The Weight Loss Drug: Is it Really a Miracle?
Obesity has become one of the most important public health problems worldwide, which suggests the need for evidence-based dietary strategies for weight loss and its maintenance. Weight management depends upon complex factors such as amount of food eaten, type of food eaten, and timing of meals. The identified evidence-based dietary strategies for weight management are based on various components. An energy deficit is the most important factor in weight loss, a low-calorie diet with a low fat or carbohydrate content; however, in some cases, a very-low-calorie diet is required for a short period, some macronutrient composition-based diets, such as the ketogenic diet or high-protein diet, could be considered in some cases, although the potential risks and long-term effectiveness remain unknown. Meal timing is also an important factor in weight management, and higher-calorie breakfasts in combination with overnight fasting may help to prevent obesity. There is no single best strategy for weight management. Hence, strategies for weight loss and its maintenance should be individualized, and healthcare providers must choose the best strategy based on patient preferences.[1]
Optimal diets for weight management have been a topic of debate not only among researchers, nutrition experts, and healthcare professionals, but also among the general public. According to a meta-analysis of several diet programs, calorie restriction was the primary driver of weight loss, followed by macronutrient composition. Recently, intermittent fasting and time-restricted eating have become popular and seem to be effective for weight loss. New dietary information has only added to the current confusion due to several controversial dietary regimens, and there is no clear guidance on the optimal diet for weight loss.[2] Obesogenic environments and biological and psychological factors all contribute to obesity. However, obesogenic environments, including social determinants, cultures, and food supply systems, are challenging to modify. Therefore, dietary interventions remain the cornerstone of weight-management strategies, and pharmacologic and surgical interventions also aim to improve dietary management. [2]
Every country is affected by obesity, with some countries showing the highest increases in the last decade. No country has reported a decline in obesity prevalence across their entire population, and none are on track to meet the World Health Organization’s (WHO) target of obesity control. Countries now need to increase efforts to prevent, manage and treat obesity throughout the life course. Action must be decisive, people centred and integrated in order to increase the chances of successfully preventing and treating obesity.[2] While preventing and treating obesity requires financial investment, the cost of failing to prevent and treat obesity will be far higher. The estimates presented in this World Obesity Atlas, 2022/2023 suggest that, on current trends, overweight and obesity will cost the global economy over US$4 trillion of potential income in 2035, nearly 3% of current global gross domestic product (GDP).[3] The estimates for the continuing increase in obesity prevalence are based on published trends from 2010 onwards and future assumptions based on various factors supporting increase in obesity. The period from 2020 to 2022 was marked by extensive restrictions or ‘lockdowns’ in many countries that appear to have increased risk of weight gain by curtailing movements outside the home, exacerbating dietary and sedentary behaviours linked to weight gain, and significantly reducing access to care. In addition, many national surveys and measurement programmes which monitor weight and weight gain were halted. A rise in obesity prevalence, which appears to have occurred especially among children, may prove hard to reverse, and suggests that a side-effect of managing the COVID-19 pandemic is a worsening of the obesity epidemic. It is difficult to know, how well, or poorly, countries are prepared to address the rise in obesity and to deal with the consequences. The estimates for global levels of overweight and obesity (BMI ≥25kg/m²), suggest that over 4 billion people may be affected by 2035, compared with over 2.6 billion in 2020. This reflects an increase from 38% in 2020 to over 50% by 2035. The prevalence of obesity (BMI ≥30kg/m²) alone is anticipated to rise from 14% to 24% of the population over the same period, affecting nearly 2 billion adults, children and adolescents by 2035.[4]
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Causes Of Obesity & Effects
Obesity is a complex issue with many causes. It's caused when extra calories are stored in the body as fat. If one consumes high amounts of energy, particularly found in high fat and high sugar foods, and do not use all of the energy through physical activity, much of the extra energy will be stored in the body as fat.
The energy value of food is measured in units called calories. The average physically active man needs about 2,500 calories a day to maintain a healthy weight, and the average physically active woman needs about 2,000 calories a day. This number of calories may sound high, but it can be easy to reach if one eats certain types of food. For example, eating a large takeaway hamburger, fries and a milkshake can total 1,500 calories – and that's just 1 meal. As well as this, many people do not meet the recommended physical activity levels for adults, so excess calories consumed end up being stored as fat in the body.
