Everything you need to know about semaglutide weight loss drugs

Wegovy can bring about significant weight loss but may need to be taken long term

Tobias Arhelger/Shutterstock

Ozempic and Wegovy are brand names for the drug semaglutide. Many countries have approved Wegovy for weight loss in people who are obese or overweight and Ozempic for people with type 2 diabetes.

How do these drugs work?

Drugs such as semaglutide mimic the actions of a hormone called glucagon-like peptide-1, or GLP-1. These so-called GLP-1 analogues have several effects, including slowing stomach emptying, acting on the brain to reduce appetite and boosting the release of insulin, which helps to regulate blood sugar levels.

For more than a decade, GLP-1 analogues have been used to help people with type 2 diabetes control their blood sugar and some users experienced modest weight loss. “These drugs augment a system that already exists within the human body, whose role it is to suppress appetite following meal ingestion,” says Simon Cork at Imperial College London.

Why are they making headlines now?

GLP-1 analogues have started to be prescribed for weight loss in people without type 2 diabetes. They have also become available in formulations that are more potent and easier to use.

Initially GLP-1 analogues were approved for use at a lower dose and needed to be given by twice-daily injections. In the latest formulations they are once-weekly injections, with Wegovy’s full dose being 2.4 milligrams for weight loss and Ozempic being used at a maximum dose of 2 milligrams for type 2 diabetes.

How widely available are they?

In 2021, Wegovy was approved for weight loss in several countries, including the US and Canada. Praise from some celebrity users brought it widespread publicity.

Manufacturing problems meant its manufacturer, Novo Nordisk, had trouble meeting global demand, so some doctors started prescribing Ozempic, which had been approved for people with type 2 diabetes in certain countries several years earlier. This led to shortages for people who required it for diabetes control.

In the UK, Wegovy was approved in 2021, but only got the nod from England’s medical guidelines body the National Institute for Health and Care Excellence in March 2023, when it said the drug should be given by weight loss clinics within the country’s national health service. Wegovy is expected to become available in the UK this year, while Ozempic has been available for type 2 diabetes since 2019.

In June 2023, the UK government announced the introduction of a two-year pilot that gives people with obesity access to new drugs, such as Wegovy, outside of a hospital setting.

How effective are they?

Very. It is a cliche but obesity doctors are talking about a paradigm shift in the field of obesity management. Previously, a loss of about 5 per cent of body weight would be considered a good result for any weight loss intervention outside of stomach surgery and is considered a benchmark in obesity drug trials.

Wegovy leads to about a 15 per cent reduction in body weight over a year, when combined with exercise and eating healthily.

In fact, some people seem to feel that the GLP-1 analogues have caused them to become too gaunt, as reflected in the rise of the search terms “Ozempic face” and “Ozempic butt”. “Ozempic doesn’t do anything specific to the skin,” says Alexander Miras at Ulster University, UK. It is the weight loss that causes these apparent side effects, with similar outcomes often also occurring after weight loss surgery, he says.

Do the drugs have any side effects?

Side effects can be mild, such as nausea, constipation and diarrhoea, which tend to occur as people get used to the drug. More worrying side effects include inflammation of the pancreas, although this is relatively rare.

How about hair loss?

Hair loss has been reported by some semaglutide users. This is also sometimes seen after significant weight loss from other causes, such as stomach surgery, says Miras.

Hair loss following weight loss surgery is thought to be due to physiological stress on the body causing an increased number of hair follicles to enter their “resting” phase, which leads to the hairs falling out a few months later. It stops when the weight loss stabilises, however, the hair doesn’t always grow back, says Miras.

Do these drugs cause suicidal thoughts?

GLP-1 analogues – such as Ozempic and Wegovy – are being investigated by the European Medicines Agency (EMA) after recent reports that they may cause thoughts of suicide or self-harm. This was after Iceland’s health regulator received three such reports regarding semaglutide and another drug called liraglutide, which is an earlier GLP-1 analogue.

The EMA says it is analysing about 150 reports of possible cases of self-injury and suicidal thoughts. This doesn’t mean the medicines caused these effects, however, only that people reported these experiences after starting to take them. “More work is needed to determine if a causal link exists,” says Michael Schwartz at the University of Washington in Seattle.

A spokesperson at Novo Nordisk, the manufacturer of liraglutide and the semaglutide drugs Ozempic and Wegovy, told New Scientist: “GLP-1 receptor agonists have been used to treat type 2 diabetes for more than 15 years and for treatment of obesity for eight years. The safety data collected from large clinical trial programmes and post marketing surveillance have not demonstrated a causal association between semaglutide or liraglutide and suicidal and self-harming thoughts.”

Need a listening ear? UK Samaritans: 116123; US 988 Suicide & Crisis Lifeline: 988; hotlines in other countries.

Do these drugs help with addictions?

Perhaps. There have been many anecdotal reports of people taking these medicines for diabetes or weight control who lose their urge to drink alcohol or see waning of other habits that could be described as “behavioural addictions”, such as compulsive shopping.

This is supported by research in animals that found the GLP-1 analogues lower consumption of alcohol and addictive drugs. A small trial in people has hinted at a similar effect from a GLP-1 analogue called exenatide, which reduced heavy drinking, but only in people who were obese.

The explanation could be connected with the way the drugs act on the brain to reduce food cravings, but the exact mechanism is unclear. We are only at the beginning of understanding how these treatments could support people with alcohol and drug additions, says Daniel Drucker at Sinai Health in Toronto, Canada. “The clinical trial data is not yet in to substantiate the anecdotes.”

What happens to a user’s weight long-term?

In an aforementioned study, taking semaglutide once a week led to people losing about 15 per cent of their body weight, compared with 2 per cent for those taking a placebo. Carried out in 2022, this two-year trial looked at people who were obese or overweight, but didn’t have diabetes.

In most countries, Wegovy has been approved for use for two years, but if people stop taking the drug, they generally regain the lost weight – two-thirds of it after one year, according to one trial.

But in 2024, Donna Ryan at the Pennington Biomedical Research Center in Louisiana and her colleagues found that taking the same dose of semaglutide once a week for four years led to reductions in weight that were maintained for the entire period.

The team compared more than 17,000 adults in 41 countries who were obese or overweight and didn’t have diabetes, but did have a form of heart disease. Among those taking semaglutide, weight loss continued to week 65 and was sustained over the trial, with the participants’ losing on average 10.2 per cent of their body weight, compared with 1.5 per cent in the placebo group.

“Our long-term analysis of semaglutide establishes that clinically relevant weight loss can be sustained for up to four years in a geographically and racially diverse population of adults with overweight and obesity but not diabetes,” said Ryan in a statement.

It has been suggested that using semaglutide for weight loss needs to be a long-term approach. “The weight loss is only sustained for as long as the drug is taken because as soon as you stop the drug, all of those physiological processes that are trying to get your body weight back up kick in again,” says Cork.

The results have led to calls to extend Wegovy’s treatment to at least four years. Under the current two-year approval, there will probably be demand from people for doctors to continue prescribing the drug “off-label”. “I think there’ll be a big push to try to change those guidelines,” says Cork. Ozempic can be prescribed long-term for type 2 diabetes because the condition is usually life-long.

Do these drugs reduce the risk of heart-related events?

It has been suggested that by bringing people’s weight towards a healthier range, these medications may inadvertently reduce the risk of heart-related events, such as heart attacks and strokes.

Based on the same dataset used by Ryan and her colleagues, a team at University College London examined the relationship between a change in weight and cardiovascular outcomes. Presenting their results at the European Congress on Obesity in Venice, Italy, the researchers found that semaglutide led to a 20 per cent reduction in such events, irrespective of people’s starting weight or the amount they lost.

“Our findings show that the magnitude of this treatment effect with semaglutide is independent of the amount of weight lost, suggesting that the drug has other actions which lower cardiovascular risk beyond reducing unhealthy body fat,” said team member John Deanfield in a statement. “These alternative mechanisms may include positive impacts on blood sugar, blood pressure, or inflammation, as well as direct effects on the heart muscle and blood vessels, or a combination of one or more of these.”

The results suggest that semaglutide could reduce the risk of heart-related events among people who are just mildly overweight. However, the study wasn’t designed to measure its effect as a preventative treatment. Further research is also required among an even more racially diverse group of people.

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The science and side effects behind the semaglutide weight loss drugs

Ozempic can help people to quickly lose weight but may also have serious side effects

Ute Grabowsky/imageBROKER/Shutterstock

Ozempic and Wegovy are brand names for the drug semaglutide. Many countries have approved Wegovy for weight loss in people who are obese or overweight and Ozempic for people with type 2 diabetes.

How do these drugs work?

Drugs such as semaglutide mimic the actions of a hormone called glucagon-like peptide-1, or GLP-1. These so-called GLP-1 analogues have several effects, including slowing stomach emptying, acting on the brain to reduce appetite and boosting the release of insulin, which helps to regulate blood sugar levels.

