Tag: weight loss

The science and side effects behind the semaglutide weight loss drugs

Post By Science And Technology , ,

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.

Topics:

Source link

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

A Charlie Munger Legacy – The Healthy Returns And Health Conundrum

Post By World , , , , , , , , ,

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.

Source link

#Charlie #Munger #Legacy #Healthy #Returns #Health #Conundrum

Obesity: A Holistic Approach

Post By Health , , ,


There’s no secret trick for 

losing weight

. Truth is, many things work together to help you shed unwanted pounds. 




In the WebMD webinar,
“Holistic Obesity Therapy,”
Octavia Pickett-Blakely, MD, MHS, explained the holistic approach to weight management, why lifestyle choices are key, and when anti-obesity meds (AOMs) and medical procedures might come into play.


She is director of the GI Nutrition, Celiac Sprue, and Obesity Program at Penn Medicine. 


“To reach your weight loss goals, there’s no magic,” says Pickett-Blakely. “The key to managing obesity and weight loss lies in the development of healthy habits and lifestyle practices that you’ll carry throughout the course of your life.”


Poll Questions


Lifestyle habits like exercise, weight training, diet, sleep, and stress management are the foundation for successful weight loss, said Pickett-Blakely.


A poll of more than 1,100 webinar attendees found that 48% want to work on getting more 

exercise or more strength training

. That’s followed by 28% who want to focus on eating healthier.



Question: I want to work on:


  • Getting more exercise or strength training: 48%


  • Eating healthier foods: 28%


  • Improving my sleep: 16%


  • Lowering my stress: 8%


Another poll asked about sleep. Pickett-Blakely explained that good sleep habits are necessary for weight management. That’s because good sleep translates into more energy to exercise and the ability to choose healthy eating options. If you combine good sleep with other healthy habits, you’re more likely to see your weight come down.


Around half of respondents said they keep a regular bedtime, while 20% said that they create a relaxing space without distractions.



Question: When it comes to sleep, I make it a habit to:


  • Keep a regular bedtime: 49%


  • Create a relaxing space without distractions: 20%


  • Avoid daytime naps: 19%


  • Stop using technology near bedtime: 12%


What’s the Holistic Approach to Weight Management?


It combines different areas of weight loss, focusing on lifestyle first, and then other tools that can help you lose weight. For example, it involves how you and your doctor might combine your healthy habits with AOMs and endoscopic procedures. 


“Medications and surgeries for weight loss get a lot of attention,” says Pickett-Blakely. “But the foundational aspects for weight loss are absolutely critical to your success, before those things.”


Viewer Questions



Why do people snack late at night when they’re not hungry?



How healthy is intermittent fasting when you have diabetes?



How important is sleep in weight management?


Late-night snacking often doesn’t come from hunger. When you get the sensation that you want to eat, typically it’s related to your blood sugar being low. Sometimes you can also have a sensation of hunger when you’re thirsty. It can be difficult to separate these.


Late-night eating often comes as a behavior. When you’re younger, you go to the movies, you eat popcorn, you drink a beverage. I encourage my patients to stop before they eat something and ask, “Am I really hungry, or thirsty?”


Another option is to avoid staying up late if you don’t need to. If you have to stay up late because your work shift is late, for example, you’re not necessarily eating, because you’re doing your job. It’s when you stay up late, at home, and you have the ability and freedom to late-night snack.


With
intermittent fasting
, it’s important to talk to your doctor or health care provider who’s managing your diabetes. Because not every person with diabetes is created equal.


Individuals have different levels of management, and different levels of severity, of diabetes. That plays a role in whether or not intermittent fasting is appropriate for you.


In terms of sleep, I don’t think people realize how important it is when it comes to weight loss. It’s a part of the weight loss recipe that many people neglect.


When you don’t get enough sleep, studies show you have increased hunger and more cravings. Being sleep-deprived is also linked to weight gain. There are changes in how your brain responds to certain things around you. For example, if you’re sleep-deprived and see commercials for food, the way you react to those is different when you’re tired, compared to when you’re rested.


If you’re having difficulty sleeping, talk to your doctor or health care provider about how you can be tested or treated for sleep issues.




Is it harder to lose weight after menopause?



Are yoga and tai chi types of exercise or stress relief?



How overweight does someone need to be before they get help from weight loss medications or procedures?


