In simpler terms, obesity is the product that a body’s energy production is lower than its energy intake. But in reality, there is nothing simple in this complex and mysterious disease.
Obesity, which has skyrocketed in recent decades (it now defines the body mass of more than 40% of American adults), is not only difficult to bear for people and for scientists to understand. It’s also incredibly difficult to deal with.
Beyond the commitment to sustained lifestyle changes (healthy eating and exercise, indeed), there are only two potential options that can help: bariatric surgery and weight loss medications.
The first is invasive and involves several risks and complications. As for drugs, they do not always work and can also have their own adverse effects.
However, an experimental treatment recently tested by scientists and detailed in a study published this week could open new doors to treat obese patients with a weight-loss drug.
In the study, which involved nearly 2,000 obese adults from 16 different countries, participants took a weekly dose of a drug called semaglutide, an existing drug that was already used to treat type 2 diabetes.
One control group only took a placebo instead of the medication. Both groups received a lifestyle intervention course designed to promote weight loss.
At the end of the trial, participants who took the placebo lost a small but clinically insignificant amount of weight. But for those who took semaglutida, the effects were pronounced.
After 68 weeks of treatment with the drug, which suppresses appetite due to various effects on the brain, participants taking 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, this makes the drug up to twice as effective as existing drugs for weight loss, the researchers say, approximating the type of effectiveness of surgical interventions.
“There is no other drug that has come close to producing this level of weight loss; that really changes the game,” says obesity researcher Rachel Batterham of University College London.
“For the first time, people can achieve through medication what was only possible through weight loss surgery.”
In addition to losing weight, participants recorded improvements in other areas, showing reductions in various cardiometabolic risk factors and reporting improvements in quality of life.
While the results are compelling, the dose of semaglutide for anti-obesity effects has some drawbacks.
Many participants reported mild to moderate effects (in both the semaglutide and placebo groups), including nausea and diarrhea. Although the effects were temporary, they were sufficient for nearly 60 of the participants to discontinue treatment, compared with only five in the placebo group.
Currently, the drug requires a weekly injection to function, while patients would prefer an oral form of the drug.
More significantly, we still have no data on what happened to participants after the drug regime ceased at the end of the trial.
However, for at least one individual he spoke to The New York Times, his weight began to drag on after the trial was over.
“While medications like this may be helpful in the short term for rapid weight loss in severe obesity, they are not a magic bullet for preventing or treating less severe degrees of obesity,” says nutritionist Tom Sanders, Professor Emeritus of King’s College London, who did not participate in the study.
“Public health measures are still needed to encourage behavioral changes, such as regular physical activity and moderation of energy intake in the diet.”
No one would deny the wisdom of this, but if an additional analysis of semaglutide turns out to be positive, we could also study an important new pharmaceutical option to help fight obesity.
And that option may come sooner than we think.
The study, funded by the pharmaceutical company Novo Nordisk, which sells semi-swallowed as an antidiabetic drug, is now being offered as evidence to international health regulators, in support of an application to market the drug as anti-obesity treatment.
The U.S. FDA, along with its UK and European counterparts, is currently evaluating the data.
The findings are reported in The New England Journal of Medicine.