For more than a decade, GLP-1 analogues have been used to help people with type 2 diabetes control their blood sugar and some users experienced modest weight loss. “These drugs augment a system that already exists within the human body, whose role it is to suppress appetite following meal ingestion,” says Simon Cork at Imperial College London.

Why are they making headlines now?

GLP-1 analogues have started to be prescribed for weight loss in people without type 2 diabetes. They have also become available in formulations that are more potent and easier to use.

Initially GLP-1 analogues were approved for use at a lower dose and needed to be given by twice-daily injections. In the latest formulations they are once-weekly injections, with Wegovy’s full dose being 2.4 milligrams for weight loss and Ozempic being used at a maximum dose of 2 milligrams for type 2 diabetes.

How widely available are they?

In 2021, Wegovy was approved for weight loss in several countries, including the US and Canada. Praise from some celebrity users brought it widespread publicity.

Manufacturing problems meant its manufacturer, Novo Nordisk, had trouble meeting global demand, so some doctors started prescribing Ozempic, which had been approved for people with type 2 diabetes in certain countries several years earlier. This led to shortages for people who required it for diabetes control.

In the UK, Wegovy was approved in 2021, but only got the nod from England’s medical guidelines body the National Institute for Health and Care Excellence in March 2023, when it said the drug should be given by weight loss clinics within the country’s national health service. Wegovy is expected to become available in the UK this year, while Ozempic has been available for type 2 diabetes since 2019.

In June 2023, the UK government announced the introduction of a two-year pilot that gives people with obesity access to new drugs, such as Wegovy, outside of a hospital setting.

How effective are they?

Very. It is a cliche but obesity doctors are talking about a paradigm shift in the field of obesity management. Previously, a loss of about 5 per cent of body weight would be considered a good result for any weight loss intervention outside of stomach surgery and is considered a benchmark in obesity drug trials.

Wegovy leads to about a 15 per cent reduction in body weight over a year, when combined with exercise and eating healthily.

In fact, some people seem to feel that the GLP-1 analogues have caused them to become too gaunt, as reflected in the rise of the search terms “Ozempic face” and “Ozempic butt”. “Ozempic doesn’t do anything specific to the skin,” says Alexander Miras at Ulster University, UK. It is the weight loss that causes these apparent side effects, with similar outcomes often also occurring after weight loss surgery, he says.

Do the drugs have any side effects?

Side effects can be mild, such as nausea, constipation and diarrhoea, which tend to occur as people get used to the drug. More worrying side effects include inflammation of the pancreas, although this is relatively rare.

How about hair loss?

Hair loss has been reported by some semaglutide users. This is also sometimes seen after significant weight loss from other causes, such as stomach surgery, says Miras.

Hair loss following weight loss surgery is thought to be due to physiological stress on the body causing an increased number of hair follicles to enter their “resting” phase, which leads to the hairs falling out a few months later. It stops when the weight loss stabilises, however, the hair doesn’t always grow back, says Miras.

Do these drugs cause suicidal thoughts?

GLP-1 analogues – such as Ozempic and Wegovy – are being investigated by the European Medicines Agency (EMA) after recent reports that they may cause thoughts of suicide or self-harm. This was after Iceland’s health regulator received three such reports regarding semaglutide and another drug called liraglutide, which is an earlier GLP-1 analogue.

The EMA says it is analysing about 150 reports of possible cases of self-injury and suicidal thoughts. This doesn’t mean the medicines caused these effects, however, only that people reported these experiences after starting to take them. “More work is needed to determine if a causal link exists,” says Michael Schwartz at the University of Washington in Seattle.

A spokesperson at Novo Nordisk, the manufacturer of liraglutide and the semaglutide drugs Ozempic and Wegovy, told New Scientist: “GLP-1 receptor agonists have been used to treat type 2 diabetes for more than 15 years and for treatment of obesity for eight years. The safety data collected from large clinical trial programmes and post marketing surveillance have not demonstrated a causal association between semaglutide or liraglutide and suicidal and self-harming thoughts.”

Need a listening ear? UK Samaritans: 116123; US 988 Suicide & Crisis Lifeline: 988; hotlines in other countries.

Do these drugs help with addictions?

Perhaps. There have been many anecdotal reports of people taking these medicines for diabetes or weight control who lose their urge to drink alcohol or see waning of other habits that could be described as “behavioural addictions”, such as compulsive shopping.

This is supported by research in animals that found the GLP-1 analogues lower consumption of alcohol and addictive drugs. A small trial in people has hinted at a similar effect from a GLP-1 analogue called exenatide, which reduced heavy drinking, but only in people who were obese.

The explanation could be connected with the way the drugs act on the brain to reduce food cravings, but the exact mechanism is unclear. We are only at the beginning of understanding how these treatments could support people with alcohol and drug additions, says Daniel Drucker at Sinai Health in Toronto, Canada. “The clinical trial data is not yet in to substantiate the anecdotes.”

What happens to a user’s weight long-term?

The longest trial of Wegovy lasted two years and found that people’s weight broadly plateaued in the second year.

In most countries, Wegovy has been approved for two years’ use, but if people stop taking the drug, they generally regain the lost weight – two-thirds of it after one year, according to one trial.

“The weight loss is only sustained for as long as the drug is taken because as soon as you stop the drug, all of those physiological processes that are trying to get your body weight back up kick in again,” says Cork.

This suggests that after two years of use, there will be demand from consumers for doctors to continue prescribing the drug “off label”. “I think there’ll be a big push to try to change those guidelines,” says Cork.

Ozempic can be prescribed long-term for type 2 diabetes because the condition is usually life-long.

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#science #side #effects #semaglutide #weight #loss #drugs

A Charlie Munger Legacy – The Healthy Returns And Health Conundrum

Charlie Munger, investing Titan and Warren Buffet’s business partner, passed away on November 28th, a month shy of his 100th birthday. Regardless of one’s opinion of Munger the man, there can be no doubt that his life influenced investing and business, quite literally, affecting the entire world. But what if his greatest impact was on the health of the globe?

As vice chairman of Berkshire Hathaway (BRK), Munger irrevocably changed not only investment strategies, as detailed in a July 20, 1996 speech titled “Practical Thought About Practical Thought.” In it, he outlined Five Simple Notions that Solve Problems which was a ground-breaking soliloquy explaining his investment strategy using the success story of Coca-Cola (KO). However, the speech was much more than an investment primer for it also detailed a trajectory for the soft drink product using the simplest and most fundamental of academic models. (Today, Berkshire Hathaway is the single largest holder of 400 million shares of Coca-Cola stock valued at $22 billion and close to 10% of the company.)

Munger explained one aspect of his approach by stating, “it will be wise to have our beverage look pretty much like wine instead of sugared water. And so, we will artificially color our beverage if it comes out clear. And we will carbonate our water, making our product seem like champagne, or some other expensive beverage, while also making its flavor better and imitation harder to arrange for competing products. And, because we are going to attach so many expensive psychological effects to our flavor, that flavor should be different from any other standard flavor so that we maximize difficulties for competitors and give no accidental same-flavor benefit to any existing product.” (This was true about Coke when it was invented. He didn’t change the color or add carbonation. There is even a clear Coke variant. What color was Coca-Cola originally? (foodly.tn)

The Coca-Cola Company started in Atlanta but strategically spread worldwide and now boasts of offering over 500 brands and 3,500 beverages in over 200 countries. It is not an exaggeration to state that Munger and his “simple” notions not only helped enrich Berkshire Hathaway, but it also helped transform Coca-Cola into a company with a market cap of $250.36 billion. But, Munger’s influence did not end with Coca-Cola.

Convincing people to switch from drinking water to a colored, carbonated, high sugar content drink did not come without a price. In this case, the cost is more than the cost of a single original 6.5-ounce bottle bottle. What Size Was The Original Coke Bottle? – PaperJaper) More significantly, it is the cost to human health. Thirty-eight million Americans (1 in 10) have diabetes while an additional 97.6 million adults (38% of the US population) are prediabetic.

While increased sugar consumption alone doesn’t cause diabetes, it does play a role in the development of obesity and that is the critical dilemma. The primary cause of Type 2 diabetes (T2D) is obesity, and obesity has become a nationwide epidemic. The number of adults diagnosed with diabetes is projected to increase from 22.3 million (9.1% of the U.S. population) in 2014 to 60.6 million (17.9%) in 2060. Those affected will include half of the population over the age of 65. The obesity problem even affects national security; 31% of young applicants are disqualified from military service because of obesity. The US is not alone in facing an obesity crisis, the global estimate of people with diabetes is 462 million or 6.28% of the world population.

Diabetes develops due to two main conditions. The first is when the pancreas does not produce enough insulin to keep blood sugar levels in a healthy range. The second is when cells don’t take in enough sugar because they become insulin resistant. There are many causes of diabetes but it is well established that people who consume sugary drinks regularly – 1-2 or more cans per day – have a 26% greater risk of developing T2D. Counterintuitively, drinking diet soda does not eliminate the increased risk.

In one study, almost 90% of diabetics were obese. It should come as no surprise that there is an almost evangelical demand for everything from specialized diets to drugs designed to not only facilitate weight loss (the fastest growing sector of drugs in healthcare) but also to achieve attendant health improvement. Weight loss is associated with remission of diabetes as well as improvement of other conditions such as hypertension.