It’s true that it’s harder to lose weight after menopause. Our basal metabolic rate, or metabolism, has a set point with which we burn energy. That set point starts to decline as early as in your second decade. So, after your 20s, your energy burn speed declines. That gets slower after you hit menopause – and further declines after menopause.


Other things are happening with menopause, too. Your hormones shift a lot. These play a role in cravings and hunger. Hormones also create a shift in your body’s muscle-to-fat ratio. So, you may see changes in the distribution of your weight, especially in your stomach fat. That can affect how easy or hard it is to lose or achieve a certain goal. This is why strength training and keeping a good amount of muscle is very important.


Yoga and tai chi are both exercise and stress relief. They’re good for resistance training as well. You hold poses, use muscle control, and engage your core strength. In certain cases, yoga and tai chi may be your only options for what you’re physically able to do.


It’s important to realize that everyone’s weight loss journey is different. Some people have been overweight for years, while others have more recently had to focus on it. Weight and body size differ around the world – and by culture, too. 


I think healthy lifestyle modifications, like being active, are incredibly helpful, regardless of your 

body mass index

. Typically, we recommend starting with lifestyle modifications when you’re in the overweight category, or if you have most of your extra weight in your belly.


If you’re in the overweight category but have other conditions like diabetes or high blood pressure, you should talk with your doctor about additional therapies. At the end of the day, it’s important to talk to them about your body’s specific needs, to find the best approach for your goals.




Source link

#Obesity #Holistic #Approach

The science and side effects of the drugs Ozempic and Wegovy

Post By Science And Technology , ,

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

Steve needed to get fit before brain surgery to treat his epilepsy. Now he’s running half marathons

Post By World , , , , , , , , , , , , , ,

A feeling of anxiety, the taste of metal and then the strongest deja vu — that’s how Warrnambool primary school teacher Steve Guthrie learnt to know a seizure was coming on.   

Each year more than 12,000 people in Australia are diagnosed with epilepsy, and not all seizures are the clonic and obvious “fits” characterised in film.

Some involve staring at a focal point, repetitive movement, or a change in conscious state.

In Mr Guthrie’s case, he learnt as an undiagnosed epileptic child to get to safety before the “dizzy spell” overtook him.

But when as an adult those warnings stopped coming, his life changed dramatically.

He was presented with a choice: to live a life constricted by multiple daily seizures, give up driving and maybe his job, or to have a section of his brain removed — an operation that might free him from seizures altogether. 

The road Mr Guthrie chose saw him shed 28 kilograms and achieve a 24-kilometre half marathon along the Great Ocean Road. 

The Great Ocean Road Running Festival takes place in Victoria along the coast of the Southern Ocean.(Supplied: Great Ocean Road Running Festival)

Scarring on the brain

At eight months old, Mr Guthrie contracted meningitis that, unbeknown to his family, caused permanent damage via scarring on his brain.

“I was suffering from non-tonic clonic seizures or complex focal epilepsy,” Steve said.

“They’re described as dizzy spells, and being such a young age, I just thought that was what everyone goes through.”

Source link

#Steve #needed #fit #brain #surgery #treat #epilepsy #hes #running #marathons

Everything you need to know about the drugs Ozempic and Wegovy

Post By Science And Technology , ,

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.

Topics:

Source link

#drugs #Ozempic #Wegovy

Top Risk Factor to Good Health Is Probably Not What You Think

Post By Health , , , , ,

March 7, 2023 — If you think the biggest risk factor to good health is smoking or genetics, think again. 

According to Stephen Kopecky, MD, a preventive cardiologist at the Mayo Clinic, “nutrition is now the number one cause of early death and early disease in our country and the world.” Moreover, he says that while having genes for disease will increase your risk by 30% to 40%, having a bad lifestyle for disease will increase your risk by 300% to 400%.

About 20 years ago, Kopecky says, the cause of death worldwide changed from infection to non-infection (like non-communicable diseases). “In those last 20 years, that’s grown in terms of what kills us and what gets us sick,” he says. “The three big non-communicable diseases are heart disease, cancer, and rapidly rising is Alzheimer’s. But there’s also diabetes, obesity, and high blood pressure — all those things are also related to diet.”

Forty-eight-year-old James, of Fredericksburg, VA, knows this all too well. James asked that his last name not be printed, to protect his privacy. For the last 30 years, he’s been managing type 1 diabetes and complications of insulin resistance, along with high blood pressure, high cholesterol, thyroid disease, and low testosterone. As a former Division 1 college athlete, James exercised regularly and ate what he believed to be a responsible diet.

