Wégovy, Mounjaro, Saxenda… Several drugs aimed at treating obesity have made headlines in recent years. Some treatments are available in France and the European Union.
Professor Emmanuel Disse, head of the endocrinology-diabetes-nutrition department at Lyon Sud hospital and coordinator of the French Clinical Research Network Nutrition, obesity and metabolic disorders, agreed to answer our questions.
Who can take obesity medication?
Professor Emmanuel Disse: “According to the recommendations of the High Authority for Health, their use is as second intention, when dietary treatment and physical activity has failed. The European marketing authorization says that patients with a body mass index (BMI) above 30 can benefit from it. They must be under 65 years old and the medication must be prescribed by an obesity doctor.
“These treatments are designed to combat obesity: they should not be diverted, for example to lose a few kilos before going to the beach. That would be dangerous. Their use must be supervised and monitored by a doctor. »
How do they work?
“Orlistat, which is an old medication, reduces the breakdown of fats in the intestine and the absorption of dietary fat. It is not reimbursed and the weight loss is moderate.
“In France, other treatments, Wegovy, Mounjaro and Saxenda, are available. They increase the biological signal of satiety, by imitating a hormone, GLP-1, that the intestine produces in response to meals. In addition, this imitation degrades less quickly in the body. Patients therefore have the impression of being at the end of a meal all day.
“Another molecule, setmelanotide, can treat obesity of genetic origin. It helps restore the feeling of satiety for people who do not have it. »
How effective are these medications?
“Not everyone has the same power when it comes to weight loss. It is on average 9% with Saxenda, 17% with Wegovy and 21% with Mounjaro. In comparison, surgery results in weight loss of between 25 and 30%. These medicinal strategies will therefore become important players in treatment, as surgery can be aggressive.
“On the other hand, not all patients respond to treatment in the same way and we cannot yet predict this. Regular reassessments are therefore necessary. The doctor usually stops treatment if, after three months, the patient has not lost 5% of their weight. »
How much do these treatments cost?
“At the moment, none of them are reimbursed. However, the High Health Authority has issued a recommendation which could lead to the reimbursement of Wegovy and Mounjaro. Generally speaking, these drugs are expensive because they are biological and therefore expensive to manufacture. A treatment based on Wegovy can therefore cost €250 to €300 per month.
“This risks creating a two-tiered medicine where only wealthy patients can have access to these treatments. The arrival of these drugs opens a new era but unfortunately, at the beginning, not everyone will be able to benefit from them. »
How long does the treatment last?
“Weight loss lasts about twelve months. But it is necessary, unless significant efforts are made, to continue the treatment beyond this to avoid weight regain. We sometimes have a false perception of obesity, which consists of thinking that it is only a situation that is reversible. But it disrupts our body’s storage capacity: losing weight does not make it disappear. »
Are there any side effects?
“It is common for patients to suffer from them, although none of the side effects are serious. Digestive disorders, nausea, transit disorders and even belching may occur. »
Obesity: what are the risks?
In France, the number of people suffering from obesity has increased significantly over the last twenty years. According to the latest figures published by Public Health France, in 2017, 13% of men and 14% of women were obese.
This disease generates “multiple risks”, indicates Emmanuel Disse. “Beyond a BMI of 30, life expectancy decreases,” continues the professor. Metabolic, cardiac, arterial or even respiratory complications may occur.
In addition, “obesity can have psychological consequences, such as depression or anxiety. People affected by it are also stigmatized systemically in our society and even in access to care,” describes Emmanuel Disse.
Finally, the scientist notes that “people suffering from obesity often have little to do with it. Obesity is a chronic disease, not simply a behavioral disease or a lack of willpower on the part of the patient. »