Returning to Munger’s Berkshire-Hathaway, the holding company owns more than half of Kraft-Heinz (makers of Kraft Macaroni and Cheese, Heinz Mayonnaise, Cool Whip, and Kool-Aid). One of Munger’s simple notions was the need for both operant and conditional conditioning of consumers. He argued for the practice of the operant reward system associated with buying these brand products and which simultaneously discouraged the consideration of buying from a proprietor marketing a competing product. As for conditional (Pavlovian) conditioning, Munger believed that the “effects of mere association” would dictate product development. The success of his reasoning speaks for itself.

Once conditioned, consumers found many of the products irresistible if not addicting. Comfort foods have always provided a temporary relief from many of life’s problems. Taken to extremes, they also can lead to obesity.

Now here’s where it becomes a bit uncomfortable, obesity is associated with diabetes and high blood pressure, the two most common causes of Chronic Kidney Disease (CKD). Progressive CKD can lead to end-stage renal disease (ESRD), that is, kidney failure. Approximately 808,000 people in the United States are living with kidney failure. Of those, 69% require dialysis. The dialysis market is a growth business.

Recognizing this growth potential, Berkshire Hathaway bought 36 million shares of DaVita, Inc. (more than 40% of the company) worth $3.4 billion. DaVita (DVA) is the largest provider of dialysis in the U.S., operating more than 3,000 dialysis facilities. DaVita stock is one of his best performing stocks of 2023 with share performance increasing by 36.63% as of November 26. What makes this even more striking is that of all of the trillion dollars in assets Munger managed, DaVita is the only healthcare concern in the current portfolio.

Charlie Munger was indeed a prodigy. He recognized value and acted boldly as he employed his Five Simple Notions to groom a population of loyal consumers who helped turn Coca-Cola into today’s behemoth. While Charlie Munger’s investment acumen will be subject to studies for many years to come, so too might be the health implications of the investments he helped to sponsor.

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The science and side effects of the drugs Ozempic and Wegovy

Ozempic can help people to quickly lose weight but may also have serious side effects

AP Photo/David J. Phillip/Alamy

Ozempic and Wegovy are brand names for the drug semaglutide. Many countries have approved Wegovy for weight loss in people who are obese or overweight and Ozempic for people with type 2 diabetes.

How do these drugs work?

Drugs such as semaglutide mimic the actions of a hormone called glucagon-like peptide-1, or GLP-1. These so-called GLP-1 analogues have several effects, including slowing stomach emptying, acting on the brain to reduce appetite and boosting the release of insulin, which helps to regulate blood sugar levels.

For more than a decade, GLP-1 analogues have been used to help people with type 2 diabetes control their blood sugar and some users experienced modest weight loss. “These drugs augment a system that already exists within the human body, whose role it is to suppress appetite following meal ingestion,” says Simon Cork at Imperial College London.

Why are they making headlines now?

GLP-1 analogues have started to be prescribed for weight loss in people without type 2 diabetes. They have also become available in formulations that are more potent and easier to use.

Initially GLP-1 analogues were approved for use at a lower dose and needed to be given by twice-daily injections. In the latest formulations they are once-weekly injections, with Wegovy’s full dose being 2.4 milligrams for weight loss and Ozempic being used at a maximum dose of 2 milligrams for type 2 diabetes.

How widely available are they?

In 2021, Wegovy was approved for weight loss in several countries, including the US and Canada. Praise from some celebrity users brought it widespread publicity.

Manufacturing problems meant its manufacturer, Novo Nordisk, had trouble meeting global demand, so some doctors started prescribing Ozempic, which had been approved for people with type 2 diabetes in certain countries several years earlier. This led to shortages for people who required it for diabetes control.

In the UK, Wegovy was approved in 2021, but only got the nod from England’s medical guidelines body the National Institute for Health and Care Excellence in March 2023, when it said the drug should be given by weight loss clinics within the country’s national health service. Wegovy is expected to become available in the UK this year, while Ozempic has been available for type 2 diabetes since 2019.

In June 2023, the UK government announced the introduction of a two-year pilot that gives people with obesity access to new drugs, such as Wegovy, outside of a hospital setting.

How effective are they?

Very. It is a cliche but obesity doctors are talking about a paradigm shift in the field of obesity management. Previously, a loss of about 5 per cent of body weight would be considered a good result for any weight loss intervention outside of stomach surgery and is considered a benchmark in obesity drug trials.

Wegovy leads to about a 15 per cent reduction in body weight over a year, when combined with exercise and eating healthily.

In fact, some people seem to feel that the GLP-1 analogues have caused them to become too gaunt, as reflected in the rise of the search terms “Ozempic face” and “Ozempic butt”. “Ozempic doesn’t do anything specific to the skin,” says Alexander Miras at Ulster University, UK. It is the weight loss that causes these apparent side effects, with similar outcomes often also occurring after weight loss surgery, he says.

Do the drugs have any side effects?

Side effects can be mild, such as nausea, constipation and diarrhoea, which tend to occur as people get used to the drug. More worrying side effects include inflammation of the pancreas, although this is relatively rare.

How about hair loss?

Hair loss has been reported by some semaglutide users. This is also sometimes seen after significant weight loss from other causes, such as stomach surgery, says Miras.

Hair loss following weight loss surgery is thought to be due to physiological stress on the body causing an increased number of hair follicles to enter their “resting” phase, which leads to the hairs falling out a few months later. It stops when the weight loss stabilises, however, the hair doesn’t always grow back, says Miras.

Do these drugs cause suicidal thoughts?

GLP-1 analogues – such as Ozempic and Wegovy – are being investigated by the European Medicines Agency (EMA) after recent reports that they may cause thoughts of suicide or self-harm. This was after Iceland’s health regulator received three such reports regarding semaglutide and another drug called liraglutide, which is an earlier GLP-1 analogue.

The EMA says it is analysing about 150 reports of possible cases of self-injury and suicidal thoughts. This doesn’t mean the medicines caused these effects, however, only that people reported these experiences after starting to take them. “More work is needed to determine if a causal link exists,” says Michael Schwartz at the University of Washington in Seattle.

A spokesperson at Novo Nordisk, the manufacturer of liraglutide and the semaglutide drugs Ozempic and Wegovy, told New Scientist: “GLP-1 receptor agonists have been used to treat type 2 diabetes for more than 15 years and for treatment of obesity for eight years. The safety data collected from large clinical trial programmes and post marketing surveillance have not demonstrated a causal association between semaglutide or liraglutide and suicidal and self-harming thoughts.”

Need a listening ear? UK Samaritans: 116123; US 988 Suicide & Crisis Lifeline: 988; hotlines in other countries.

Do these drugs help with addictions?

Perhaps. There have been many anecdotal reports of people taking these medicines for diabetes or weight control who lose their urge to drink alcohol or see waning of other habits that could be described as “behavioural addictions”, such as compulsive shopping.

This is supported by research in animals that found the GLP-1 analogues lower consumption of alcohol and addictive drugs. A small trial in people has hinted at a similar effect from a GLP-1 analogue called exenatide, which reduced heavy drinking, but only in people who were obese.

The explanation could be connected with the way the drugs act on the brain to reduce food cravings, but the exact mechanism is unclear. We are only at the beginning of understanding how these treatments could support people with alcohol and drug additions, says Daniel Drucker at Sinai Health in Toronto, Canada. “The clinical trial data is not yet in to substantiate the anecdotes.”

What happens to a user’s weight long-term?

The longest trial of Wegovy lasted two years and found that people’s weight broadly plateaued in the second year.

In most countries, Wegovy has been approved for two years’ use, but if people stop taking the drug, they generally regain the lost weight – two-thirds of it after one year, according to one trial.

“The weight loss is only sustained for as long as the drug is taken because as soon as you stop the drug, all of those physiological processes that are trying to get your body weight back up kick in again,” says Cork.

This suggests that after two years of use, there will be demand from consumers for doctors to continue prescribing the drug “off label”. “I think there’ll be a big push to try to change those guidelines,” says Cork.

Ozempic can be prescribed long-term for type 2 diabetes because the condition is usually life-long.

Topics:

Source link

#science #side #effects #drugs #Ozempic #Wegovy

Everything you need to know about the drugs Ozempic and Wegovy

Ozempic can cause weight loss in people with type 2 diabetes

Canadian Press/Shutterstock

Ozempic and Wegovy are brand names for the drug semaglutide. Many countries have approved Wegovy for weight loss in people who are obese or overweight and Ozempic for people with type 2 diabetes.

How do these drugs work?

Drugs such as semaglutide mimic the actions of a hormone called glucagon-like peptide-1, or GLP-1. These so-called GLP-1 analogues have several effects, including slowing stomach emptying, acting on the brain to reduce appetite and boosting the release of insulin, which helps to regulate blood sugar levels.