Diet and lifestyle factors contribute to development of obesity and overweight. Some of the most common ones are: eating large amounts of processed or fast food – this is food that's high in fat and sugar, drinking too much alcohol – alcohol contains a lot of calories, eating out a lot – food cooked in a restaurant ( junk food) may be higher in fat and sugar, eating larger portions than one needs, drinking too many sugary drinks – including soft drinks and fruit juice, comfort eating – some people may comfort eat due to many other factors affecting their life such as low self-esteem or low mood.
Changes in society have also made it more difficult to have a healthy diet. High calorie food has become cheaper and more convenient, and is heavily advertised and promoted.[5] Lack of physical activity is another important factor related to obesity. Many people have jobs that involve sitting at a desk for most of the day. They also rely on their cars, rather than walking or cycling. For relaxation, many people tend to watch TV, browse the internet or play computer games, and rarely take regular. If one is not active enough, he/she does not use the energy provided by the food one eats and the extra energy so consumed is stored by the body as fat. It is recommended that adults do at least 150 minutes of moderate-intensity aerobic activity, such as cycling or fast walking, every week.[6] This does not need to be done all in a single session, but can be broken down into smaller periods. For example, one could exercise for 30 minutes a day for 5 days a week. There are some genes associated with obesity and overweight. In some people, genes can affect how their bodies change food into energy and store fat. Genes can also affect people's lifestyle choices. In many cases, obesity is more to do with environmental factors, such as not having easy access to healthy food, or unhealthy eating habits learned during childhood. In some cases, underlying medical conditions may contribute to weight gain. These include: an underactive thyroid gland (hypothyroidism) – where thyroid gland does not produce enough hormones and Cushing's syndrome – a rare disorder that causes the over-production of steroid hormones. However, if these conditions are not properly diagnosed and treated, they may pose a barrier to weight loss. Certain medicines, including some steroids, medications for epilepsy and diabetes, and some medications used to treat mental illness – including some antidepressants and medicines for schizophrenia – can contribute to weight gain. Weight gain can sometimes be a side effect of stopping smoking. Obesity is strongly associated with type 2 diabetes mellitus (T2DM); cardiovascular diseases including myocardial infarction and stroke; osteoarthritis; obstructive sleep apnea; depression; and some types of cancer, such as breast, ovarian, prostate, liver, kidney, and colon cancer.[7]
Role Of Medication In Weight Management[7]
Weight management medications aren’t for everyone with a high BMI. If one is overweight or has obesity, he/she might be able to lose weight with a lifestyle program that changes one’s behaviors and improves eating and physical activity habits. A lifestyle program may also address other things that cause one to gain weight, such as eating triggers and not getting enough sleep. Prescription medications to treat overweight and obesity work in different ways. For example, some medications may help one feel less hungry or full sooner. Other medications may make it harder for one’s body to absorb fat from the foods one eats.
Weight management medications are meant to help people who have health problems related to overweight or obesity. Health care professionals use BMI to help decide whether one might be benefited from weight management medications. The health care professional may prescribe a medication to treat overweight or obesity if an adult is with
· a BMI of 30 or greater
· a BMI of 27 or greater, and one has weight-related health problems such as high blood pressure or type 2 diabetes
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Weight Management Medications In Children
The U.S. Food and Drug Administration (FDA) has approved four weight management medications for children ages 12 and older: orlistat (Xenical), liraglutide (Saxenda), phentermine-topiramate (Qsymia), and semaglutide (Wegovy). A fifth prescription medication, setmelanotide (IMCIVREE), is approved by the FDA for children ages 6 years and older who have rare genetic disorders causing obesity. Medications don’t replace physical activity or healthy eating habits as a way to lose weight. Studies show that weight management medications work best when combined with a lifestyle program. One must get advice from health care professional about lifestyle treatment programs for weight management that will work on individual basis. Weight management medications don’t replace physical activity and healthy eating habits.[8]
Benefits Of Using Prescription Medications Weight Loss
When combined with lifestyle and behavior changes, including healthy eating and increased physical activity, prescription medications help some people lose weight and maintain weight loss. On average, after 1 year, adults who take prescription medications as part of a lifestyle program lose 3% to 12% more of their starting body weight than people in a lifestyle program who do not take medication. Research shows that some people taking prescription weight management medications lose 10% or more of their starting weight. Results vary by medication and by person. Weight loss of 5% to 10% of starting body weight may help improve health by lowering blood sugar, blood pressure, and triglyceride levels. Losing weight also can improve some other health problems related to overweight and obesity, such as joint pain and sleep apnea. Most weight loss takes place within the first 6 months of starting the medication.[9]
Concerns About Using Prescription Medications To Lose Weight
Experts are concerned that, in some cases, the side effects of prescription medications that treat overweight and obesity may outweigh the benefits. For this reason, never take a weight management medication only to improve the way one may look. In the past, some weight management medications were linked to serious health problems, and they were removed from U.S. markets. Possible side effects vary by medication and how it acts on one’s body. Most side effects are mild and most often improve if one continues to take the medication. Rarely, serious side effects can occur.
