Medical Treatments or Weight Loss — Dr. Shomali Diabetes Updates
Many of my patients struggle with losing weight. In fact, obesity is the “other” pandemic in the world today. Over 40% of Americans are obese. In Canada, that number is approximately 30%. Obesity puts people at risk for diabetes, high blood pressure, heart disease, and certain forms of cancer. Today, I am excited to tell you about two new and effective weight loss medications for people with obesity.
Obesity is a complex condition that has genetic, biochemical, as well as behavioral components. A physician or other healthcare professional telling a patient in the office “you have to lose weight” is not particularly effective without giving the patient tools to do it. Obviously diet and exercise are important, and now medications are a tool to help partially overcome genetic and biological barriers.
Many of my patients over the years have benefited from weight loss surgery, but surgery, with its potential complications, is not for everyone. A new option is medications that are based on manipulating the effects of naturally occurring hormones in the human body. These hormones are known as incretins and include two molecules, GLP-1 and GIP. The science of these incretin hormones was elucidated, in part, by the Canadian endocrinologist, Dr. Daniel Drucker.
Medications based on incretin hormones have been a huge help for people with type 2 diabetes. These medications include such brands as Byetta, Victoza, Trulicity, Ozempic, and Bydureon. They lower blood glucose, and ALSO help most people lose a modest amount of weight. It has been found that taking some of these same medications at higher doses increases weight loss. The manufacturer of Victoza and Ozempic has produced new versions of these medications packaged at higher doses to help people with obesity: Saxenda and Wegovy.
Saxenda
Saxenda shares the same active ingredient as Victoza (liraglutide). This medication is an injection that is given once a day. Saxenda is approved for use in the United States and Canada. It is indicated for adults with excess weight (BMI ≥30), or adults with excess weight (BMI ≥27) who also have weight-related medical problems such as diabetes. It can also be used in children aged 12–17 years with excess body weight, weighing above 132 pounds (60 kg). In clinical studies with Saxenda, participants lost an average of between 4.9 and 7.4% of their body weight. Depending on the study, approximately 40 to 60% of participants lost more than 5% of their body weight and 20 to 30% lost over 10% of their body weight.
Wegovy
Wegovy has the same active ingredient as Ozempic (semaglutide). Wegovy is a once weekly injection and is approved for use in the United States, but not yet Canada. It is indicated for adults with excess weight (BMI ≥30), or adults with excess weight (BMI ≥27) who also have weight-related medical problems. Study participants using Wegovy lost a mean of 10 to 16% of their body weight. Depending on the study, approximately 70 to 80% of participants lost more than 5% of their body weight, 40 to 70% lost over 10% of their body weight, and 25 to 50% lost over 15% of body weight. Wegovy appears to be more potent than other weight loss medications. The higher weight loss was seen in people who were also undergoing intensive nutritional management along with the medication.
Of course there are drawbacks and barriers to these and all medications. Common side effects may include nausea, diarrhea, vomiting, constipation, and other GI symptoms. If side effects occur, they often get better with continued use. You should discuss and understand all the risks with your medical care team. In addition, these medications are very expensive and are not covered by many insurance plans at this time. Finally, these mediations do not “fix” obesity. If someone takes one of them and loses weight, then stops the medication, weight gain often ensues. Still, for the right person struggling with excess weight, these medications combined with diet and exercise regimens are helpful.
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