Insights on Anti-Obesity Medications: The Future is Now!
- Martin Kueh, Nicole Fong
Obesity has long been viewed as a personal fault brought on by a lack of willpower in lifestyle decisions. Until the recent decade, as the causes of obesity are better understood, it is now widely acknowledged as a chronic disease. This renewed perception leads to an expanded development in anti-obesity medications. Many may pose a question, especially regarding medication: is it really necessary?
These medicines are more than just about shedding excess pounds; they are meant for multi-aspect health gain. Obesity medicine sets off a surge of excitement, given its meaningful impact and potential to advance towards the norm of primary healthcare management. The future is here, and we at BeyondBMI are fortunate to be led by pioneers in this discipline. Three particular medication classes are now within arm’s reach, including Mysimba, Orlistat, and Semaglutide. In this article, we will explore how they work and what are the benefits or side effects to be aware of.
What is MySimba?
Mysimba consists of two key players - naltrexone and bupropion. Each of them is involved in separate brain areas responsible for food intake control. Naltrexone increases appetite suppressant and reduces appetite stimulant through interacting with the appetite regulatory centre. On the other hand, bupropion improves motivation and mood by increasing dopamine at the reward and pleasure centres. Together, the formula promotes satiety and increases energy balance and determination to adhere to healthy habits. Imagine it as two musicians playing guitar and drums in an ensemble. Distinct efforts but a harmonious performance.
Such teamwork has led to a promising benefit where studies found twice more likely to achieve a 5% reduction in body weight in 12 months. Alongside, Mysimba has been shown to lower cardiovascular risk factors such as blood sugar levels and lipid profiles (triglycerides, low-density lipoprotein cholesterol). As discussed by Prof. Alex Miras in the previous BeyondBMI introductory video, weight loss may plateau after 12 months, but continuing to stay the course of medication is important to reap greater benefits. If the medication does not show positive results after 3 to 4 months, the treatment strategies may need re-evaluation. Several side effects to be mindful of include dry mouth, nausea, constipation, headaches, vomiting, and dizziness. Further attention is needed for people living with chronic kidney or liver disease.
What is Orlistat (Xenical)?
Orlistat has a history of being accepted since the Food and Drug Administration and European Medicines Agency authorized it 2 decades ago. The enduring legacy speaks for itself. It blocks fat-digestive enzymes, reducing fat from being absorbed by the intestines. Orlistat prevents about 30% of fat from being absorbed when consumed in a mildly low-calorie diet; this equates to about 200 more calories. A study lasting 4 years found that orlistat consistently leads to a weight loss of approximately 6 kg. Additionally, there is also a decreasing tendency towards liver and muscle fat accumulation, thereby improving metabolic health.6
There are a few systemic adverse effects. The common ones are mainly caused by the increased amount of fats in the gastrointestinal system, leading to flatulence with discharge, faecal urgency, oily spotting, fatty or oily stool, abdominal pain or discomfort, and increased defecation. However, these symptoms improve over time and usually will not last longer than 4 weeks. Prof. Carel le Roux pointed out that this medication may not be an effective or suitable option for everyone. If the medication is ineffective within three months, the treatment may need to be changed.
What is Semaglutide (Wegovy)?
This is a game-changing medication that has gained traction in the United States in recent years. The good news is you are not missing out! Semaglutide is a once-weekly injection via the skin. This medication mimics glucagon-like peptide 1(GLP-1), a hormone that promotes insulin secretion and sensitivity. This hormone behaves like a neurotransmitter in the central nervous system and suppresses appetite while promoting satiety (fullness). Satiety usually happens when the stomach distends, and how much is caused by food intake is influenced by how fast it empties. Semaglutide delays gastric emptying and gut motility, prolonging the feeling of fullness.
The landmark Semaglutide Treatment Effect in People with Obesity trials showed that people with obesity receiving once weekly subcutaneous semaglutide (2.4mg) lost an average of 15% (15kg) over 68 weeks. With previous medicines have generally been contained within 10% weight loss threshold, this phenomenal result marks a major breakthrough in obesity treatment. Moreover, it helps to maintain healthy vascular cells and reduce inflammation.
It is thought that GLP-1 agonists are considered to be the novel blood glucose-lowering drugs, owing to their advantages of inducing weight loss. Side effects may include nausea, vomiting, constipation, or diarrhoea. Two uncommon complications are gallstones and pancreatitis, but stopping the medication should resolve these issues without any long-term effects. If you experience any symptoms, speak with your doctor right away to discuss the course of action.
Conclusion
With pharmacological treatment on the horizon, we are at an exciting phase of tackling obesity. To maximize the effectiveness of medications, it is essential to remember that they work best when combined with a healthy lifestyle, such as a balanced diet and regular physical activity. Although it may sound like a wonder drug, it certainly is not a magic bullet to weight decline. It is not just about weight reduction for people living with obesity, but also about building up a long-term health portfolio for overall well-being. The future is here and we invite you to seek professional advice to explore the right choice for smarter investment in a more secure future.