- Obesity - when do you need to take medication?
- Pharmacotherapy in obesity
- Known drug for type 2 diabetes as a breakthrough in the treatment of obesity
- Obesity - when is surgery needed?
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Until recently, the recipe for obesity was primarily to modify the lifestyle by drastically changing the diet and significantly increasing physical exertion, and if that did not help - bariatric surgery. Today, modern drugs, also available in Poland, are the salvation for many people suffering from obesity. One of them - the well-known diabetes drug - has recently been hailed as a real breakthrough in the treatment of obesity. What is known about him?
Obesity - when do you need to take medication?
Obesity is a he alth and social problem. And, as the drug explains. Marzenna Gadomska, diabetologist from the Obesity Treatment Clinic at Medicover Hospital, a chronic disease that occurs worldwide.
- Over 90 percent people with type 2 diabetes are overweight or obese and over 20 percent. People with obesity also have type 2 diabetes. Obesity can lead to over 200 diseases, including but not limited to insulin resistance, high blood pressure and fat disorders. It is associated with complications such as type 2 diabetes, cardiovascular diseases: myocardial infarction, stroke, atherosclerosis of the arteries of the lower extremities and non-alcoholic fatty liver, which significantly reduces the quality of life of patients. - calculates the expert.
- Recently, this disease has led to an increase in hospitalizations, the need for more frequent mechanical ventilation, and has contributed to the death of many people with Covid-19. - he adds.
In cases where obesity is caused by another disease (e.g. thyroid problems), it is necessary to properly treat the underlying disease. Where the cause is primarily a lifestyle: an unhe althy, high-calorie diet and lack of physical activity, its modifications are necessary.
As emphasized by Dr. Gadomska, compliance with these recommendations is extremely difficult for many patients in the long run. In addition, the use of diet and exercise alone allows you to reduce body weight by only about 3-4 percent. - only a few well-motivated patients are able to achieve better results.
Thereforecurrent clinical recommendations for obese patientswith a BMI greater than or equal to 30 and those with a lower BMI of 27that is, they are only overweight, but with complications characteristic of obesity already present, they suggest the use of adjuvant pharmacotherapy, which will help to achieve the goals of therapy.
It is not only about the cosmetic effect of such treatment, i.e. improving the patient's appearance, but most of allabout reducing complications related to this disease and inhibiting their formation , which can be achieved with reduction of 5-10 percent. starting body weight, adds Dr. Gadomska.
Pharmacotherapy in obesity
Various medications supporting the treatment of obesity are currently available in Poland to facilitate the implementation of changes in eating habits. They are prescribed by prescription, each of them works on a different basis.
The drug containing the active substance orlistatreduces the digestion of fats and impairs their absorption. fatty foods.
A drug based on n altrexone / bupropion substancesregistered in Europe since 2015 prolongs the feeling of fullness and inhibits the desire to look for food, i.e. reduces appetite. It is intended for those who have an eating disorder or eat under the influence of emotions.
In turn, liraglutide(belonging to the so-called GLP-1 analogues) registered in Europe in 2015, available in Poland from 2022, initially used in a dose of 1.8 mg only in patients diagnosed with type 2 diabetes, due to its beneficial effect in diabetes, improving its control, and then after increasing the dose of the drug to 3 mg for people struggling with obesity treatment, it facilitates compliance with medical recommendations when changing eating habits.
Known drug for type 2 diabetes as a breakthrough in the treatment of obesity
In mid-2022, the media reported that the FDA - the US Food and Drug Administration - had approved an injectable drug to help significantly reduce weight.
This medicine contains the active substance semaglutide(also a long-acting GLP-1 analogue) is used for chronic weight control in obese or overweight adults with at least one medical condition related to excess body weight (e.g. high cholesterol, high blood pressure, type 2 diabetes) in a dose of 2.4 mg administered once a week.
Semaglutide is not a completely new drug - it has been used to treat type 2 (non-insulin dependent) diabetes since January 2022. also in Poland in the maximum dose so far equal to 1 mg.
- Application of GLP-1 analogs, including semaglutide,was a milestone in the treatment of type 2 diabetes, explains the drug. Marzenna Gadomska. - This drug has an extremely positive effect on the patient's quality of life, as it greatly facilitates compliance with restrictive medical recommendations by acting on the central nervous system, contributing to reducing the feeling of hunger (the patient stops thinking about food all the time) and increasing the feeling of fullness, as well as acting in digestive tract by delaying the passage of food from the stomach to the intestines. Thanks to this, it is easier to reduce body weight, unlike some other drugs used in diabetes so far, which increase body weight, which adversely affects the disease itself and its comorbidities. - says.
The expert emphasizes thatsemaglutide has significantly changed the possibilities of diabetes therapyand thanks to it the control of this disease is also improving. The level of glycated hemoglobin HbA1c - an indicator of long-term diabetes control - decreases, and thanks to it there is also an improvement in other metabolic parameters associated with this disease.
One of the key effects of semaglutide is the so-called cardioprotection - it reduces the risk of developing cardiovascular diseases arising from atherosclerosis, such as myocardial infarction, ischemic stroke, atherosclerosis of the lower limbs, which are often diagnosed in diabetic patients.