“Those weirdos in the gym at 5 a.m. who eat chicken salads for every lunch? Yeah, that’s me,” says James. 

But he went from a playing weight of 202 pounds to 320 pounds, despite continuing to lift weights and do cardiovascular exercise at least 5 days a week. “Whenever I went to the doctor and stepped on the scale, I got skeptical looks when I made claims of ‘exercising and eating right.’ In all honesty, I thought I was,” says James, noting he followed a low-carb, high-protein diet. “But I didn’t count calories or consider the impact of fat on my already insulin-resistant body,” he says.

After visiting many health professionals, James finally found success with Nancy Farrell Allen, a registered dietitian nutritionist.

Previous doctors applauded his diet, but Allen explained that his insulin resistance was linked to the amount of fat James consumed. “The more fat in my system, the more insulin I needed to inject,” he says. “The more insulin I injected, the more weight I’d gain. The more weight I’d gain, the more insulin I’d inject, continuing this regrettable cycle.” 

Allen suggested he shift his diet to a more balanced approach, with a strict eye on fat. “She completely changed my way of thinking about food, broke my belief that all carbs are bad, helped me identify my daily caloric needs, and focused me on eating a balanced diet enriched with fiber,” says James, who then lost 45 pounds in 3 months. “I found myself having more energy, sleeping better, focusing better, and taking less insulin than I had in nearly 20 years,” he says. 

Another patient, Sheila Jalili of Miami, took a proactive approach to her health when she turned 40, getting some tests and lab work done for a baseline comparison. “My BMI was around 20, I exercise every day, and I don’t have any diseases in my family,” Jalili says, noting everything checked out fine. 

She continued her annual checkups and tests, noticing her triglycerides and cholesterol numbers increasing. When her cholesterol reached alarming levels and her triglycerides skyrocketed to 1,230, she met with Kopecky, the Mayo Clinic cardiologist, who prescribed fish oil and asked about her diet. Jalili started tracking what she ate and did an exhaustive review of her fridge contents, noting the sodium levels, cholesterol levels, and fat levels in the foods. 

To her surprise, she discovered she ate a lot of unhealthy carbs and fats. “I went into overload. I changed everything. I did so much research,” she says. After 42 days of eating extremely healthy, she dropped her total cholesterol by about 100, halved her HDL, and reduced her triglycerides from 1,238 to 176.

A bad lifestyle often starts with what you eat — and what you don’t. Even if you think you’re eating healthy, you might want to revisit your diet. In particular, reconsider ultra-processed foods (like doughnuts, hot dogs, and fast-food burgers). Though convenient and affordable, they’re inflammatory and, over time, can cause many health issues.

“It bothers our tissues, our heart, our arteries, our brains, our pancreas, our liver, and our lungs, and that leads to disease,” Kopecky says. “It could be in the brain with Alzheimer’s, the heart with coronary artery disease, or cancers elsewhere.”

Ideally, you’d immediately overhaul an unhealthy diet. But that’s not a reality for most people. Making sweeping changes all at once can feel overwhelming. Take small steps instead.

Baby-Step Your Way to a Healthier Diet

Before making any dietary changes, Selvi Rajagopal, MD, MPH, advises having a conversation with your health care provider to figure out your specific health status. Rajagopal, assistant professor of medicine at Johns Hopkins University, says that, generally speaking, everyone will benefit from eating a balanced, healthy diet filled with a variety of nutrient-rich foods. 

That includes fruits, vegetables, whole grains, lean protein, low-fat/fat-free dairy, and healthy fats. However, talking with your doctor can help you identify any specific nutrient deficiencies, health issues, and lifestyle factors that need to be addressed. Then you can devise a healthy eating plan that works specifically for your needs.

Revamp how you organize your refrigerator. Most refrigerators put two opaque drawers labeled “Fruits” and “Vegetables” at the bottom, where you’re least likely to see them. Kopecky advises moving your produce to eye level and put the less-healthy options in those bottom drawers. “When we open the fridge, that’s what we see, and that’s what we tend to eat,” he says.

Change your perspective. “There isn’t one healthy weight or one healthy size,” says Rajagopal. Don’t aim for a number on the scale or a certain BMI or certain clothing size. Every body is different, not only in shape and size, but in health risk factors. Also, many people feel really overwhelmed trying to “be healthy.” Rajagopal says, “Healthy is just trying to do something to improve your health, and that improvement can be really small.”

