The battle of the bulge is rarely out of the public eye. The American waistline is expanding exponentially, with obesity rates rising from 13.4% in 1980 to 41.9% of the population in 2020.
However, what has become a massive public health crisis – the CDC estimates obesity costs the US healthcare system $147bn per annum – has over the same period been tasked as a matter for the individual. The 1980s saw the advent of ‘diet foods’ as a way of controlling weight; brands like Diet Coke and Lean Cuisine launched onto the supermarket shelves while Jenny Craig shipped calorie-counted TV dinners around the country. The 1990s and 2000s saw the weight loss come out of the kitchen into your living room as increasing ownership of VCRs (and subsequently DVD players) saw almost every celebrity, from Cindy Crawford to Angela Lansbury, follow in the path of Jane Jane Fonda and release their own fitness programs.
What was noticeable by its absence from the weight management sphere was the medical world. Common wisdom said that ‘diet pills’ wouldn’t work and were at best, benign herbal supplements, or worse amphetamine-laced dangers. In 2014 that changed. The FDA approved liraglutide – a GLP-1 drug similar to those used in diabetes treatment for around a decade prior – for obesity. GLP-1s work by increasing insulin production, signaling to the brain that the user is full. They also inhibit gastric emptying – literally slowing down the passage of food through the stomach – keeping the user fuller for longer. With proven results of helping to lose between 5-15% of a patient’s body weight, GLP-1s have caught fire in the imagination of both the public and the medical profession. In response, the industry is bringing a wealth of prescription weight loss medication to market. So, with that in mind, let’s take a look at some of the solutions that are reshaping our shape.
Semaglutide
Semaglutide goes under two different names – it’s branded as Ozempic for diabetes prescriptions and Wegovy when prescribed for weight loss. It’s perhaps the best known of the GLP-1s, due to celebrities like Oprah Winfrey and Tracy Morgan openly divulging they’ve used the medication to lose weight. Wegovy is administered via a once-weekly injection – it typically comes in the form of a pre-filled ‘pen’ containing one shot of the prescribed dosage.
Naltrexone-Bupropion
Of course, even when medications can have similar effects, the key to finding the right one differs from patient to patient. Tailoring therapies to individual needs is commonplace across many medical spheres. For those who perhaps need a more involved regimen than once weekly – routine builds mindfulness – or simply have a deep phobia of needles, Naltrexone-Bupropion is an option. This combination of two medications needs to be taken twice daily, in pill form.
Liraglutide
The treatment that kickstarted the rush to bring GLP-1s to the public is still available and still produces impressive results. A 2022 study in Belgium with 115 patients with a median Body Mass Index of 34.8 (BMI of 30+ is considered obese) resulted in the group’s median body weight decreasing by over 9% after four months. Liraglutide (often branded as Saxenda) is administered similarly to Wegovy, by a weekly injection.
Tirzepatide
Tirzepatide, or Zepbound, is the newest of these treatments, having been FDA-approved for weight loss in November 2023. Like Wegovy, it’s administered via a weekly shot, although the injection site should be changed each week between the stomach, upper thigh, or the back side of the upper arm. While it’s a self-administered shot, a partner can be useful for the arm site and a record should be kept of the schedule. However, this discipline should pay off. Tirzepatide has shown increased weight loss results as compared to semaglutide – trials in 2022 showed patients losing 21% of their body weight after 72 weeks at the maximum dose of tirzepatide versus 15% after 104 weeks with the equivalent in semaglutide.
Is medical weight loss the way of the future? The pharmaceutical companies think so. Zepbound manufacturer Lilly has a new medication in the pipeline that replicates three gut hormones. The benefits of GLP-1s may just be getting started – Wegovy was greenlighted by the FDA for the treatment of heart problems in March 2024, and maker Nordisk has also noted trial subjects have shown reduced progression in kidney disease. It may be time to start believing the hype.
