Ozempic the new ‘Miracle’ Weight-Loss drug: a Game Changer for Obesity/Overweight
Obesity and overweight are major health problems in the United States. They affect 40% and 30% of the American population respectively.
The groundbreaking discovery of a new class of ‘miracle’ weight-loss drugs, known as GLP-1 agonists, such as Ozempic (approved to treat type 2 diabetes, but also used off-label for weight loss), is transforming the way obesity is perceived and treated.
The stigma attached to obesity is gradually giving way to the concept of obesity as a treatable chronic disease, not a behavioral disorder. Evidence suggests that the complex interactions between our biology and our environment play a key role in the condition - and that, as with other chronic diseases, treatment may be beneficial.
These powerful and remarkably effective GLP-1 agonists work by mimicking a natural hormone that suppresses appetite and controls blood sugar levels, enabling some patients to lose 10-20% of their body weight. They have sparked great public interest, and Ozempic has proved particularly popular with celebrities such as Oprah Winfrey, who recently reported very encouraging personal results.
The example of Oprah Winfrey
Oprah Winfrey, a long-time prominent figure in the national conversation about dieting and weight stigma, devoted a special one-hour primetime show to talk about the rise of weight-loss drugs. Her goal was to “start releasing the stigma and the shame and the judgment” around weight and weight loss - starting with her own.
Oprah reportedly experienced significant weight loss after incorporating medications such as Ozempic into her routine, alongside her commitment to healthy eating and regular exercise. She also reported that the incessant internal chatter that so often surrounds eating, also known as “food noise”, had completely disappeared.
Her entire life, she has battled excess weight, which has been a central aspect of her identity and public persona.
Back in 1988, she made headlines after shedding a lot of weight on a liquid diet. As proof of her weight loss, she wheeled out a red wagon filled with fat across the stage of her television show, symbolic of the 67 pounds she had lost. However, she later gained back the weight, leading to a cycle of yo-yo dieting that continued for years.
Oprah's openness about her struggles and triumphs resonates with so many of us. Watching her dieting efforts over decades, and her successive failed attempts to lose weight, illustrates the complexity of this endeavor, as well as the emotional toll that weight loss can take.
Historically, pharma lacked enthusiasm to develop weight-loss drugs
There was very little interest in the pharmaceutical industry in developing drugs to treat obesity. First of all, obesity was not thought to be a disease. It was looked at as a behavioral problem – a lack of willpower, and second the body has so many redundant circuits of interacting nerve impulses and hormones to control weight that tweaking one simply did not make a difference. No drug that was tried worked very well, and every one that led to even modest weight loss had serious side effects. So, obesity had become a dead end in the pharmaceutical industry.
Until the day when…. researchers accidentally discovered that exposing the brain to GLP-1 a naturally occurring hormone, at levels never before seen in nature, resulted in weight loss. They found that rats lost their appetites when GLP-1 was injected into their brains. Human subjects who received an intravenous infusion of GLP-1 ate 12% less at a lunch buffet than subjects who received a placebo. There was something in these peptides that was really important for appetite regulation!
The mechanism of action of GLP-1s is a mystery
When the researchers discovered this ‘miracle’ drug by chance, they didn't know how it worked or what long-term side effects it might have.
GLP-1 drugs are not intended to correct a lack of GLP-1 in the body - people suffering from obesity produce native GLP-1 in abundance. However, these drugs like Ozempic and Wegovy do expose the brain to hormone levels never seen in nature. Patients taking Wegovy, for example, receive 5 times the amount of GLP-1 that they would normally produce in response to a Thanksgiving dinner!
What's more, in the brain, “the drugs go to unusual places”. They don't just go to the areas supposed to control overeating.
Researchers continue to marvel at these biochemical mysteries. But doctors and patients have their own conclusion: the drugs work. People are losing weight. The constant chatter in their brains about food and eating is gone.
How should these new drugs be used?
This potent new class of drugs has shifted the therapeutic landscape, sparking the debate on the best way to use them, and the place to be given to lifestyle interventions, which have long taken center stage. That said, these products are no substitute for a balanced diet or regular physical activity. Package inserts explicitly state that they should be prescribed in conjunction with increased physical activity and a low-calorie diet.
Patients discouraged after years of ineffective dieting have welcomed these treatments as a godsend, as have some obesity specialists, whose toolbox has long been limited to bariatric surgery - effective but invasive and, in many cases, irreversible - as well as older, less effective drugs and lifestyle approaches, which have so far proved effective in the long term for only 10% of patients.
Excess body weight is tied to a whole range of medical problems, including diabetes, heart disease, osteoarthritis, sleep apnea and many types of cancer. It's linked to shorter life expectancy and higher rates of disability. Reducing or reversing obesity significantly improves health. We know from years of studying bariatric surgery that it reduces the risks of cancer, heart disease and diabetes-related death.
These new pharmacotherapeutic tools not only shed pounds, they also 'shed food-related anxieties'. No longer stressing about food, or feeling out-of-control around food, nor believing that there's something wrong with you that's preventing you from making the right choices, provides significant mental health benefits.
Final thoughts
Remarkably, the introduction of new pharmacotherapeutic agents is changing the perception and treatment of obesity and overweight. As obesity is now recognized as a pathophysiological condition that can be treated by the new drugs, rather than an individual behavioral disorder, our society is showing greater readiness to embrace all body types.
Should all obese or overweight patients be treated with GLP-1 agonists? No. In agreement with their healthcare professional everyone should do whatever works best for them. For people who feel happy and healthy in celebrating life in a bigger body and don't want the medications, the answer is: “fine”. As for those who believe that diet and exercise is the best and only way to lose excess weight, why not, if that suits them. And for all those whose obesity leads to additional comorbidities, or those who think medication could provide them with the relief, support and freedom they've always sought, that's fine too.
