.

For a start, they are expensive and not covered by most insurance companies in the U.S., except for Wegovy, which costs $1,300 a month and is used for weight loss.

The OAC is pushing the pharmaceutical companies to offer affordability programmes. Eli Lilly has a program in which it costs as little as $25 for the first three months of use to treat type 2 diabetes. Novo Nordisk has a similar programme for Wegovy.

Whatever the upfront costs, some scientists stress that addressing obesity could allow health-care systems to save enormous amounts of money by reducing a slew of conditions that are linked to the disease.

Many people cannot afford to stay on the medication for the long term due to the cost, which is about $200 a month out of pocket. Recovering weight gain is hard to control when people stop taking it. In fact, a study found that most people gain back most of the weight within a year of stopping the medicine.

Since Wegovy was approved by the FDA, some insurers have begun to cover the medication for people that meet certain guidelines. People with a body mass index (BMI) of at least 27 are eligible if they have at least one weight-related ailment such as hypertension, diabetes, or high cholesterol. Or they have a BMI of 30 or higher, regardless of weight-related ailments.

Dozempic Wegovy Weight-Loss Drugs: a Case Study in Yolanda Hamilton, a Northwestern University Medical Advisor

“It gave me more energy,” she says, allowing her to exercise and do house chores. She did not crave sugar anymore, and felt more satisfied with smaller meals. “I was very surprised by how good I felt,” Hamilton says. Hamilton says it is easy to administer the drug at home.

Blue Cross and Blue Shield of Illinois told NPR that benefits offered by employer plans can vary. “Weight-loss drugs like Wegovy might be covered by the company, depending on the membership’s benefit plan,” the spokesman said. Employers are often willing to cover the coverage of other insurance carriers.

“This hormone is telling your brain, I’m full, I don’t need to eat anymore,” explains Dr. Robert Kushner of Northwestern University, who treats Yolanda Hamilton. Kushner also serves on a Novo Nordisk medical advisory board, for which he receives an honoraria.

He explains that the pharmaceutical companies have taken a naturally occurring hormone and restructured it into a drug. He says that people stop taking the medicine because they start to feel hungrier.

“I crave sweets,” Hamilton says. And her appetite has increased. She used to feel satisfied with small meals. She says she is losing her energy as she gets back into shape.

Kushner’s office is helping Hamilton appeal the insurance denial, but as she waits, she’s worried that stopping the medication will also influence her blood pressure and blood sugar. “She is at risk of having her physical conditions go downhill if she regains her weight,” she says.

Hamilton says that he will be on more drugs if he gains more weight. Given her long struggle with weight loss, she’d finally found something that was working.

Source: https://www.npr.org/sections/health-shots/2023/01/30/1152039799/ozempic-wegovy-weight-loss-drugs

The Beauty of Weight Loss: Reducing Obesity Through Medicine, Exercise and Diet: A Drifting Comment from GoodRX

The lowest price among retailers is out of reach for most people, even with a coupon, as shown by the chart from GoodRX.

Robinson points out that people with low incomes are more likely to be obese, and that they are unable to access it.

The American Academy ofAllergies recommends that physicians offer weight loss drugs to adolescents with obesity as an alternative to lifestyle interventions.

He says starting with a low dose and increasing it over time can help people tolerate the drug better. There’s ongoing research to evaluate the drug’s effect on the cardiovascular system, which is positive so far.

There is a black box warning for the drug because it causes tumors in rodents. If a person has a family history of a particular kind ofthyroid carcinoma, then doctors need to screen them for another rare condition called multiple endocrine neoplasia syndrome type 2. “This would be an individual patient conversation,” Kushner says. Generally, if you don’t have a history of these conditions, “this medication is thought to be safe,” he says.

If this sounds unsettling, it’s a reminder of how high the stakes are to combat obesity. The risk of tumors may be unnerving. But doctors point to the risks of leaving obesity untreated: Heart disease is the leading cause of death in the U.S., and obesity and weight-related conditions are top risk factors.

Of course, exercise and diet modification are still the first strategies to try. Given that over 70% of Americans are overweight or obese, doctors’ groups say there is an urgent need to layer on more interventions that can help.

“We, as a society, are spending $173 billion in obesity-related health care costs,” says Dr. Marcus Schabacker, CEO of ECRI, an independent, nonprofit group that has reviewed the evidence of new weight loss drugs.

He argues that the drugs can be part of destigmatizing obesity by treating it like any other disease that you treat with medicine. We don’t want to ask someone with high blood pressure to change their diet or do exercises in order to be fine. No, we give them beta blockers. It’s not different here. He says that the key elements of tackling obesity are exercise and diet, but also medication which has shown to be effective.

The victorious narratives gilding drugs like Mounjaro are already being positioned as a direct challenge to fat activism. For decades, the movement has pushed for social and economic opportunity for people of all sizes through civil rights and fat pride. Thanks to prominent voices like Audrey Gordon and Michael Hobbes, many people now know that “lifestyle changes” like calorie restriction and exercise fail to produce sustained weight loss for 97 percent of people and that many dieters end up gaining back more weight than they lost. But what happens to the strength of these arguments when a weight loss drug seems to work?

From their inception in the 1950s, operations like gastric bypass (which reroutes food away from the stomach, inducing malabsorption) and gastric sleeve (which involves partially amputating the stomach so it holds less food and produces fewer hunger hormones) have been sold as a potential panacea, says Lisa Du Breuil, a clinical social worker at Massachusetts General Hospital. Those who are eligible for the surgery can lose up to 70 percent of their excess weight if they keep a diet and exercise regimen.