An assistant professor of endocrinology at Rutgers University’s Robert Wood Johnson Medical School who has specialized in treating obesity for more than a decade, sees reason for hope in newly approved diabetes drugs coming to market.
Obesity rates have steadily risen over the years: The Centers for Disease Control estimate that about 42 percent of American adults are obese. Shah discusses Victoza (liraglutide) and Wegovy (semaglutide), two medications developed for the treatment of type 2 diabetes and recently approved for the treatment of obesity. He also discusses a third diabetes drug, Mounjaro (tirzepatide), which has shown positive results in an obesity trial.
What is an effective treatment for obesity?
The ideal, of course, is to eliminate all excess weight, but any weight reduction of more than 5 percent offers clinically meaningful benefits, such as lowering the risk of heart attack and other cardiovascular problems.
Were there effective medical treatments before the diabetes drugs arrived?
Yes, both Qsymia, which helps people control their cravings, and Contrave, which speeds up metabolism, typically reduce weight by about 7 percent, but several drawbacks make them unsuitable for many patients.
What Diabetes Drugs Are Currently Available to Treat Obesity?
The two that have been approved so far are Victoza (liraglutide) and Wegovy (semaglutide). Both are more effective and better tolerated than older drugs, but semaglutide is probably the better drug for most people. It tends to cause more weight loss — up to 15 percent of body weight — and it’s a weekly rather than a daily injection.
What new drugs are likely to be approved soon?
Results of the final phase of the trial just published in The New England Journal of Medicine showed that a weekly injection of 15 milligrams of the diabetes drug tirzepatide caused patients to lose an average of 20% of their body weight.
How bad is that?
That’s a game changer. That’s the kind of weight loss you normally associate with surgery. It is not enough to eliminate all the excess weight, but it is enough to put most obese people in the mere overweight category and eliminate most of their weight-related health risks.
What side effects do these drugs have?
Many people suffer from gastrointestinal upset when they start treatment, but it usually goes away.
Will most obese people be on one of these drugs in a few years?
They probably should already be.
Why aren’t they?
Two reasons: First, the primary care physicians who treat most patients for obesity and everything else are not yet comfortable prescribing it. Specialists like me should do a better job of educating GPs about how safe and effective they are.
Second, these drugs are expensive, and while most insurers seem to cover them for diabetes, they are hesitant to cover them only for obesity. Most insurers do not reimburse obesity medication unless patients can demonstrate that they have been on a diet and exercise program for at least three months.
So these treatments are in addition to — rather than instead of — diet and exercise?
Unfortunately yes. There is no magic thin medication yet. You can still eat out any treatment, including gastric bypass. But these drugs help immensely, enough to significantly reduce obesity.
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