The drug rep had a smug look on his face; he knew he had a winner. He didn’t need to sell anything, the American public had already bought the story. There are very few drugs in history where patients are excited by the conversation and want to take a new drug. I’m talking about the new class of diabetes drugs called GLP-1 (glucagon-like peptide) agonists. The particular drugs are Ozempic (semaglutide) and Mounjaro (Tirzpatide). Initially developed for the treatment of type 2 diabetes, they have been shown to have a significant effect on weight loss.
I had already heard the stories of my other patients. Most of them loved it. They had lost weight, had a better grip on their diabetes, and most importantly, didn’t crave the foods that weren’t healthy for them. In trials, the average weight loss in this class ranged from 5 to 11 kg. These drugs bind to and activate the GLP-1 receptor, which causes insulin secretion and decreases glucose levels. They also reduce the time it takes for your stomach to empty, making you feel full. These drugs reduce appetite by acting on GLP-1 receptors in the brain, causing satiety. There was one big complaint from all my patients: they couldn’t find a pharmacy that had the drug; they were out of stock. Yes, you heard it right, drug companies couldn’t do enough, despite charging an arm and a leg. The cost of a monthly supply of these drugs is about a thousand dollars.
Obesity is a new world disorder. In the past (in the early part of the 19th century), obesity was linked to prosperity. With food scarce, extra fat was insurance against starvation. The adaptive process of energy accumulation became maladaptive and pathological as food sources increased and the effort required to obtain food decreased. Obesity is now defined as a chronic disease with an increased risk of diabetes, hypertension, kidney disease and vascular disease, not to mention a social problem with the myriad mental health problems that accompany our quest to have a good I wait.
Our society, with all of our technology, is pushing us further and further towards the precipice of obesity. Technology has made it easier: you can manage your finances, pay your bills, meet your friends and of course order your favorite food right away with just a click. Energy expenditure is much lower than what we put. Today a BMI (body mass index in kg/height in m^2) greater than 25 is considered overweight. India, with the largest population in the world, along with other developing countries, has joined the developed nations in the weight issue, with a sudden increase in cardiovascular mortality over the past 20 years. While there are many reasons at play here, the familiar suspects of obesity and diabetes are omnipresent. There is now data that Ozempic reduces cardiovascular outcomes in patients with diabetes. The FDA recently approved additional labeling for the reduction of cardiovascular disease.
The South Asian population has a higher incidence of abdominal obesity. Compared to Europeans, we may have normal BMI but higher abdominal obesity. Unfortunately, this is the worst form of obesity, with visceral abdominal fat resulting in a higher degree of insulin resistance and hyperinsulinemia, a term called metabolic syndrome. None of this happened overnight, and there won’t be an easy cure, and that’s exactly where drug companies are moving for a cure for a disease caused by other capitalist companies.
The companies that make these drugs, Novo Nordisk and Eli Lilly, have already seen their stock prices soar to extraordinary new heights. The irony is that Mounjaro hasn’t even been approved for weight loss. That hasn’t stopped weight clinics from the prescription overdrive. The side effect profile of these drugs is nothing to envy. The fine print has a black box warning for thyroid cancer and everything in between, from pancreatic disease to kidney failure to bowel problems. That doesn’t stop the $76 billion diet industry from going full steam ahead.
Health is an active process and requires a lot of discipline. There are no shortcuts to your daily diet and exercise routine, and it gets progressively more difficult as you get older. Like most relationships, we fetch what we put in. There’s now hope for people who can’t heal because of a weight problem, but it comes at a price. Welcome to the new worldwide network where we continue to strive for perfection.
Dinesh Arabis a cardiologist.
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