According to the summary of product characteristicsin Poland, semaglutide is used at a maximum dose of 1 mg subcutaneouslyonce a weekonly in patients with type 2 diabetes .
Some doctors, however, also prescribe it to patients with obesity and accompanying insulin resistance or prediabetes , although - as the drug emphasizes. Marzenna Gadomska - in accordance with applicable law, the use of semaglutide in a patient suffering from obesity without coexisting diabetes in Poland is currently out of registration.
However, clinical studies have shown that semaglutide lowers body weight not only in diabetic patients, but also in people who do not have diabetes.
- In the United States, clinical trials have been carried out with this drug at a higher dose equal to 2.4 mg, and now the first phase of these trials, which belong to the 3rd phase - the STEP program, has ended. In these studies, the dose used was 2.4 mg per week and the observation period was 68 weeks. A total of 4,684 obese patients, including 1,210 patients with type 2 diabetes, participated in the STEP 1-4 studies.
They found the average weight reduction for patients taking 2.4 mg of semaglutidewas from -9.6 percent. down to -17.4 percent from your starting body weight. For patients with type 2 diabetes taking this dose, weight loss was on average -9.6%. compared to the 1 mg dose, where the reduction was -7% and for patients taking placebo it was -3.4%
In other words, the reduction in body weight was 2.6 percent. higher for the dose of 2.4 mg and by 6.2 percent. higher than placebo. In addition, at least 5 percent. weight reduction occurred in 69 percent. patients taking a dose of 2.4 mg, compared with 57 percent. patients on a dose of 1 mg. - says the drug. Marzenna Gadomska.
- Semaglutide at a dose of 2.4 mg also contributed to a more significant reduction in cardiovascular risk with a slightly increased number of side effects. The safety profile of the 2.4 mg dose of this drug was the same as that of the 1 mg dose. No new areas have been identified with regard to the safety of the therapy, compared to those seen with the long-term use of another drug in this group, namely liraglutide at the optimal dose of 3 mg.So this is a breakthrough in the treatment of obesity, the first injectable drug approved for chronic weight control . - says the expert.
As the drug emphasizes. Marzenna Gadomska, based on the results of clinical trials, the FDA recommends that in the treatment of obesity, semaglutide in a dose of 2.4 mg once a week for chronic weight control in people with obesity (BMI greater than or equal to 30) and overweight (greater than 27 kg / m2), with at least one medical condition (including high blood pressure, type 2 diabetes, cardiovascular disease, high cholesterol, sleep apnea syndrome, obesity-induced hypoventilation syndrome, joint disease requiring surgery) to be used as addition to a diet with reduced calories and increased physical activity.
November 11, 2022 Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency adopted a positive opinion recommending the granting of a marketing authorization for a drug containing semaglutide in a dose of 2.4 mg. medicinal product. In Poland, the drug in this dose - similarly to the lower doses - will be available only on prescription.
Obesity - when is surgery needed?
Will weekly injections solve my obesity problem? Probably not. As the drug explains. Marzenna Gadomska,In some cases, a necessary therapeutic option is the surgical treatment of obesity , i.e. bariatric surgery.
- Patients with BMI equal to or above 40 are eligible for surgerykg / m2, with a BMI in the range of 35-40 kg / m2 in which surgically induced weight loss may bring about a potential improvement in diseases caused by obesity, e.g. type 2 diabetes, hypertension, etc., with a BMI in the range of 30.0-34 , 9 kg / m2 with type 2 diabetes mellitus and persistent high sugar levels despite the use of oral medications and insulin. - says the drug. Marzenna Gadomska.
Reduction of excess body weight after various surgical procedures is on average minus 50-70 percent. in observations dating back more than 10 years after surgery.
- But remember thatthe operation must be part of a comprehensive treatment , it can only be performed on a patient under the care of the treatment team. In the Medicover Hospital where I work, according to world standards, such a team consists of a surgeon, an anaesthesiologist, and internists in the treatment of obesity, the so-called obesitologists, as well as a dietitian, psychologist / psychiatrist. The surgery itself requires proper preparation of the patient, which takes several months. It is important to realize that the surgical treatment of obesity is by no means the same as weight loss and the possibility of returning to any dietary restrictions. - emphasizes the drug. Marzenna Gadomska.
- A surgical procedure, and most often it is the so-called Sleeve gastrectomy is the creation of conditions for a new anatomical situation, which is aimed at gradual weight reduction, while maintaining an appropriate lifestyle by the patient and maintaining this change at an acceptable level. The condition of surgical treatment is the ineffectiveness of conservative treatment, which absolutely requires a prior attempt of such treatment. One should take into account the risk of recurrence of the obesity disease, therefore comprehensive treatment is recommended: pharmacotherapy combined with surgery, nutritional education and support from a psychologist or psychiatrist. Drugs from the above-mentioned group turn out to be of great help in preparing patients for surgery as well as they enable the enhancement of the effects of bariatric and metabolic treatment in people who have already undergone surgery. We should also remember that bariatric surgery is a method of choice for treating patients with morbid obesity, i.e. one whose BMI is equal to or higher than 40, concludes Dr. Gadomska.
