Ruminations

Emerging Weight-Loss Strategies, Pharmaceuticals

"This time around we know much more about the biology and patho-physiology of obesity."
"Everyone [clinicians, before 2010, convinced that people could be spurred to burn more calories] felt that if we could just get a medication that increased metabolic rate, that would work."
"Everything starts moving faster and causes lots of problems [when metabolism is chemically driven]."
"[For full safety effects with the use of some drugs] you need years on a drug. But at the very least, we're showing people are staying on the medication for a longer period of time, because it's tolerable, and it's working [new generation of drugs]."
Dr.Sean Wharton, internal medicine specialist, McMaster University

"Every medication industry goes through its 20 or 30 years of nonsense, where nothing works and things aren't safe."
"We're coming out the other side now. We have effective and safe medications that are already making significant changes in someone's ability to lose weight and keep it off."
Dr.David Macklin, medical director, weight management program, Mount Sinai Hospital, high risk/special pregnancy BMI unit, Toronto

"However you look at it, obesity is deleterious for health - functionality, mental health and metabolic health. [The history of medical treatments, early anti-obesity pills] has been a bit of a train wreck."
"[But] drugs will be important for the management of obesity and, I think, especially for weight loss maintenance."
"With the new acceptance of injectable [peptides] we will have more success and probably less side effects."
Dr.Eric Ravussin, editor-in-chief, Journal Obesity, associate executive director, clinical science, Louisiana State University Pennington Biomedical Research Center, Baton Rouge

A 2018 study in the Lancet Diabetes and Endocrinology points out that people mostly regain at least some of the weight they shed, a year after beginning a new, successful protocol that allows them to shed at least 5 percent of their weight. And though 5 percent doesn't seem like much, given peoples' propensity to be overweight in this modern world, it is frequently considered just enough to see improvement in weight-related health problems such as pre-diabetes and high blood pressure.

An estimated ten million Canadians actively engage on a diet on any given day of the week. Irrespective of what comprises the dieting, according to Dr.Daniel Bessesen of the University of Colorado, and Dr.Luc Van Gaal, University of Antwerp, once weight is dropped, the body tends to dial down energy expended at rest, undergoing alterations in insulin sensitivity favouring fat storage. "Long-term studies suggest that these changes are probably permanent", they caution.

Add to that the fact that not everyone is able to use anti-obesity drugs, and those who can benefit from their use must continue taking them if the intention is to keep weight down. "Weight increases gradually to the level seen with lifestyle changes alone", according to all studies of anti-obesity medications which conclude this outcome when the individual decides to stop taking the medication.

When leptin, the hormone known as an appetite-suppressant was discovered, scientists felt they had discovered the cure for obesity, until the revelatory understanding that many obese people are not deficient in the hormone, but rather are resistant to it.

After years of dismal failure with emerging drugs viewed as weight loss winners, but which later studies indicated were instead beginning to cause an epidemic of serious heart-valve problems in people with no known history of cardiac disease, the drugs were removed from the market, after millions of people had begun their use. Decades on, the pharmaceutical industry is returning anti-obesity drugs to the marketplace. Between the years 1975 and 2016, obesity has tripled among the general population.

It remains unknown why this has been occurring, although educated guesswork brings up less physical-oriented lifestyles and the normalization of the consumption of convenience, ultra-processed foods, along with the vast array of foods now available. While the common origins of the increasing rise in obesity is not yet understood, what medical science does acknowledge as fact is that once weight is gained, it becomes inordinately difficult to lose, and once lost, it then becomes even more difficult to maintain that loss.

To date, bariatric surgery is acknowledged as the most successful treatment for obesity, but many people cannot qualify for the surgery, or would prefer not opting for invasive surgery which has its own potential risks. And then there is the surgical wait list, of up to eight years. So the prospect of next-generation drug treatments for obesity has its obvious allure. Drugs of various types are beginning to emerge and tests carried out to determine their feasibility. Some of which have side effects that include nausea, constipation and diarrhea.

And then there is the recognition that the problem of obesity cannot be addressed by drugs alone even as two thirds of Canadians are recognized to be living with an overweight condition, or obesity. And for these people attempting to lose weight, the situation is that all anti-obesity drugs approved for use in Canada must be used in conjunction with a reduced-caloric diet and exercise plan. Some of the medications cost up to $4,000 annually, none paid for by provincial public drug benefit plans, whereas in the U.S. guidelines recommend such treatments only for those carrying a BMI of 30 or greater.