Understand how to read food labels. Allen takes every patient to the grocery store to read and understand food labeling and to highlight different foods. She shares the guidelines below with her patients. 

  • Fat: Low-fat foods contain 3 grams of fat or less per serving.
  • Sugar: Four grams equal 1 teaspoon. When a serving of sugar lists 12 grams of sugar in a 2/3-cup serving, that means it contains roughly 3teaspoonsof sugar.
  • Fiber: A naturally high-fiber food can contain about 5 grams of fiber per serving. 
  • Sodium: A low-sodium food contains less than or equal to 140 milligrams of sodium per serving. 
  • Protein: Seven grams of protein equal about 1 ounce of protein. 

This approach is particularly important as the FDA is exploring a change in which foods can be labeled as healthy. The agency in September unveiled a proposed rule to try and counter the fact that, as the agency claims, more than 80% of people in the U.S. aren’t eating enough vegetables, fruit, and dairy. And most people consume too much added sugars, saturated fat, and sodium.

Under the proposed rule, in order to be labeled “healthy” on food packaging, products must contain “a certain meaningful amount” of food from at least one of the food groups or subgroups (e.g., fruit, vegetable, dairy, etc.) recommended by the agency’s dietary guidelines.

They must also stick to specific limits for certain nutrients, such as saturated fat, sodium, and added sugars. 

Breakfast cereals, for example, would need to contain 0.75 ounces of whole grains and contain no more than 1 gram of saturated fat, 230 milligrams of sodium, and 2.5 grams of added sugars to qualify, the agency said.

Don’t fear carbs or fat! Your body needs both to survive, as carbs help fuel your body and fat helps your body absorb fat-soluble nutrients like vitamins A, D, and E. But not all carbs or fats are equal. Choose complex carbohydrates found naturally in plant-based foods (like fruits, vegetables, and whole grains) over simple carbohydrates often found in processed foods (like white bread, enriched pasta, and white rice). 

Similarly, strive to include healthy, unsaturated fats (including polyunsaturated and monounsaturated fats) found in foods such as fatty fish, vegetable oils, avocadoes, and some seeds and nuts. Avoid foods with unhealthy saturated and trans fats found primarily in animal products (such as meat, eggs, high-fat dairy) and highly processed foods (frozen pizza and microwave popcorn). “Having a baseline understanding of what this means makes you a much savvier consumer,” says Rajagopal, who suggests going to the U.S. Department of Agriculture’s website to learn about these food components. 

Adopt healthier cooking methods. Maybe you’re buying healthy foods but preparing them in unhealthy ways. That lean, skinless chicken breast just got a lot less healthy once you breaded it, deep-fried it, and smothered it with cheese. Allen suggests lighter, leaner techniques such as baking, roasting, grilling, and steaming. “Frying, sautéing, breading, au gratin, buttery, and Alfredo all add additional calories to burn off,” says Allen.

Start small. Eliminate the all-or-nothing thinking, such as, “I want to cut out all sugar” or “I want to cook all my meals at home.” 

If you’ve been eating sugar your whole life or eating dinner out 5 nights a week, eliminating this bad habit at once is a huge undertaking. Instead, start small. For instance, reduce one sugary food item you frequently eat. 

“Maybe it’s soda,” says Rajagopal. “Maybe you go from four cans of soda a day to two cans. Make one change and see how it goes for a week or two.” 

Ditto for cooking — aim to add one more home-cooked meal a week rather than trying to cook at home 7 days a week. She also advises bringing in an accountability buddy to help you stay on track. 

Take one bite. “If you take a bite of a ground meat or sausage and replace that with a bite of something that’s a little healthier — like black beans or a vegetable — then, after doing this for a couple of years, that actually reduces your risk of heart attack and reduces your risk in the long-term of cancers and Alzheimer’s,” advises Kopecky. “Literally one bite difference.”

By making small, consistent changes, they can have a big impact over time. Pick one tip that resonates most, implement it, and stick to it until it becomes second nature. Once mastered, move on to another tip, building on that foundation of success.

Source link

#Top #Risk #Factor #Good #Health

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

Post By Health , , , , , ,

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. 

Source link

#Kids #Dont #Lose #Weight

Dieters Who Use Scarce Diabetes Drug Ozempic Could Face Side Effects

Post By Health , , , ,

By Dennis Thompson 

HealthDay Reporter

WEDNESDAY, Feb. 1, 2023 (HealthDay News) — Mila Clarke started taking Ozempic in 2020 to help manage her diabetes, but was pleasantly surprised to find herself soon shedding pounds.

