What is the “B-side” of new anti-obesity drugs?

Young woman with beautiful body and measuring tape — Photo: Freepic

With the recent arrival of the drug “Mounjaro” in July of this year, we already have in Spain several drugs with slimming properties to treat. Diabetes and obesity The problem that arises is that patients believe that medications are the main measure to combat obesity, while this is not the case, but the main thing is the patient’s lifestyle; at the same time there is a shortage of these health products for diabetics.

“Treating obesity is a priority for our public health. Recently, there has been an increase in the use of medications to help with weight loss. While these medications may be beneficial for some people, it is important that they are used responsibly and under medical supervision,” says Dr. Liliam Flores, board member of the Spanish Society for Obesity (SEEDO).

In this regard, we must remember, as also defended by the Obesity Unit Specialist of the Endocrinology and Nutrition Department of the Hospital Clínic de Barcelona, that obesity is a “complex condition” that requires a multifaceted approach: “Medications can be a useful tool, but they do not replace the importance of following a healthy and balanced lifestyle.”

Thus, in another interview with Infosalus, Dr. Rocío Villar Taipo, member of the Spanish Diabetes Society (SED) and specialist in endocrinology and nutrition at the University Hospital of Santiago de Compostela, warned that “GLP1 receptor agonists”, as these drugs are called, are products with “important benefits”, not only in controlling sugar levels in diabetics, but also have other benefits at the heart or kidney level, which also lead to a significant weight loss, through a reduction in appetite and an increase in satiety.

“This has led to a significant increase in its use in people with obesity or overweight in recent years and may explain the current situation of stock shortages,” explains a member of the Spanish Diabetes Association.

Adjuvants for primary treatment, which is lifestyle

It should be noted, according to the member of the Spanish Society of Obesity, that these drugs not only help to lose weight, but also improve other related health conditions, contributing to a more comprehensive and personalized approach to obesity management: “In the treatment of obesity, GLP-1 analogue drugs are an adjunct or adjunct to the main treatment, which remains lifestyle modification.”

For this reason, it is “important,” says Dr. Liliam Flores, that these treatments be used “as part of a comprehensive approach,” which includes lifestyle changes and ongoing medical/nutritional support to make necessary dosage adjustments based on response and side effects.

More caution in its use

Furthermore, this expert from the Hospital Clinic of Barcelona defends that the increased use of drugs to treat obesity can have both benefits and risks, “so it is important to approach this trend with caution.”

It should be taken into account that these drugs, like any medicine, have indications, contraindications and side effects, which can range from mild to serious, and although drugs go through strict processes before being marketed, some of them may cause side effects and unexpected harmful effects. The doctor stressed that once they are widely used.

That’s why he insists that “we must not forget that the treatment of obesity is long-term and multifaceted, including dietary changes, exercise and psychological support.” In fact, he believes that “relying on medication alone may not be enough to address all aspects of obesity.”

Medicine shortage

Specifically, Dr. Rocio Villar Taipo, from the Spanish Diabetes Association, reminds us that from the end of 2022 in Spain we will suffer a shortage of these drugs.

Remember that since 2022, when the supply problem began, the Spanish Agency for Medicines and Health Products (AEMPS) has issued a series of recommendations to try to mitigate the impact of the high demand for these products and has recommended prioritizing their use in patients with DM2, since treatment alternatives to maintain good control in these patients may be more complex (such as insulin).

However, these drugs continued to be used in non-diabetic patients to achieve weight loss and prolonged this state of deprivation to this day.

How do these medications work?

On the other hand, we ask Infosalus, a specialist at the Spanish Diabetes Association, about how these drugs work, explaining that in addition to their effect on appetite and digestion, “GLP1 receptor agonists”, as they say, have several other effects: “In terms of controlling type 2 diabetes, they act on the pancreas, the organ responsible for producing insulin, by stimulating its own insulin production. This helps improve sugar levels in diabetics.”

In addition, this doctor emphasizes that this drug “does it safely”, without increasing the risk of hypoglycemia (low blood sugar); remembering at this point that DM2 is often associated with overweight and obesity, and this condition increases the patient’s resistance to the action of insulin (own and exogenous).

“Therefore, the weight-loss effect of these drugs is an added advantage,” confirms Dr. Villar. However, according to this specialist in endocrinology and nutrition at the University Hospital of Santiago de Compostela, the real revolution came with the clinical trials conducted on thousands of patients proving that these drugs can modify the course of diabetes.

“We know that the most common cause of death associated with DM2 is cardiovascular disease, and these drugs have been shown to reduce the incidence of cardiovascular disease, preventing heart attacks, strokes or death from cardiovascular disease. Therefore, they would be indicated in patients with DM2 with a history of cardiovascular disease (i.e. who have had a previous attack), or who are at high risk of developing it (which is the vast majority),” he adds.

For her part, Dr. Liliam Flores, from the Spanish Obesity Association, confirms that GLP-1 analogues are a class of drugs initially developed to treat type 2 diabetes, which have proven effective in weight loss and are therefore also used to treat obesity.

These medicines include liraglutide (Saxenda), semaglutide (Wegovy), and tirzepatide (Mounjaro). Indications in adults are: Patients with a body mass index (BMI) greater than 30 kg/m2 or patients with a BMI greater than 27 kg/m2 who have at least one condition associated with excess weight, such as high blood pressure, type 2 diabetes, or dyslipidemia.

“These drugs mimic the action of the hormone GLP-1, which is naturally released in the gastrointestinal tract in response to food intake, and act on excess weight through several physiological mechanisms that affect the regulation of appetite, food intake, and glucose metabolism,” explains the obesity expert.

Medicines that should be prescribed by a doctor

Finally, Dr. Rocio Villar Taipo, member of the Spanish Diabetes Association, emphasizes that these drugs should always be prescribed by a specialist, since they require an appropriate choice for patients; whether they are indicated for someone with DM2, or when they are prescribed in the context of obesity without diabetes.

On the one hand, he believes that it is necessary for the doctor to carefully explain the dosage, adapt it to the condition of each patient, and follow up to make a gradual increase in the dosage until the desired effect is achieved. With good tolerance.

Secondly, it is important to explain to the patient the adverse digestive effects, which although usually mild, can be bothersome, especially if the patient does not use the medication properly and changes his eating habits, towards a healthier diet.