For more than a decade, GLP-1 analogues have been used to help people with type 2 diabetes control their blood sugar and some users experienced modest weight loss. “These drugs augment a system that already exists within the human body, whose role it is to suppress appetite following meal ingestion,” says Simon Cork at Imperial College London.

Why are they making headlines now?

GLP-1 analogues have started to be prescribed for weight loss in people without type 2 diabetes. They have also become available in formulations that are more potent and easier to use.

Initially GLP-1 analogues were approved for use at a lower dose and needed to be given by twice-daily injections. In the latest formulations they are once-weekly injections, with Wegovy’s full dose being 2.4 milligrams for weight loss and Ozempic being used at a maximum dose of 2 milligrams for type 2 diabetes.

How widely available are they?

In 2021, Wegovy was approved for weight loss in several countries, including the US and Canada. Praise from some celebrity users brought it widespread publicity.

Manufacturing problems meant its manufacturer, Novo Nordisk, had trouble meeting global demand, so some doctors started prescribing Ozempic, which had been approved for people with type 2 diabetes in certain countries several years earlier. This led to shortages for people who required it for diabetes control.

In the UK, Wegovy was approved in 2021, but only got the nod from England’s medical guidelines body the National Institute for Health and Care Excellence in March 2023, when it said the drug should be given by weight loss clinics within the country’s national health service. Wegovy is expected to become available in the UK this year, while Ozempic has been available for type 2 diabetes since 2019.

In June 2023, the UK government announced the introduction of a two-year pilot that gives people with obesity access to new drugs, such as Wegovy, outside of a hospital setting.

How effective are they?

Very. It is a cliche but obesity doctors are talking about a paradigm shift in the field of obesity management. Previously, a loss of about 5 per cent of body weight would be considered a good result for any weight loss intervention outside of stomach surgery and is considered a benchmark in obesity drug trials.

Wegovy leads to about a 15 per cent reduction in body weight over a year, when combined with exercise and eating healthily.

In fact, some people seem to feel that the GLP-1 analogues have caused them to become too gaunt, as reflected in the rise of the search terms “Ozempic face” and “Ozempic butt”. “Ozempic doesn’t do anything specific to the skin,” says Alexander Miras at Ulster University, UK. It is the weight loss that causes these apparent side effects, with similar outcomes often also occurring after weight loss surgery, he says.

Do the drugs have any side effects?

Side effects can be mild, such as nausea, constipation and diarrhoea, which tend to occur as people get used to the drug. More worrying side effects include inflammation of the pancreas, although this is relatively rare.

How about hair loss?

Hair loss has been reported by some semaglutide users. This is also sometimes seen after significant weight loss from other causes, such as stomach surgery, says Miras.

Hair loss following weight loss surgery is thought to be due to physiological stress on the body causing an increased number of hair follicles to enter their “resting” phase, which leads to the hairs falling out a few months later. It stops when the weight loss stabilises, however, the hair doesn’t always grow back, says Miras.

Do these drugs also help with addictions?

Perhaps. There have been many anecdotal reports of people taking these medicines for diabetes or weight control who lose their urge to drink alcohol or see waning of other habits that could be described as “behavioural addictions”, such as compulsive shopping.

This is supported by research in animals that found the GLP-1 analogues lower consumption of alcohol and addictive drugs. A small trial in people has hinted at a similar effect from a GLP-1 analogue called exenatide, which reduced heavy drinking, but only in people who were obese.

The explanation could be connected with the way the drugs act on the brain to reduce food cravings, but the exact mechanism is unclear. We are only at the beginning of understanding how these treatments could support people with alcohol and drug additions, says Daniel Drucker at Sinai Health in Toronto, Canada. “The clinical trial data is not yet in to substantiate the anecdotes.”

What happens to a user’s weight long-term?

The longest trial of Wegovy lasted two years and found that people’s weight broadly plateaued in the second year.

In most countries, Wegovy has been approved for two years’ use, but if people stop taking the drug, they generally regain the lost weight – two-thirds of it after one year, according to one trial.

“The weight loss is only sustained for as long as the drug is taken because as soon as you stop the drug, all of those physiological processes that are trying to get your body weight back up kick in again,” says Cork.

This suggests that after two years of use, there will be demand from consumers for doctors to continue prescribing the drug “off label”. “I think there’ll be a big push to try to change those guidelines,” says Cork.

Ozempic can be prescribed long-term for type 2 diabetes because the condition is usually life-long.

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Don’t use sugar substitutes for weight loss, World Health Organization advises | CNN



CNN
 — 

Don’t use sugar substitutes if you are trying to lose weight, according to new guidance from the World Health Organization.

The global health body said a systematic review of the available evidence suggests the use of non-sugar sweeteners, or NSS, “does not confer any long-term benefit in reducing body fat in adults or children.”

“Replacing free sugars with non-sugar sweeteners does not help people control their weight long-term,” said Francesco Branca, director of WHO’s department of nutrition and food safety. “We did see a mild reduction of body weight in the short term, but it’s not going to be sustained.”

The guidance applies to all people except those with preexisting diabetes, Branca said. Why? Simply because none of the studies in the review included people with diabetes, and an assessment could not be made, he said.

The review also indicated that there might be “potential undesirable effects” from the long-term use of sugar substitutes such as a mildly increased risk of type 2 diabetes and cardiovascular diseases.

However, “this recommendation is not meant to comment on safety of consumption,” Branca said. “What this guideline says is that if we’re looking for reduction of obesity, weight control or risk of noncommunicable diseases, that is unfortunately something science been unable to demonstrate,” he said. “It’s not going to produce the positive health effects that some people might be looking for.”

Non-sugar sweeteners are widely used as an ingredient in prepackaged foods and beverages and are also sometimes added to food and drinks directly by consumers. WHO issued guidelines on sugar intake in 2015, recommending that adults and children reduce their daily intake of free sugars to less than 10% of their total energy intake. Following that recommendation, interest in sugar alternatives intensified, the review said.

“This new guideline is based on a thorough assessment of the latest scientific literature, and it emphasises that the use of artificial sweeteners is not a good strategy for achieving weight loss by reducing dietary energy intake,” said nutrition researcher Ian Johnson, emeritus fellow at Quadram Institute Bioscience, formerly the Institute of Food Research, in Norwich, United Kingdom.

“However, this should not be interpreted as an indication that sugar intake has no relevance to weight-control,” Johnson said in a statement.

Instead, one should cut back on using sugar-sweetened drinks, and try to use “raw or lightly processed fruit as a source of sweetness,” Johnson added.

Dr. Keith Ayoob, scientific adviser for the Calorie Control Council, an international association representing the low-calorie food and beverage industry, told CNN via email the WHO’s “insistence on focusing only on prevention of unhealthy ‎weight gain and non-communicable diseases is at the very least, misguided.”

Robert Rankin, president of the Calorie Control Council, said “low- and no-calorie sweeteners are a critical tool that can help consumers manage body weight and reduce the risk of non-communicable diseases.”

The guidance is meant for government health organizations in countries who may wish to use the scientific analysis to implement policy changes for their citizens, Branca said.

“That will likely depend on the way that which sweeteners are consumed in a specific country,” he said. “For example, in a country where consumption patterns are high, those countries might decide to take action in a way or another.”

A total of 283 studies were included in the review. Both randomized controlled trials, considered the gold standard of research, and observational studies were included. Observational studies can only show an association, not direct cause and effect.

Results from randomized trials found the use of non-sugar sweeteners had a “low” impact on reducing body weight and calorie intake when compared with sugar, and no change in Intermediate markers of diabetes such as glucose and insulin, according to the report.

Observational studies also found a low impact on body weight and fat tissue, but no change in calorie intake. However, those studies found a low increase in risk for type 2 diabetes, high blood pressure, stroke, heart disease and death from heart disease, the report noted. A very low risk was also found for bladder cancer and an early death from any cause.

WHO said that the recommendation was “conditional” because the identified link between sweeteners and disease outcomes might be confounded by complicated patterns of sweetener use and the characteristics of the study participants.

In an emailed statement, the International Sweeteners Association, an industry assocation, said “it is a disservice to not recognise the public health benefits of low/no calorie sweeteners and is disappointed that the WHO’s conclusions are largely based on low certainty evidence from observational studies, which are at high risk of reverse causality.”

However, observational studies that follow people over time are important, Branca said. “To show that overweight people can reduce their body weight requires a long-term study. And we’re not seeing that impact from the research we have.”

The recommendation included low or no calorie synthetic sweeteners and natural extracts, which may or may not be chemically modified, such as acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives and monkfruit, the report said.

“Stevia and monkfruit are newer sweeteners so so there’s less published research in the scientific literature,” Branca said. “However they probably work in the body with a similar physiological mechanism as other sweeteners. We cannot say they are different from the others based on the data we have — they play the same role.”

Many people consider stevia products to be more “natural,” since they are derived from the stevia plant. Some natural and artificial sweeteners add bulking sugars to their products to cut their sweetness and add bulk to the product for baking.

A recent study by researchers at the US-based Cleveland Clinic found erythritol — used to add bulk or sweeten stevia, monkfruit and keto reduced-sugar products — was linked to blood clotting, stroke, heart attack and early death.

