Are We Losing Sight of Overall Health? Science Says

The craze for new drugs in the class of GLP-1 (Glucagon-like peptide 1) and GIP (Gastric inhibitory polypeptide) analogues, better known by the brand names Ozempic and Wegovy, is notable, but not entirely unprecedented in the history of pharmaceutical blockbusters.

The number of prescriptions and the budget allocated to them by public health insurance companies are exploding, as are the profits of the companies that produce them.

Part of the popularity of these drugs is due to social media, but they are not always the best source of health information. When it comes to the topic of weight loss, both fantasy and prejudice play a role. This works to the detriment of everyone’s well-being, but especially those who are already stigmatized.

As specialists in the philosophy of medicine (Université de Montréal), nutrition and food science (Université Laval), sociology of medicine (Université de Montréal), and endocrinology (Institut de recherches cliniques de Montréal), we feel it is necessary to take a step back and consider the promises and limitations of these new treatments.

The best of both worlds

GLP-1/GIP analogues were originally developed to help control glycemia (blood sugar) in people with type 2 diabetes, preventing complications associated with the disease. When studies were conducted to assess their safety and effectiveness, it was discovered that these drugs also led to weight loss. This led to new research showing that at higher doses, the drugs could lead to very significant weight lossfrom 15 to 25% of the starting weight.

The mode of action of these drugs on blood sugar regulation is clear: they simulate incretin hormones which in turn increase insulin secretion. Weight loss, on the other hand, was only explained in retrospect: in addition to the pancreas, these molecules also act on the brain by regulating the feeling of satiety and indirectly on the stomach by delaying gastric emptying. These two combined effects reduce appetite and lead to weight loss.

This created a new application for the drug, so the company Novo Nordisk began marketing the same drug under two different names: Ozempic for the treatment of type 2 diabetes and Wegovy for the fight against obesity.

A new era

GLP-1/GIP analogs are a welcome therapeutic breakthrough at a time when prevalence of type 2 diabetes And obesity is explosive and is affecting increasingly younger people.

These diseases primarily affect women, members of racialized groups, and socioeconomically disadvantaged populations. The physical and mental suffering they cause and the costs associated with their treatment are both significant. The arrival of new weapons in the therapeutic arsenal is therefore a source of hope.

Draconian lifestyle changes are certainly effective. But they are very difficult to implement and maintain over time for reasons that go beyond the individual sphere; on the one hand, genetic predisposition plays a major role in the development of type 2 diabetes and obesity; on the other hand, because these conditions multifactorialTo be effective and long-lasting, its management must be comprehensive: it must combine medical interventions, but also nutritional, functional, psychosocial, environmental and even institutional interventions.

Such support services do exist, but only in large university hospital centers where many people do not have access. Also, many people do not have easy access to healthy and varied food optionssports facilities or social and psychological support.

Treat the consequences, but not the causes

To be effective in the long term, GLP-1/GIP analogs must be taken continuously: without drastic lifestyle changes, The lost weight is regained within a year after quittingand blood sugar levels are compromised again.

In other words, the drugs treat the effects of type 2 diabetes and obesity, but not the causes. And yet some of these causes are modifiable: for example, according to Statistics Canadaless than half of the Canadian population (49.2% for adults; 43.9% for youth and children) achieves the recommended amount of weekly physical activity. According to the same source, food insecurity affects approximately 14% of the population of Quebec (22% in Alberta).

Pharmacological treatment, even if it enables a person to eat less, does not necessarily mean that the person will eat less. eat better. Likewise, losing weight does not mean becoming more active or healthy. So these new drugs do not cure type 2 diabetes or obesity. Nor do they prevent these diseases from developing, although they do help limit the many complications they cause.

Prescribing and treating

A drug like Mounjaro is as effective for weight loss as bariatric surgery. Much easier to administer and much less risky, it could be a real game changer in the treatment of obesity. It would also be much more accessible and easier to administer to those who need it, as it would be prescribed directly by GPs and dispensed in pharmacies.

This raises the question of cost and reimbursement, but not only that: prescribing is not the same as treating. Here the manufacturers are following the recommendations of the health authorities: this treatment must be preceded by a careful assessmentthen management and, above all, close and regular monitoring of nutrition, physical activity, mental health and, if necessary, socio-economic assistance.

This requires not only time that GPs do not have, but also coordination with other players in the healthcare network. The problem is not whether the treatment will be effective, but what can happen if it is. Losing 25% of your body weight in just a few months has serious consequences, which are not always beneficial: it involves loss of body fat, but also of muscle mass, which is accompanied by intense fatigue. And we need to challenge to adapt physically and psychologically to a body transformation of this magnitude. Losing weight is not a cure-all, and expectations should be kept realistic.

What lessons can we learn from this?

The clinical effectiveness of GLP-1/GIP analogues in reducing the complications associated with type 2 diabetes and obesity is undeniable. However, these drugs are not for everyone and they are certainly not miracle cures that make it possible to return to health without making changes in lifestyle or environment.

We must keep in mind that their success, both commercial and medical, is also the result of a failure: our societies have failed to prevent these diseases, promote healthy lifestyles and create an environment conducive to the health of all.

This article has been republished from The conversation under a Creative Commons license. Read the original article.