Obesity Game Changer?

Obesity is a serious issue in the U.S. and around the world; type 2 diabetes, hypertension, CVD, and other diseases associated with obesity have significant health costs. That’s why a real game changer would be important to help people lose weight and maintain their weight loss. The latest candidate is semaglutide, an anti-diabetic medication used for the treatment of type 2 diabetes by increasing insulin secretion. In my opinion, the results of this study do not achieve game-changing status. Let’s take a look at the details.

There Was Limited Weight Loss

The mean weight loss was 14.9% which translated to 34 pounds in 68 weeks. That’s really not impressive; most people can lose a half pound a week by paying more attention to their diet and increasing their activity level. The rate of weight loss in the placebo group stabilized at about 20 weeks, and that’s where it stayed for the rest of the study. In the experimental group, the rate of weight loss declined twice; first at about 20 weeks and then again at 52 weeks. By 60 weeks, the experimental subjects did not appear to be losing any more weight.

The Lifestyle-Change Program Was Ineffective

With 35 years of experience in weight loss programs, my hunch is that by 20 weeks, both the placebo and the experimental group had reverted to their prior eating patterns. We don’t know for sure because no nutritional data were presented, but that would explain the lack of continued weight loss in the placebo group and slowing weight loss in the experimental group. The drug may be game-changing, but without permanent lifestyle changes, it’s just another weight loss drug.

The medication was effective in continuing weight loss in the experimental groups, but we don’t know how. Insulin is the most powerful hormone in the body, but we don’t know exactly how semaglutide helped these subjects lose weight. Did it influence appetite? Did it impact insulin levels alone?

At What Price?

The lowest price I could find with insurance coverage was $800 per month. This would be cost-prohibitive for most people. Another way of looking at: it cost $376 per pound of weight lost. I’m not sure that’s worth the price because we still don’t know if the drug will help maintain the loss for a significant period.

And besides the monetary cost, what physical cost did the drug have? Every drug has side effects. That’s why in most cases I recommend trying lifestyle changes before adding a medication; if unhealthy habits helped create the problem, changing those habits is the best place to start. Even if a healthier diet and increased activity don’t solve the problem, those changes may mean you can take a lower dose of the med, thus reducing side effects. Except in urgent cases, most doctors will give you some time to try lifestyle changes before adding a medication.

The Bottom Line

I consider the study a failure because the subjects in both groups never learned how to change their food intake and exercise behaviors. Yes, those people taking the pharmaceutical did better related to weight loss, and because of that, some metabolic factors improved. But the rate of weight loss slowed down as the study progressed and eventually appeared to stop. Maybe this drug will give some people an edge with initial weight loss and thus improve their odds of long-term success, but if they don’t permanently change their behaviors, they won’t permanently lose weight.

We have to quit thinking of a healthier diet as a temporary change. The challenge is not losing weight; the challenge is in maintaining the lost weight. If you go back to your old eating habits, you’ll go back to your old weight; if you won’t commit to changing your diet and activity, taking a pill isn’t going to help you for very long.

While interesting, this study doesn’t change the game. The game was, is, and always will be eat better, eat less, and move more. For life.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2021. DOI: 10.1056/NEJMoa2032183