However, the foundation of successful weight loss remains a healthy, calorie-controlled diet combined with increased physical activity. For successful, long-term weight loss, one must make permanent changes in lifestyle and health habits. The combination of weight-loss medicine and lifestyle changes leads to greater weight loss than do lifestyle changes alone. Taking these drugs for a year can mean a loss of total body weight of 3% to 12% more than that lost with lifestyle changes alone.
Selection Of Weight Management Medication
Choosing a medication to treat overweight or obesity is a decision between one who intends to reduce weight and health care professional. Important factors to consider include
· the likely benefits of weight loss
· the medication’s possible side effects
· current health issues and other medications
· family’s medical history
· cost
Duration Of Weight Management Medication
How long one will need to take weight management medication depends on whether the drug helps in losing weight and keep it off and whether one experiences serious side effects. If one has lost enough weight to improve health and not experiencing serious side effects, the health care professional may advise to stay on the medication indefinitely. If one does not lose at least 5% of starting weight after 12 weeks on the full dose of medication, the health care professional will probably advise to stop taking it. The health care professional may also
· change treatment plan or consider using a different weight management medication
· have try different lifestyle, physical activity, or eating programs
· change other medications that might be causing weight gain
· refer one to a bariatric surgeon to see if weight-loss surgery might be an option (Gastric bypass and other types of weight-loss surgery also called bariatric or metabolic surgery involve making changes to digestive system to help losing weight. Bariatric surgery is done when diet and exercise haven't worked or when one has serious health problems because of weight.)
Because obesity is a chronic disease, one may need to continue eating and physical activity habits and other behaviors for years—or even a lifetime—to improve health and maintain a healthier weight.
Health Problems After Stopping Taking Weight Management Medication
One probably will regain some weight after he/she stops taking weight management medication. Developing and maintaining healthy eating habits and increasing physical activity may help regaining less weight or keep it off.
Medications Available To Treat Overweight And Obesity[10]
People know that being overweight is unhealthy, but for many, losing weight can be a real challenge. Even with the right diet and exercise plan in place, shedding enough pounds to get down to a healthy size can be a slow and demoralizing process. That’s why many people who are looking to get fitter and healthier turn to a safe weight loss use medicines like Orlistat, Xenical, Alli and others. The table below lists prescription drugs approved by the FDA for weight loss. The FDA has approved five of these drugs—orlistat (Xenical, Alli), phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), liraglutide (Saxenda), and semaglutide (Wegovy)—for long-term use. A sixth approved drug, setmelanotide (IMCIVREE), is limited to people who have been diagnosed with one of three specific rare genetic disorders, which must be confirmed by genetic testing.
One can keep taking these medications as long as one benefiting from treatment and not experiencing serious side effects. Some weight management medications that curb appetite are approved by the FDA for short-term use only, for up to 12 weeks. Although some health care professionals prescribe them for longer periods, not many research studies have looked at how safe and effective they are for long-term use. Never take weight management medications if one is pregnant as some of them may harm the fetus.[11]
Tips For Taking Weight Management Medication
· Follow health care professional’s instructions about weight management medications.
· Buy medication from a pharmacy or online distributor approved by health care professional.
· Only take weight management medication to support healthy eating and physical activity program.