People with existing risk factors for heart disease, such as diabetes, were twice as likely to experience a heart attack or stroke if they had the highest levels of erythritol in their blood, the study found.

Just as many people have learned to eat and cook without salt, they can learn to reduce their dependence on free sugars and non-nutritive sweetners, Branca said.

“We need to target children in early life,” he said. “For example, why do parents typically use sweeteners as a reward for children and after almost every meal? We need to recommend to parents to avoid building that sweetness Interest in young children — that’s a very important action to take.”

Even if you are a true sugar “addict,” the good news is that you can tame your sweet tooth, registered dietitian Lisa Drayer said in an article for CNN. She provides the following steps:

Train your taste buds. If you gradually cut back on sugar — including artificial sweeteners — and include more protein and fiber-rich foods in your diet, that can help you crave less sugar, Drayer said.

“When we consume protein and fiber, it slows the rise in blood sugar if we consume it with a sugar-containing food. It can help satisfy us and help us reduce our sugar intake as well,” she said in a previous interview.

Choose no-sugar-added foods and avoid all sugar-sweetened drinks. For example, choose whole-grain cereal or Greek yogurt with no sweeteners. The sugar-sweetened drinks to take off your grocery list should include sodas, energy drinks, sports drinks and fruit punch. Choose water instead.

“If you like sweet carbonated beverages, add a splash of cranberry or orange juice to seltzer or try flavored seltzers. You can also flavor your own waters with fruit slices for natural sweetness or try herbal fruit teas,” Drayer said.

Drink coffee and tea with no or fewer sugars. Be careful at coffee shops, Drayer suggested. All those lattes and flavored coffees can have as much sugar as a can of soda, or more.

Enjoy fruit for dessert. Try cinnamon baked apples, berries or grilled peaches instead of cookies, cake, ice cream, pastries and other sweet treats, Drayer said.

Watch for stealth sugars. Added sugars are often present in foods that you might not think of as “sweet,” like sauces, breads, condiments and salad dressings, Drayer said.

“Pre-packaged sauces — like ketchup, BBQ sauce and tomato sauce — tend to be some of the biggest offenders of hidden added sugars in the diet,” Kristi King, senior pediatric dietitian at Texas Children’s Hospital and a national spokesperson for the Academy of Nutrition and Dietetics, told Drayer in a prior interview.

Check nutrition facts labels. All foods and beverages must list the amount and kind of sugar on the label.

Added sugars can go by other names such as “agave, brown sugar, corn sweetener, corn syrup, dextrose, evaporated cane juice, fructose, fruit juice concentrate, fruit nectar, glucose, high-fructose corn syrup, honey, invert sugar, lactose, malt syrup, maltose, molasses, maple syrups, raw sugar, sucrose, trehalose and turbinado sugar,” Drayer said.

The higher up these added sugars are on the ingredients list, the greater the amount of added sugar in the product, she said.

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Kids need to gain weight during adolescence. Here’s why | CNN

Editor’s Note: Michelle Icard is the author of several books on raising adolescents, including “Fourteen Talks by Age Fourteen.”



CNN
 — 

I’ve worked with middle schoolers, their parents and their schools for 20 years to help kids navigate the always awkward, often painful, sometimes hilarious in hindsight, years of early adolescence.

Most of the social and development stretch marks we gain during adolescence fade to invisibility over time. We stop holding a grudge against the kid who teased us in class for tripping, or we forgive ourselves our bad haircuts, botched friendships and cringy attempts at popularity.

But one growing pain can be dangerously hard to recover from, and ironically, it’s the one that has most to do with our physical growth.

Children are supposed to keep growing in adolescence, and so a child’s changing body during that time should not be cause for concern. Yet it sends adults into a tailspin of fear around weight, health and self-esteem.

Kids have always worried about their changing bodies. With so many changes in such a short period of early puberty, they constantly evaluate themselves against each other to figure out if their body development is normal. “All these guys grew over the summer, but I’m still shorter than all the girls. Is something wrong with me?” “No one else needs a bra, but I do. Why am I so weird?”

But the worry has gotten worse over the past two decades. I’ve seen parents becoming increasingly worried about how their children’s bodies change during early puberty. When I give talks about parenting, I often hear adults express concern and fear about their children starting to gain “too much” weight during early adolescence.

Parents I work with worry that even kids who are physically active, engaged with others, bright and happy might need to lose weight because they are heavier than most of their peers.

Why are parents so focused on weight? In part, I think it’s because our national conversations about body image and disordered eating have reached a frenzy on the topic. Over the past year, two new angles have further complicated this matter for children.

Remember Jimmy Kimmel’s opening monologue at the Oscars making Ozempic and its weight-loss properties a household name? Whether it’s social media or the mainstream press, small bodies and weight loss are valued. It’s clear to young teens I know that celebrities have embraced a new way to shrink their bodies.

Constant messages about being thin and fit are in danger of overexposing kids to health and wellness ideals that are difficult to extract from actual health and wellness.

Compound this with the American Academy of Pediatrics recently changing its guidelines on treating overweight children, and many parents worry even more that saying or doing nothing about their child’s weight is harmful.

The opposite is true. Parents keep their children healthiest when they say nothing about their changing shape. Here’s why.

Other than the first year of life, we experience the most growth during adolescence. Between the ages of 13 and 18, most adolescents double their weight. Yet weight gain remains a sensitive, sometimes scary subject for parents who fear too much weight gain, too quickly.

It helps to understand what’s normal. On average, boys do most of their growing between 12 and 16. During those four years, they might grow an entire foot and gain as much as 50 to 60 pounds. Girls have their biggest growth spurt between 10 and 14. On average, they can gain 10 inches in height and 40 to 50 pounds during that time, according to growth charts from the US Centers for Disease Control and Prevention.

Boys do most of their growing between ages 12 and 16 on average. They may even grow an entire foot.

“It’s totally normal for kids to gain weight during puberty,” said Dr. Trish Hutchison, a board-certified pediatrician with 30 years of clinical experience and a spokesperson for the American Academy of Pediatrics, via email. “About 25 percent of growth in height occurs during this time so as youth grow taller, they’re also going to gain weight. Since the age of two or three, children grow an average of about two inches and gain about five pounds a year. But when puberty hits, that usually doubles.”

The American Academy of Pediatrics released a revised set of guidelines for pediatricians in January, which included recommendations of medications and surgery for some children who measure in the obese range.

In contrast, its 2016 guidelines talked about eating disorder prevention and “encouraged pediatricians and parents not to focus on dieting, not to focus on weight, but to focus on health-promoting behaviors,” said Elizabeth Davenport, a registered dietitian in Washington, DC.

“The new guidelines are making weight the focus of health,” she said. “And as we know there are many other measures of health.”

Davenport said she worries that kids could misunderstand their pediatricians’ discussions about weight, internalize incorrect information and turn to disordered eating.

“A kid could certainly interpret that message as not needing to eat as much or there’s something wrong with my body and that leads down a very dangerous path,” she said. “What someone could take away is ‘I need to be on a diet’ and what we know is that dieting increases the risk of developing an eating disorder.”

Many tweens have tried dieting, and many parents have put their kids on diets.

“Some current statistics show that 51% of 10-year-old girls have tried a diet and 37% of parents admit to having placed their child on a diet,” Hutchison said in an email, adding that dieting could be a concern with the new American Academy of Pediatrics guidelines.

“There is evidence that having conversations about obesity can facilitate effective treatment, but the family’s wishes should strongly direct when these conversations should occur,” Hutchison said. “The psychological impact may be more damaging than the physical health risks.”

It’s not that weight isn’t important. “For kids and teens, we need to know what their weight is,” Davenport said. “We are not, as dietitians, against kids being weighed because it is a measure to see how they’re growing. If there’s anything outstanding on an adolescent’s growth curve, that means we want to take a look at what’s going on. But we don’t need to discuss weight in front of them.”

In other words, weight is data. It may or may not indicate something needs addressing. The biggest concern, according to Davenport, is when a child isn’t gaining weight. That’s a red flag something unhealthy is going on.

“Obesity is no longer a disease caused by energy in/energy out,” Hutchison said. “It is much more complex and other factors like genetics, physiological, socioeconomic, and environmental contributors play a role.”

It’s important for parents and caregivers to know that “the presence of obesity or overweight is NOT an indication of poor parenting,” she said. “And it’s not the child or adolescent’s fault.”

It’s also key to note, Hutchison said, that the new American Academy of Pediatrics guidelines, which are only recommendations, are not for parents. They are part of a 100-page document that provides information to health care providers with clinical practice guidelines for the evaluation and treatment of children and adolescents who are overweight or obese. Medications and surgery are discussed in only four pages of the document.

Parents need to work on their own weight bias, but they also need to protect their children from providers who don’t know how to communicate with their patients about weight.

“Working in the field of eating disorder treatment for over 20 years, I sadly can’t tell you the number of clients who’ve come in and part of the trigger for their eating disorder was hearing from a medical provider that there was an issue or a concern of some sort with their weight,” Davenport said.

