2023-12-31 05:03:13
Science is one of the two “top” magazines in the scientific world. And for 143 years it has focused on the advances of science. In December, following a long tradition, it dedicated its cover to the most relevant discovery of the year that ends today: the “2023 prize” went to a new family of drugs that is demonstrating its power to help control another major global epidemic: overweight and obesity.
This situation affects more than one billion people. According to the World Health Organization, there are 650 million adults, 340 million adolescents and 39 million children. All numbers in an upward trend.
The theme leaves the merely aesthetic far behind.
Each “extra kilo” increases risk factors, deteriorates the cardiovascular system, increases the incidence of diabetes and joint pain, causes more metabolic diseases (raises triglyceride and cholesterol values), is associated with fatty liver, generates hormonal changes and fertility disorders. And it is associated with mood disorders, such as depression and anxiety. It even increases the incidence of certain cancers.
As it is a central element of good health and – culturally – aesthetics, the pharmaceutical industry has spent decades of research looking for molecules capable of controlling it. But all attempts were unsuccessful or counterproductive. Until now, the novelty, which was the Discovery of 2023, is that a new family of drugs called “GLP-1 receptor agonist” (glucagon-like peptide type 1) is being consolidated that were designed to control diabetes, but they were also shown to serve to reduce obesity.
Numerous studies have proven that these molecules induce significant weight loss (9 to 15% of body weight) in those who use them. The number may seem small, but there are many indications that it provides benefits such as control of hypertension, cholesterol and triglycerides. Additionally, it reduces blood glucose, improves fatty liver and other health biomarkers.
While it is true that they can cause side effects, these are usually temporary and manageable.
In addition, this same year, other clinical trials using GLP-1 were published that showed reductions in heart failure symptoms and a reduction of up to 20% in the combined risk of heart attack, stroke, and cardiovascular mortality. In other words, more convincing data that they provide other benefits, in addition to weight loss.
“The action of these drugs occurs at different levels: in the cerebral hypothalamus it inhibits appetite and generates less thought regarding food. And it increases the time food remains in the stomach, which contributes to early satiety. In other words, you end up eating fewer calories and glucose improves,” cardiologist and nutritionist Paola Harwicz told PERFIL. “But – added the member of the Argentine Society of Cardiology – they are drugs that must be used within the framework of a weight loss program guided by a specialist who can optimize the treatment and accompany the process. They also need a physical activity plan and, eventually, psychological therapy. In other words, they are very useful medications, but they must be prescribed in the context of comprehensive treatment and under supervision.”
On the other hand, according to the expert, there are other situations to consider: obesity is a chronic and multi-causal disease, which is usually associated with other illnesses. “That is why chronic treatments must be designed, evaluating each patient.” For example, if the medication is withdrawn, appetite control and satiety disappear and there may be a weight “rebound” effect. “We should not think of them as a magic drug, but as part of a comprehensive treatment that makes it easier to adopt healthier habits,” she explained.
History. Harwicz explained that this family of medications has proven, in numerous clinical studies, to be safe and effective. And the experience of its use (in diabetes) is almost 15 years old. Furthermore, they were evolving. “At first it was applied twice a day, then it went to an injection every 24 hours and now we are on a weekly one.” The future of these drugs also seems promising. For example, in the US it is now available in pill form (for diabetes control).
In Argentina, Anmat approved semaglutide (diabetes) in 2021. And, a few months ago, that organization gave the OK for its use in obesity, in higher doses, but this format has not yet reached local pharmacies.
The expert concluded that “they are options for certain patients, such as those who are overweight associated with other comorbidities (diabetes, heart disease). Or, if your body mass index is greater than 30, even without other pathology. Always under supervised use. But these drugs are making their place in the treatment of obesity, within a comprehensive conception of chronic disease.”
A comprehensive look
A few weeks ago, half a dozen medical and patient associations issued a document: “Overweight and obesity: a challenge for health and development that requires the participation of civil society.” It summarizes the causes that explain the epidemic of overweight and obesity, and proposes measures to stop it.
“Basically, it is a problem to be addressed from multiple perspectives, including a social perspective, broader than just the medical one,” Rubén Torres, a health scientist and director of the Institute of Health Policies and Public Health (Ipegsa), explained to PERFIL. In addition, the expert recalled the high economic cost of dealing with its consequences instead of prevention. And he highlighted “the worrying increase in weight that is noted among children and adolescents.”
This situation is the result of a combination of environmental, social, cultural, biological, psychological and genetic factors.
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