In the simplest terms, obesity is the result of the body’s energy output being less than the energy input. But in reality there is nothing simple about this complex and mysterious disease.
Obesity, which has skyrocketed in recent decades – now defining the body mass of more than 40 percent of adult Americans – is not only difficult for humans to tolerate and understand scientists. It is also incredibly difficult to treat.
Aside from the commitment to sustained lifestyle changes – eating healthy and exercising, there are really only two possible options that can help: bariatric surgery and weight loss medication.
The former is invasive and carries various risks and complications. As for the drugs, they do not always work and can have their own detrimental consequences.
However, an experimental treatment recently tested by scientists and in a study published this week may open new doors for the treatment of obesity patients with a weight loss drug.
In the study, which involved nearly 2,000 obese adults in 16 different countries, participants took a weekly dose of a drug called semaglutide, an existing medication already used in the treatment of type 2 diabetes.
A control group only took a placebo in place of the medication. Both groups received a lifestyle intervention course to lose weight.
At the end of the trial, the participants who took the placebo lost a small but clinically insignificant amount of weight. But for those taking semaglutide, the effects were obvious.
After 68 weeks of treatment with the drug – which suppresses appetite due to various effects on the brain – participants who took semaglutide lost an average of 14.9 percent of their body weight. And more than 30 percent of the group lost more than 20 percent of their body weight.
Broadly speaking, it makes the drug up to twice as effective as existing weight-loss medicines, say the researchers, who approach the kind of effectiveness of surgical interventions.
“No other drug has come close to producing this level of weight loss – it’s really a game changer,” says researcher Rachel Batterham of University College London Obesity.
“For the first time, people can achieve through drugs that were only possible through weight loss surgery.”
In addition to losing weight, participants reported improvements in other areas, showing the reduction in various cardiometabolic risk factors and reported improvement in quality of life.
Although the results are convincing, semaglutide dosing for obesity effects has some disadvantages.
Mild to moderate effects have been reported by many participants (in the semaglutide and placebo groups), including nausea and diarrhea. Although the effects were temporary, it was enough for almost 60 participants to discontinue their treatment, compared with only five in the placebo group.
At present, the drug requires a weekly injection to work – while patients probably prefer an oral form of the drug.
More significantly, we do not yet have information on what happened to the participants after the drug regime stopped at the end of the trial.
For at least one individual who spoke, however The New York Times, began to creep up on her weight after the trial was over.
“While drugs like these can be helpful in the short term to achieve rapid weight loss in severe obesity, it is not a miracle spot to prevent or treat less severe obesity,” says nutritionist Tom Sanders, an emeritus professor at King’s College in London, who were not involved in the study.
“Public health measures that encourage behavioral change, such as regular physical activity and the moderate intake of energy in the diet, are still needed.”
No one would deny the wisdom of it, but if further analysis of semaglutide turns out to be positive, we can also look at an important new pharmaceutical option to combat obesity.
And the option may come sooner than we think.
The study, funded by the pharmaceutical company Novo Nordisk – which sells semaglutide as an antidiabetic medication – is now being presented to the international health authorities as evidence, in support of an application to market the drug as an obesity treatment.
The US FDA, along with its peers in the UK and Europe, is currently reviewing the data.
The findings are presented in The New England Journal of Medicine.