In simpler terms, obesity is the product of a body’s production of energy less than its energy intake. But in reality, there is nothing simple about this complex and mysterious disease.
Obesity, which has skyrocketed in recent decades – now defining the body mass of more than 40 percent of adult Americans – is not just difficult for people to endure and scientists to understand. It is also incredibly difficult to treat.
In addition to the commitment to sustained lifestyle changes – healthy eating and exercise, effectively – there are only two potential options that can help: bariatric surgery and weight loss drugs.
The first is invasive and carries 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 for treating obesity patients with a weight loss drug.
In the study, which involved nearly 2,000 obese adults in 16 different countries, participants took a weekly dose of a drug called semaglutide, an existing drug already used to treat type 2 diabetes.
A control group took only a placebo, instead of 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 semagglutide, the effects were pronounced.
After 68 weeks of treatment with the drug – which suppresses appetite due to a variety of effects on the brain – participants who took semaglutide lost an average of 14.9 percent of body weight. And more than 30% of the group lost more than 20% of their body weight.
In general terms, this makes the drug up to twice as effective as existing weight-loss drugs, say the researchers, approaching the type of effectiveness of surgical interventions.
“No other drug has come close to producing that level of weight loss – this really is a game changer,” 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 registered improvements in other areas, showing a reduction in several cardiometabolic risk factors and reporting improvements in quality of life.
Although the results are convincing, the dosage of semagglutide for anti-obesity effects has some disadvantages.
Mild to moderate effects were reported by many participants (in the semaglutida and placebo groups), including nausea and diarrhea. Although the effects were temporary, they were sufficient for almost 60 of the participants to discontinue treatment, compared with just five in the placebo group.
Currently, the drug requires a weekly injection to work – while an oral form of the drug would probably be preferred by patients.
Most significantly, we still don’t have data on what happened to participants after the drug regimen ended at the end of the trial.
For at least one individual, however, who spoke to The New York Times, his weight started to increase after the trial ended.
“While medications like this may be useful in the short term to achieve rapid weight loss in severe obesity, they are not a magical solution to prevent or treat less severe degrees of obesity,” says nutritionist Tom Sanders, professor emeritus at King’s College London , who was not involved 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 further analysis of semagglutide is positive, we may also be looking at an important new pharmaceutical option to help fight obesity.
And that option may come sooner than we think.
The study, funded by pharmaceutical company Novo Nordisk – which sells semagglutide as an antidiabetic drug – is now being offered as evidence to international health regulatory authorities, in support of a request to market the drug as a treatment for obesity.
The US FDA, along with its peers in the UK and Europe, is evaluating the data.
The results are reported in The new English medical journal.