Hutchison said doctors and other health providers need to do better.

“We all have a lot of work to do when it comes to conversations about weight,” Hutchison said. “We need to approach each child with respect and without (judgment) because we don’t want kids to ever think there is something wrong with their body.”

The right approach, according to American Academy of Pediatrics training, is to ask parents questions that don’t use the word “weight.” One example Hutchison offered: “What concerns, if any, do you have about your child’s growth and health?” 

Working sensitively, Hutchison said she feels doctors can have a positive impact on kids who need or want guidance toward health-promoting behaviors.

Kids can misunderstand doctors' discussions about their weight and internalize incorrect information.

Davenport and her business partner in Sunny Side Up Nutrition, with input from the Carolina Resource Center for Eating Disorders, have gotten more specific. They have created a resource called Navigating Pediatric Care to give parents steps they can take to ask health care providers to discuss weight only with them — not with children.

“Pediatricians are supposed to ask permission to be able to discuss weight in front of children,” Davenport said. “It’s a parent’s right to ask this and advocate for their child.”

Davenport advises parents to call ahead and schedule an appointment to discuss weight before bringing in a child for a visit. She also suggests calling or emailing ahead with your wishes, though she admits it may be less effective in a busy setting. She said to print out a small card to hand to the nurse and physician at the appointment. You can also say in front of the child, “We prefer not to discuss weight in front of my child.” 

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Colorectal cancer is rising among younger adults and scientists are racing to uncover why | CNN



CNN
 — 

Nikki Lawson received the shock of her life at age 35.

A couple of years ago, she noticed that her stomach often felt irritable, and she would get sudden urges to use the restroom, sometimes with blood in her stool. She even went to the hospital one day when her symptoms were severe, she said, and she was told it might be a stomach ulcer before being sent home.

“That was around the time when Chadwick Boseman, the actor, passed away. I remember watching him on the news and having the same symptoms,” Lawson said of the “Black Panther” star who died of colon cancer at age 43 in August 2020.

“But at that time, I was not thinking ‘this is something that I’m going through,’ ” she said.

Instead, Lawson thought changing her diet would help. She stopped eating certain red meats and ate more fruits and vegetables. She began losing a lot of weight, which she thought was the result of her new diet.

“But then I went for a physical,” Lawson said.

Her primary care physician recommended that she see a gastroenterologist immediately because she had low iron levels.

“When I went and I saw my gastro, she said, ‘I’m sorry, I have bad news. We see something. We sent it off to get testing. It looks like it is cancer.’ My whole world just kind of blanked out,” Lawson said. “I was 35, healthy, going about my day, raising my daughter, and to get a diagnosis like this, I was just so shocked.”

Lawson, who was diagnosed with stage III rectal cancer, is among a growing group of colon and rectal cancer patients in the United States who are diagnosed at a young age.

The share of colorectal cancer diagnoses among adults younger than 55 in the US has been rising since the 1990s, and no one knows why.

Researchers at Dana-Farber Cancer Institute are calling for more work to be done to understand, prevent and treat colorectal cancer at younger ages.

In a paper published last week in the journal Science, the researchers, Dr. Marios Giannakis and Dr. Kimmie Ng, outlined a way for scientists to accelerate their investigations into the puzzling rise of colorectal cancer among younger ages, calling for more specialized research centers to focus on younger patients with the disease and for diverse populations to be included in studies on early-onset colorectal cancer.

Their hope is that this work will help improve outcomes for young colorectal cancer patients like Lawson.

Among younger adults, ages 20 to 49, colorectal cancer is estimated to become the leading cause of cancer-related deaths in the United States by 2030.

Lawson, now 36 and living in Palm Bay, Florida, with her 5-year-old daughter, is in remission and cancer-free.

The former middle school teacher had several surgeries and received radiation therapy and chemotherapy to treat her cancer. She is now being monitored closely by her doctors.

For other young people with colorectal cancer, “my words of hope would be to just stay strong. Just find that courage within yourself to say, ‘You know what, I’m going to fight this.’ And I just looked within myself,” Lawson said.

“I also have a very supportive family system, so they were definitely there for me. But it was very emotional,” she said of her cancer treatments.

“I remember crying through chemotherapy sessions and the medicine making you so weak, and my daughter was 4, and having to be strong for her,” she said. “My advice to any young person: If you see symptoms or you see something’s not right and you’re losing a lot of weight and not really trying to, go to see a doctor.”

Signs and symptoms of colorectal cancer include changes in bowel habits, rectal bleeding or blood in the stool, cramping or abdominal pain, weakness and fatigue, and weight loss.

A report released this month by the American Cancer Society shows that the proportion of colorectal cancer cases among adults younger than 55 increased from 11% in 1995 to 20% in 2019. Yet the factors driving that rise remain a mystery.

There’s probably more than just one cause, said Lawson’s surgeon, Dr. Steven Lee-Kong, chief of colorectal surgery at Hackensack University Medical Center in New Jersey.

He has noticed an increase in colorectal cancer patients in their 40s and 30s within his own practice. His youngest patient was 21 when she was diagnosed with rectal cancer.

“There is a phenomenon of decreasing overall colorectal cancer rates in the population in general, we think because of the increase in screening for particularly for older adults,” Lee-Kong said. “But that doesn’t really account for the overall increase in the number of patients younger than, say, 50 and 45 that are developing cancer.”

Some of the factors known to raise anyone’s risk of colorectal cancer are having a family history of the disease, having a certain genetic mutation, drinking too much alcohol, smoking cigarettes or being obese.

“They were established as risk factors in older cohorts of patients, but they do seem to be also associated with early-onset disease, and those are things like excess body weight, lack of physical activity, high consumption of processed meat and red meat, very high alcohol consumption,” said Rebecca Siegel, a cancer epidemiologist and senior scientific director of surveillance research at the American Cancer Society, who was lead author of this month’s report.

“But the data don’t support these specific factors as solely driving the trend,” she said. “So if you have excess body weight, you are at a higher risk of colorectal cancer in your 40s than someone who is average weight. That is true. But the excess risk is pretty small. So again, that is probably not what’s driving this increase, and it’s another reason to think that there’s something else going on.”

Many people who are being diagnosed at a younger age were not obese, including some high-profile cases, such as Broadway actor Quentin Oliver Lee, who died last year at 34 after being diagnosed with stage IV colon cancer.

“Anecdotally, in conferences that I’ve attended, that is the word on the street: that most of these patients are very healthy. They’re not obese; they’re very active,” Siegel said, which adds to the mystery.

“We know that excess weight increases your risk, and we know that we’ve had a big increase in body weight in this country,” she said. “And that is contributing to more cancer for a lot of cancers and also for colorectal cancer. But does it explain this trend that we’re seeing, this steep increase? No, it doesn’t.”

Yet scientists remain divided when it comes to just how much of a role those known risk factors – especially obesity – play in the rise of colorectal cancer among adults younger than 55.

Even though the cause of the rise of colorectal cancer in younger adults is “still not very well understood,” Dr. Subhankar Chakraborty argues that dietary and lifestyle factors could be playing larger roles than some would think.

“We know that smoking, alcohol, lack of physical activity, being overweight or obese, increased consumption of red meat – so basically, dietary factors and environmental and lifestyle factors – are likely playing a big role,” said Chakraborty, a gastroenterologist with The Ohio State University Comprehensive Cancer Center.

“There are also some other factors, such as the growing incidence of inflammatory bowel disease, that may also be playing a role, and I think the biggest factors is most likely the diet, the lifestyle and the environmental factors,” he said.

It has been difficult to pinpoint causes of the rise of cases in younger ages because, if someone has a polyp in their colon for example, it can take 10 to 15 years to develop into cancer, he says.

“During that, all the way from a polyp to the cancer stage, the person is exposed to a variety of things in their life. And to really pinpoint what is going on, we would need to follow specific individuals over time to really understand their dietary patterns, medications and weight changes,” Chakraborty said. “So that makes it really hard, because of the time that cancer actually takes to develop.”

Some researchers have been investigating ways in which the rise in colorectal cancer among younger adults may be connected to increases in childhood obesity in the US.

“The rise in young-onset colorectal cancer correlates with a doubling of the prevalence of childhood obesity over the last 30 years, now affecting 20% of those under age 20,” Dr. William Karnes, a gastroenterologist and director of high-risk colorectal cancer services at the UCI Health Digestive Health Institute in California, said in an email.

“However, other factors may exist,” he said, adding that he has noticed “an increasing frequency of being shocked” by discoveries of colorectal cancer in his younger patients.

There could be correlations between obesity in younger adults, the foods they eat and the increase in colorectal cancers for the young adult population, said Dr. Shane Dormady, a medical oncologist from El Camino Health in California who treats colorectal cancer patients.

“I think younger people are on average consuming less healthy food – fast food, processed snacks, processed sugars – and I think that those foods also contain higher concentrations of carcinogens and mutagens, in addition to the fact that they are very fattening,” Dormady said.

