There is a new(ish) class of medicines out now called Semaglutide or GLP1 receptor agonists that are getting a lot of attention. Seldom does something "new" really make a difference in population health. But these drugs have the capacity to change the landscape for obesity and the myriad of health problems that are a result of our overweight Nation.
Just like building more jails did not curb the drug crisis, telling overweight people to eat better and exercise hasn't been working. Obesity in America has reached 41.9% and accounts for $150 billion in health care costs. Obesity is the "mother of all diseases", including cardio-vascular, hypertension, arthritis, cancer, diabetes, dyslipidemia, reproductive disorders, liver disease and mood disorders. So a drug that can help people actually bring their weight and health risk factors under control is truly a block-buster.
Semaglutide (Ozempic and Wegovy) and Tirzepatide ( Mounjaro and newly released Zepbound) work in multiple physiologic ways to control appetite, reduce inflammation and correct metabolic abnormalities, facilitating weight loss like never before. The new study, (SELECT), on Wegovy shows semaglutide reduces death and heart attacks, stroke by 20% in overweight people with cardiovascular disease. These drugs were first developed for people with diabetes but this reduction occurred even in patients without diabetes. The trial was conducted at 804 sites in 41 countries.
I can do a future post on the mechanism of action of these drugs, which is complicated, if readers are interested. Obesity and inflammation are very complicated and once the body starts accumulating enlarged fat cells, metabolism goes haywire. Scientists are just starting to recognize the mind, gut, neurotransmitter and hormone connections that drive obesity and risk. That is why simple advice to exercise and eat less are not effective in the majority of people. I won't even get into our food industrial complex that supersizes processed cheap foods. Just turn on the TV and watch the ads. Its pretty sickening (and makes you hungry too!).
Prevention is the key to health span (healthy aging without being frail and invalid). Getting a jump on obesity is in everyones best interest. The naysayers that say this is just a "Pharma grab" or "We need more evidence" are ignoring the health crisis we experience. The extreme cost of these drugs in the US are obscene. The shortages are real and have driven hundreds of thousands of eager women and men to underground and compound sources. It's the Wild West that can't really be stopped. A legitimate drug that everyone wants!
If insurers and the government really cared about prevention, there would be solutions to getting the GLP1 drugs into the hands of people who can benefit from them. Big Pharma could make the same amount of money by ensuring millions of people get the drug at a reasonable cost rather than a few at inflated prices.
In the meantime, stay tuned to more studies that show the benefits. The SELECT study that I referenced above showed there was no increased risk of gall bladder disease, pancreatitis, cancers or psychiatric disorders with use. The drop-out rate was driven by gastrointestinal side effects. These drugs are instant biofeedback. If you eat crap, you will feel GI problems.
(Image by Freepic)
As a comprehensive preventive medicine doctor and a woman who wants to maintain a healthy weight (like millions of my fellow Americans) I welcome help to do just that.