Innovative obesity drugs go mainstream: What scientists are learning

A new generation of drugs is revolutionizing obesity and the treatment of obesity. an amazing researcher with that ability. For example, the drug semaglutide helped her one-third of clinical trial participants lose at least 20% of her body weight.¹.Competitive therapy, tirzepatide, achieved similar results in more than half of study participants².

Despite their high efficacy, researchers are learning that these drugs are not necessarily the solution for everyone living with obesity. “Everyone wants to try them, but not everyone responds to them,” says Andrés Acosta, an obesity specialist at the Mayo Clinic in Rochester, Minnesota. Now that semaglutide and tirzepatide have been around for some time, health care providers are beginning to identify who are most likely to benefit from them and are beginning to recognize the challenges in using these drugs. increase.

Hungry brain or hungry gut?

This drug mimics a hormone called glucagon-like peptide 1 (GLP-1), which is involved in regulating appetite. In 2021, the U.S. Food and Drug Administration approved semaglutide under the trade name Wegobee for the treatment of obesity. And in 2022, authorities approved tirzepatide, marketed as Mounjaro, for the treatment of type 2 diabetes only, although the drug is often prescribed as a weight-loss drug.

Motor molecules burn away hunger

Experts have observed that people’s response to drugs depends on the underlying cause of their obesity. Observations like these prompted Acosta and his colleagues to develop ways to tailor the drug to each individual.³. The research team classified obese people into four subtypes. People who need to eat more to feel full (researchers called this the hunger brain). A person who reaches fullness after eating a normal amount of food but quickly feels hungry again (hungry gut). People who eat to cope with their emotions (emotional hunger). People with relatively slow metabolism (slow burning).

According to anecdotal observations by Acosta and his team, people with gut hunger, who tend to get hungry between meals, seemed to respond best to the new drug. Acosta says it’s not clear why, but he has a theory. “These patients have low levels of the GLP-1 hormone, which we believe is the cause of their obesity. ”

At the Mayo Clinic, doctors have used these criteria to guide treatment with an older GLP-1 mimetic drug called liraglutide.A study led by Acosta found that after one year of using liraglutide, participants with fasting bowel obesity lost twice as much weight as the obese general population.³.

packed full

Acosta’s team was the first to subdivide obesity into these categories, said Beverly Chan, an endocrinologist at Weill Cornell Medicine in New York City. Her own anecdotal experience has led her to agree that people with the Hungry Gut phenotype tend to do well when she takes her GLP-1 mimetic.Data from other groups also support Acosta’s hypothesis^Four. “We know that semaglutide slows bowel movements and improves satiety measures,” she says.

Peminda Kabandugama, an endocrinologist at the Cleveland Clinic in Ohio and a spokeswoman for the Obesity Association, said the drug is given weekly, which also benefits people with irregular schedules and work shifts. do. Some other drugs have to be taken at certain times of the day, which “can be difficult” for people with irregular sleep schedules, he said.

Lifetime regimen?

Researchers want to know not only who works best, but also how long they should take these drugs.clinical trials^Five The researchers showed that participants who stopped taking semaglutide after 20 weeks regained most of the initial weight loss, while those who remained on the medication continued to lose weight. Acosta said obesity is now understood as a chronic disease and these treatments are recommended over the long term. “Now, do you know what long term means?

Obesity: Benefits of Fat

Another challenge, Tchang said, is that these drugs are so effective that doctors are starting to debate how much weight loss is too much. Weight loss leads to loss of both fat and muscle, she says. Muscle loss also increases the risk of cardiovascular disease, osteoporosis, and other diseases. This is a particular problem for the elderly and those with pre-existing cardiovascular disease. Such people are exposed to the so-called obesity paradox, where weight loss is correlated with increased mortality.

When treating these at-risk populations with new drugs, health care professionals focus on obesity-related problems such as sleep apnea, fatty liver disease, and type 2 diabetes, rather than aiming for significant weight loss. I’m starting to look for a solution. To achieve that balance, experts like Tchang are increasingly exploring the possibility of prescribing lower doses.

“We want to find places that treat people for health, disease prevention, and improving their quality of life,” Chan said. “It’s not always important to lose as much weight as possible.”