“It’s well-publicized that child, adolescent, young adult obesity is rampant, if not epidemic, in our country,” he said. “And whenever a person is at an unhealthy weight, especially at a young age, which is when the cells are most susceptible to DNA damage, it really starts the ball rolling in the wrong direction.”

Yet at the Center for Young Onset Colorectal and Gastrointestinal Cancers at Memorial Sloan Kettering Cancer Center, researchers and physicians are not seeing a definite correlation between the rise in colorectal cancer among their younger adult patients and a rise in obesity, according to Dr. Robin Mendelsohn, gastroenterologist and co-director of the center, where scientists and doctors continue to work around the clock to solve this mystery.

“When we looked at our patients, the majority were more likely to be overweight and obese, but when we compare them to a national cohort without cancer, they’re actually less likely to be overweight and obese,” she said. “And anecdotally, a lot of the patients that we see are young and fit and don’t really fit the obesity profile.”

That leaves many oncologists scratching their heads.

Some scientists are also exploring whether genetic mutations that can raise someone’s risk for colorectal cancer have played a role in the rise of cases among younger adults – but the majority of these patients do not have them.

Karnes, of UCI Health, said “it is unlikely” that there has been an increase in the genetic mutations that raise the risk of colorectal cancer, “although, as expected, the percentage of colorectal cancers caused by such mutations, e.g., Lynch syndrome, is more common in people with young-onset colorectal cancer.”

Lynch syndrome is the most common cause of hereditary colorectal cancer, causing about 4,200 cases in the US per year. People with Lynch syndrome are more likely to get cancers at a younger age, before 50.

“In my practice and in the medical community, the oncologic community, I don’t think there’s any proof that genetic syndromes and gene mutations that patients are born with are becoming more frequent,” El Camino Health’s Dormady said. “I don’t think the inherent frequency of those mutations is going up.”

The tumors of younger colorectal cancer patients are very similar to those of older ones, said Mendelsohn at Memorial Sloan Kettering Cancer Center.

“So then, the question is, if they’re biologically the same, why are we seeing this increasingly in younger people?” she said. “About 20% may have a genetic mutation, so the majority of patients do not have a family history or genetic predisposition.”

Therefore, Mendelsohn added, “it’s likely some kind of exposure, whether it be diet, medication, changing microbiome,” that is driving the rise in colorectal cancers in younger adults.

That rise “has been something that’s been on our radar, and it has been increasing since the 1990s,” Mendelsohn said. “And even though it is increasing, the numbers are still small. So it’s still a small population.”

Dormady, at El Camino Health, said he now sees more colorectal cancer patients in their early to mid-50s than he did 20 years ago, and he wonders whether it might be a result of colorectal cancer screening being easier to access and better at detecting cancers.

“The first thing to consider is that some of our diagnostic modalities are becoming better,” he said, especially because there are now many at-home colorectal cancer testing kits. Also, in 2021, the US Preventive Services Task Force lowered the recommended age to start screening for colon and rectal cancers from 50 to 45.

“I think you have a subset of patients who are being screened earlier with colonoscopies; you have advancing technology where we can potentially detect tumor cell DNA in the stool sample, which is leading to earlier diagnosis. And sometimes that effect will skew statistics and make it look like the incidence is really on the rise, but deeper analysis shows you that part of that is due to earlier detection and more screening,” he said. “So that could be one facet of the equation.”

Overall, pinpointing what could be driving this surge in colorectal cancer diagnoses among younger ages will not only help scientists better understand cancer as a disease, it will help doctors develop personalized risk assessments for their younger patients, Ohio State University’s Chakraborty said.

“Because most of the people who go on to develop colorectal cancer really have no family history – no known family history of colon cancer – so they would really not be aware of their risk until they begin to develop symptoms,” he said.

“Having a personalized risk assessment tool that will take into account their lifestyle, their environmental factors, genetic factors – I think if we have that, then it would allow us hopefully, in the future, to provide some personalized recommendations on when a person should be screened for colorectal cancer and what should be the modality of screening based on their risk,” he said. “Younger adults tend to develop colon cancer mostly in the left side, whereas, as we get older, colon cancer tends to develop more on the right side. So there’s a little difference in how we could screen younger adults versus older adults.”

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Q&A: Maybe Kids Don’t Need to Lose Weight

Feb. 22, 2023 — After the American Academy of Pediatrics’ new guidelines for treating obese kids came out, I wrote “What Parents Should Know” for WebMD. It included insights from several experts and two moms of overweight children. The guidelines have proven controversial due to the recommendations of medication and bariatric surgery for older kids — but also because a growing number of people question whether telling a child to lose weight is ever a good idea. 

One of the most prominent voices reaching parents about kids and weight belongs to Virginia Sole-Smith. A journalist and creator of a newsletter and podcast focused on fatphobia, diet culture, and parenting called Burnt Toast, she’s also the author of a forthcoming book on the subject. Fat Talk: Parenting in the Age of Diet Culture will be published in April. I spoke with her about the AAP guidelines and how to parent a fat — or thin — child in our seemingly inescapable diet culture.

This interview has been edited for length and clarity.

Q: This is probably due to my own history as a fat kid, but when I read the new AAP guidelines, they struck me as thoughtful and empathetic, though the idea of medicating or operating on teens made me uneasy. But you point out that encouraging weight loss in the first place is likely to cause more problems than it solves.

A: We don’t have a ton of evidence that high body weight itself is the problem. There are reasons to be concerned about weight-linked health conditions, but pathologizing body size brings with it a whole other set of complications. When you do that, you start telling kids their bodies are problems to solve, you start focusing on food in ways that can raise their risk for disordered eating and eating disorders. There’s a whole ripple effect to this that the guidelines aren’t reckoning with. 

Underpinning this whole conversation is anti-fat bias. We live in a culture that believes fat bodies are less valuable, less lovable, and less attractive than thin bodies. Our whole world is built to celebrate and welcome thin bodies and push out larger ones. This is just another way we’re doing that.

Q: People may wonder why the AAP would put out guidelines that might be harmful for kids since this is an organization that clearly cares about children’s health. 

A: It’s really tricky. Officially, in their paper, they say, “We have no financial disclosures to reveal, everything’s on the up and up.” But the AAP itself receives donations from pharmaceutical companies, including Novo Nordisk, which is the manufacturer of two of the biggest weight loss drugs. A lot of the authors on this paper have received research funds, speaking fees, consulting fees, etc., or they’re employed by centers that do bariatric surgery. That doesn’t need to get disclosed because it’s just their job. They’re considered an expert because of it, but they’re financially entangled with weight loss being a thing we push for. (Editor’s note: WebMD reached out to the AAP for comment. This is their reply: The AAP has a strict conflict-of-interest disclosure policy and process for all authors of policy statements, clinical reports and clinical practice guidelines. The authors include medical experts with a wide range of perspectives, medical specialties and professional experiences, including some who have conducted research on weight and obesity and others who have devoted their careers to this aspect of medicine. Their knowledge and expertise was important in the development of these evidence-based guidelines. The guidelines also underwent an extensive peer-review process among many other groups of pediatricians and pediatric specialists, and ultimately were approved by the AAP Board of Directors.)

Q: Is trying to lose weight always bad? The moms I interviewed for that article, both of whom use the new injectable weight loss drugs, said they found it reassuring to have a medical solution to their weight problems. It removed a lot of the shame to know it was a physiological thing. And doctors point out that if your child had diabetes you wouldn’t hesitate to give them drugs. So why is this different?

A: Why is because body size in and of itself isn’t a medical condition. Doctors have pathologized it and made obesity a diagnosis, but there’s a lot of evidence to suggest it shouldn’t be. So it’s not the same as giving your kid an inhaler for asthma or insulin for diabetes. That’s what I want — I want doctors to medicate the actual medical conditions. 

The moms you spoke to are being told over and over that their kid’s body is a problem, and they are to blame. Parents in general, but moms especially, get so much judgment if they have a fat kid. And if you’re a fat parent with a fat kid, doubly so. They’re being told if you don’t get this problem under control, your child will have lifelong health consequences. Your child will be bullied. Your child will be unpopular, unlovable, less employable, and so on. All of that is driven by bias. That’s not medical. 

I empathize with parents — they’re terrified for their kids so making kids smaller feels like the answer. But when we choose that, we reinforce anti-fat bias and we make it more powerful. And we say to these kids, yup, the bullies are right, your body is the problem, you are the problem. We need to change you. We don’t need to change this whole system.

Q: The AAP guidelines say that the treatments they’re recommending statistically don’t lead to eating disorders. You argue that in reality, they do. 

A: Eating disorders are really underdiagnosed in fat people because we assume they only happen to thin white girls. But we know they happen to people of every age, every gender, every race. There’s a lot of evidence to show that fat folks, by the time they do get treated, are much sicker because doctors have been reinforcing that disordered behavior along the way. They’re so happy to see weight loss, they don’t question how the loss was achieved. But you absolutely can have an eating disorder, you can be experiencing the physical complications of eating disorders, the heart issues, the fainting, all of that, in a larger body. You don’t have to be emaciated to deserve treatment.

