Still, the prospect of a lifetime of weekly injections to maintain weight loss raises a number of questions, beginning with safety. Rather, in the view of the National Institutes of Health and the American Medical Association, it is a chronic, relapsing disease-one that disrupts multiple physiological systems. The premise of such treatments is that serious obesity is not a transitory condition related mainly to behavior and environmental factors, as many people see it. In fact, a 2021 study led by Rubino found that people on semaglutide regain weight when the drug is stopped. The hitch is that these drugs must be used throughout life, much like diabetes medications, or else the benefits are lost. Other medications are in development that combine two or three hormones involved in appetite. Patients can eat less and not be bothered by hunger and cravings. The medicine mimics a gut hormone called glucagon-like peptide-1 (GLP-1) that acts on the pancreas to increase insulin production, on the stomach to slow emptying, and on the brain to turn down appetite and signal satiety. Semaglutide is widely seen as a breakthrough-“a new paradigm for the hormonal treatment of obesity,” as Kushner puts it. “We want to be sure our patients are getting healthier, not just thinner,” he says. Kushner emphasizes the drug is not just for weight loss but to reduce the associated risk of chronic illnesses.
Weight loss medication trial#
Evidence from the trial suggests that along with weight loss come reductions in blood pressure, blood glucose and unhealthy lipids, as well as C-reactive protein (a measure of inflammation). Such results are about double what older weight-loss drugs achieve, says Robert Kushner of Northwestern University, one of the study’s principal investigators. A study involving 1,961 such individuals published last year in the New England Journal of Medicine found that, on average, people taking semaglutide lost 14.9 percent of their initial body weight over 68 weeks compared with just 2.4 percent for a group receiving placebo injections. It was approved in June 2021 for treating people with a body mass index in the obese range or just under that range but with weight-related health issues. The medication generating the most excitement is a weekly injectable drug called semaglutide (brand name: Wegovy). “We are finally able to help people lose weight in the ranges that help the complications of obesity,” Rubino says.
That changed with the recent advent of medications directly targeting the brain-gut axis that regulates appetite. Rubino, director of the Washington Center for Weight Management and Research in Arlington, Va., says that for years she had relatively few tools to help them.
Many patients have medical problems related to severe obesity, including diabetes, fatty liver disease, hypertension, polycystic ovary syndrome, sleep apnea and painful arthritic joints. Some have turned to gastric bypass surgery, lost scores of pounds but then regained them. The people who seek out endocrinologist Domenica Rubino have tried again and again to lose weight.
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