· Know the side effects and warnings before taking any medication.
· If one is not losing weight after 12 weeks on the full dose of medication, ask the health care professional whether to stop taking it.
· Talk with health care professional about any other medications one is taking, including supplements and vitamins, when considering weight management medications.
· Never take weight management medications during pregnancy or if planning a pregnancy.
There is no single best strategy for weight management, although some evidence-based methods have been suggested. Reducing daily calorie intake is the most important factor for weight loss. Low-calorie recipes, especially those for low-fat or low-carbohydrate diets, have been suggested as the first dietary strategy. Except for energy deficit, there seems to be no significant difference between macronutrient composition-based diets. Improvement in cardiometabolic factors strongly depends on degree of weight loss. However, increasing consumption of fruits and vegetables and intake of healthy fats (including monounsaturated as well as polyunsaturated fats) can be a healthy strategy for weight loss and maintenance. Additionally, increased protein intake can help with weight loss maintenance. Eating breakfast and avoiding late-night eating should be considered important dietary strategies not only for weight loss, but also for metabolic health and are based on the physiologic clock. Time restricted eating or intermittent fasting can be considered other options for weight loss and its maintenance. Maintenance of a low-calorie intake should be continued throughout an individual’s lifespan. Thus, the best diet for weight management is one that can be maintained in the long term. Healthcare providers should consult with patients before choosing the optimal diet strategy because successful weight loss and its maintenance depends on the patient’s choices, preferences, and long-term adherence to the diet plan. Over the last few years, the FDA has approved a number of anti-obesity medications that help control appetite and food cravings. Because weight loss drugs make one less hungry, they also reduce the number of calories one’s body takes in each day. Over time, eating fewer calories will cause to lose weight.
References
1. Egger G, Dixon J. Beyond obesity and lifestyle: a review of 21st century chronic disease determinants. Biomed Res Int 2014;2014:731685.
2. World Health Organization. Controlling the global obesity epidemic. Geneva: World Health Organization; 2020.
3. NCD Risk Factor Collaboration (NCD-RisC) (2017). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet 2017, 390:2627–2642. doi.org/10.1016/S0140-6736(17)32129-3
4. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief 360. National Center for Health Statistics; 2020. Accessed December 7, 2020. www.cdc.gov/nchs/products/databriefs/db360.htm External link
5. Ryan DH, Kahan S. Guideline recommendations for obesity management. Med Clin North Am 2018;102:49-63.
6. Makris A, Foster GD. Dietary approaches to the treatment of obesity. Psychiatr Clin North Am 2011;34:813-27.
7. Turner LR, Harris MF, Mazza D. Obesity management in general practice: current practice match guideline recommendations. Med J Aust 2015;202:370-2.
8. New drug therapy approvals 2022. US Food and Drug Administration. Updated January 2023. Accessed February 8, 2023. www.fda.gov/drugs/new-drugs-fda-cders-new-molecular-entities-and-new-therapeutic-biological-products/new-drug-therapy-approvals-2022 External link
9. Weight-loss medicines. MedlinePlus, US National Library of Medicine. Updated May 21, 2017. Accessed January 31, 2019. https: / / medlineplus .gov / ency /patientinstructions/000346.htm NIH external link
10. FDA approves treatment for chronic weight management in pediatric patients aged 12 years and older. News release. US Food & Drug Administration. June 27, 2022.www.fda.gov/drugs/news-events-human-drugs/fda-approves-treatment-chronic -weight-management-pediatric-patients-aged-12-years-and-older
11. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: A systematic and clinical review. JAMA. 2014;311(1):74–86. doi:10.1001 /jama.2013.281361
Health care professionals use the Body Mass Index (BMI), a measure of weight in relation to height, to define overweight and obesity. People who have a BMI between 25 and 30 are considered to be overweight. Obesity is defined as having a BMI of 30 or greater. If one is overweight, or have obesity, or have severe obesity, may increase risk of health problems. The health care professional can assess individual risk caused by weight. If one is struggling with weight, a healthy eating plan and regular physical activity may help lose weight and keep it off over the long term. If these lifestyle changes are not enough to help lose weight or maintain weight loss, the health care professional may prescribe medications as part of weight-control program.