As for the AAP saying these programs don’t cause eating disorders, the research they used to determine that didn’t follow kids long enough. Often studies only follow people for 1 to 2 years. If you put a 10-year-old on a diet and follow them until they’re 11 or 12, that eating disorder may not onset until age 14 or 15. 

And then when they did check for eating disorder symptoms, they looked for things like binge eating, overeating, purging. They looked for the symptoms they expect fat people to show, but they did not look for restriction, skipping meals, cutting out food groups, because No. 1, they don’t think fat people do that, and No. 2, that is exactly what they’re teaching the kids to do: to restrict. 

Q: There are diseases with clear correlations to excess weight. I was just diagnosed with arthritis in my hip, and I suspect it has to do with the fact that I was 100 pounds overweight for years. How should we be talking about that?

A: We often rush to say weight is legitimately an issue without investigating. Might a thin person with the same habits have the same risk for the condition? Just focusing on making body size smaller won’t necessarily affect whatever lifestyle factors are at play. 

There’s also the fact that people in larger bodies receive significantly worse medical care, so a thin person reporting symptoms might get treatment faster than a fat person. I remember interviewing a weight-inclusive doctor, and I asked about knee issues. I’m fat and I have knee problems. And she said, “I have knee problems, too. I get physical therapy, I’ve gotten surgery, I’ve been prescribed all these different treatments.” But fat people get told to lose weight to take pressure off your knees. They don’t get referrals to physical therapy and things that might help these issues. The bias becomes a self-fulfilling prophecy.

Of course, there are conditions where weight may play a causal role. I’m not disputing that. I don’t think anyone is disputing that. What we’re disputing is treating fat people like it’s their fault — if only they’d had more willpower, they wouldn’t be in this situation. Denying them care in a punitive way. That’s the harder thing for the medical community to wrap their heads around. Even if you’re fat and unhealthy, your body is still worthy of dignity and respect and health care. 

The last piece is that sustainable weight loss doesn’t work most of the time. Dieting has a huge failure rate. Medications and surgery may be starting to change that, but they come with significant side effects. The surgery is going to be lifelong, and the medication you have to stay on for life to sustain the weight loss. You’re looking at a lifetime of consequences.

Q: Let’s talk about the more positive side of things. In your book, you write about fat positivity and how to instill it, telling your child, “Your body is never the problem.” What does a kid get out of hearing that?

A: It’s not the doctor’s fault, but doctors always see bodies as problems to solve — why is this symptom or behavior happening? For a kid sitting under the microscope, what a gross feeling that is, knowing someone has to invest time and money into fixing them. And with weight, it reinforces this whole larger bias. 

But you can’t necessarily control what the doctor says in an appointment. You can ask not to discuss BMI or weight, you can try to set boundaries, but you can’t guarantee how the conversation will go. The only thing you can control is what your child hears you say. If you say to the doctor, “I don’t view their body as a problem,” at least your child comes away with the knowledge that my body is safe in my home, with my family. My parents don’t see me this way. It feels like an important foundation that so many fat kids don’t get. 

Q: What about parents of thin kids? What should they be doing?

A: I really want parents of thin kids to be talking about this, for two reasons. One, thin kids aren’t immune to the harms of anti-fat bias. Not every thin kid will grow up to be a thin adult. I say this as a former thin kid who’s a fat adult. It’s really important that thinness not be so interwoven with their identity, that if they can’t maintain that thinness, they feel like they’re failing.

Thing two is, parents of thin kids need to talk about anti-fat bias the same way parents of white kids need to talk about racism. If we don’t have these hard conversations, if we don’t teach our kids to name and unlearn this bias, the rest of the culture is going to teach them instead. 

It’s not that I want parents to try to keep their kids in a fat-positive bubble with no exposure to diet culture. I want parents to be naming these things, to be learning alongside their kids, to be having conversations so that we can help kids develop critical thinking skills. Then they can start to point out diet culture to us, they can say, “Hey, this is a really messed up way to talk about bodies in this TV show or this book I’m reading or this person I’m following on TikTok.” That is going to do more to buffer kids against these influences because we’re giving them the option to disagree with it. We’re giving them the option to think about going a different way. 

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What’s the magic number of steps to keep weight off? Here’s what we know | CNN

Editor’s Note: Sign up for CNN’s Fitness, But Better newsletter series. Our seven-part guide up will help you ease into a healthy routine, backed by experts.



CNN
 — 

Taking 8,600 steps a day will prevent weight gain in adults, while already overweight adults can halve their odds of becoming obese by adding an additional 2,400 steps — that’s 11,000 steps a day, according to an October 2022 study.

Studies show the average person gains between 1 and 2 pounds (0.5 to 1 kilograms) each year from young adulthood through middle age, slowly leading to an unhealthy weight and even obesity over time.

“People really can reduce their risk of obesity by walking more,” said study author Dr. Evan Brittain, associate professor in the division of cardiovascular medicine at Vanderbilt University Medical Center in Nashville.

The study also found key benefits for chronic diseases and conditions: “Diabetes, sleep apnea, hypertension, diabetes, depression, and GERD showed benefit with higher steps,” said Brittain via email.

“The relationship with hypertension and diabetes plateaued after about 8,000 to 9,000 steps but the others were linear, meaning higher steps continued to reduce risk,” he said. “I would say that the take home messages are that more steps are better.”

It’s yet another study illustrating the powerful impact that walking and other forms of exercise have on our health. In fact, if you get up and move for 21.43 minutes each day of the week, you cut your risk of dying from all causes by one-third, according to the US Centers for Disease Control and Prevention.

Current physical activity recommendations for adults are 150 minutes of moderate-intensity exercise, such as brisk walking, dancing, bicycling, doubles tennis and water aerobics, and two days of muscle-strengthening activity each week.

“Physical activity is just absolutely magnificent,” Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver, told CNN in an earlier interview.

“And when if you blend that with eating a more plant-based diet, de-stressing, sleeping enough and connecting with others — that’s your magic recipe,” Freeman said. “It’s the fountain of youth, if you will.”

Activity trackers allow researchers to get more accurate data that can be compared with health records.

The study analyzed an average of four years of activity and health data from more than 6,000 participants in the National Institutes of Health’s All of Us Research Program, dedicated to research on ways to develop individualized health care.

Participants in the study, published on October 10, 2022, in the journal Nature Medicine, wore activity trackers at least 10 hours a day and allowed researchers access to their electronic health records over multiple years.

“Our study had an average of 4 years of continuous activity monitoring. So, we were able to account for the totality of activity between when monitoring started and when a disease was diagnosed, which is a major advantage because we didn’t have to make assumptions about activity over time, unlike all prior studies,” Brittain said.

People in the study ranged in age from 41 to 67 and had body mass index levels from 24.3, which is considered in the healthy weight range, to 32.9, which is considered obese.

Researchers found that people who walked 4 miles a day — about 8,200 steps — were less likely to become obese or suffer from sleep apnea, acid reflux and major depressive disorder. Sleep apnea and acid reflux respond well to weight loss, which can reduce pressure on the throat and stomach, while exercise is a cornerstone treatment for depression.

The study also found that overweight participants (those with BMIs ranging from 25 to 29) cut their risk of becoming obese by half if they increased their steps to 11,000 steps a day. In fact, “this increase in step counts resulted in a 50% reduction in cumulative incidence of obesity at 5 years,” the study found.

Applying the data to a specific example, the authors said individuals with BMIs of 28 could lower their risk of obesity 64% by increasing steps from about 6,000 to 11,000 steps per day.

This research echoes results from a recent study in Spain in which researchers found health benefits rose with every step until about 10,000 steps, when the effects began to fade. Counting steps may be especially important for people who do unstructured, unplanned physical activity such as housework, gardening and walking dogs.

“Notably, we detected an association between incidental steps (steps taken to go about daily life) and a lower risk of both cancer and heart disease,” study coauthor Borja del Pozo Cruz told CNN in an earlier interview. Del Pozo Cruz is an adjunct associate professor at the University of Southern Denmark in Odense and senior researcher in health sciences for the University of Cadiz in Spain.

The same research team also published a similar study in September 2022 that found walking 10,000 steps a day lowered the risk for dementia by 50%; the risk decreased by 25% with as few as 3,800 steps a day.

However, if walking occurred at a brisk pace of 112 steps a minute for 30 minutes, it maximized risk reduction, leading to a 62% reduction in dementia risk. The 30 minutes of fast-paced walking didn’t have to occur all at once either — it could be spread out over the day.

Researchers found the association between peak 30-minute steps and risk reduction to be dependent on the disease studied: There was a 62% reduction for dementia, an 80% decline for cardiovascular disease and death, and about a 20% drop in risk for cancer.

The study also found an association between step intensity and health benefits as well, “although the relationships were less consistent than with step counts,” researchers said.

A major limitation of all studies using step trackers is that people who wear them tend to be more active and healthier than the norm, the researchers said. “Yet the fact that we were able to detect robust associations between steps and incident disease in this active sample suggests even stronger associations may exist in a more sedentary population,” they said.

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