“I was like, this is really weird because I’m not having to try very hard to do this,” said Clarke, who has been diagnosed with both type 1 and type 2 diabetes and chronicles her diabetes journey on her Hangry Woman blog. “And as I kept going on, I kept noticing that the weight was falling off.”

Then the side effects started — most worryingly, a racing and palpitating heartbeat.

“I could be laying down in bed and my heart rate, like resting heart rate, would be 120 beats per minute,” the sort of rate associated with exercise, Clarke said in an interview with HealthDay Now. “It was really having an effect on my heart rate, and that was really terrifying.”

First approved to treat diabetes under the brand name Ozempic, the drug semaglutide received federal approval in June 2021 to also be prescribed as a weight-loss medication — with the brand name Wegovy.

People interested in dropping pounds — either for their health or for vanity’s sake — flooded the market for semaglutide, making it difficult to impossible for people with diabetes to fill prescriptions needed to manage their condition.

But semaglutide comes with some troubling side effects that people might not have considered in their search for the perfect body, experts say.

These can range from nausea and vomiting to premature aging of the face, as well as heart problems.

The drug is a synthetic form of a naturally occurring gut hormone, Dr. Holly Lofton, an obesity medicine specialist with NYU Langone Health in New York City, told HealthDay Now.

“It goes to different areas of the brain and blocks hunger signals, it goes to your stomach and slows down the rate your stomach empties, and it hormonally helps your body be more sensitive to the insulin that you produce, thus helping your fat cells shrink,” Lofton explained.

Because of the way it works, semaglutide’s most commonly reported side effects involve the gastrointestinal system, Lofton said.

Those were the first that Clarke experienced.

Scary side effects, like a racing heartbeat

“You start out on a very low dose to have your body get used to it,” Clarke said. “You can get a lot of nausea, diarrhea, you can feel dizzy.”

When Clarke advanced to the therapeutic dose of semaglutide, she developed heart palpitations and tachycardia (racing heartbeat).

“It got to a point where it was like I could feel my heart beating out of my chest,” Clarke said. “It would wake me up in the middle of the night, and I was kind of panicking because I was like, this doesn’t feel right. It feels very scary.”

Clarke didn’t mention it, but other people who take semaglutide appear to develop what’s becoming known as “Ozempic face,” in which rapid weight loss causes a person’s face to look gaunt, saggy and prematurely aged.

“When you lose weight so acutely and quickly, you see more of a global facial wasting,” Dr. Paul Jarrod Frank, a New York City dermatologist, told NBC’s TODAY show.

“It’s not just a wrinkle we’re seeing in one area or a heaviness around the eyes,” Frank continued. “We’re seeing it in the temples, the jaw line, around the mouth, under the eyes.”

Despite her side effects, Clarke stuck with Ozempic for about a year because the drug was very effective in controlling her diabetes and helping her lose weight.

Clarke dropped about 10 pounds within a month. By the time she decided to stop taking Ozempic a year later, she’d lost 35 pounds.

“It was really tempting to continue it because it’s such an easy medication to take,” Clarke said. “It’s once weekly, it’s an injection, it does not hurt that badly at all, barely feels like a pinch.”

“I just felt like, I kind of want to continue this because I’m seeing really good results on it. But then for the flip side, it was like, even though I’m seeing these great results, I feel awful all the time,” Clarke added. “I don’t feel good, I don’t have any energy, I feel sick and nauseous. And that’s not quality of life.”

Clarke was worried that she’d regain the weight she lost after she stopped taking Ozempic, but that wasn’t what happened.

“I actually ended up maintaining my weight for a little while and then even losing a little bit more. So total, I lost about 50 pounds,” Clarke said.

As demand exceeds supply, some with diabetes go without

Clarke has described the semaglutide shortages as “really frustrating” on her blog, particularly for people who need the drug to manage their diabetes.

Wegovy contains a higher dose of semaglutide, because that’s the dose needed to treat obesity as approved by the U.S. Food and Drug Administration.

Ever since Wegovy arrived on the market, manufacturer Novo Nordisk has struggled to meet demand, prompting off-label prescription of Ozempic for weight loss.

“There are people who are using it for weight loss for health purposes, and I think that is amazing,” Clarke said. “Especially with my own experience, I know how helpful it can be.”

But social media has spurred demand by promoting semaglutide as a miracle weight-loss drug, Lofton said.

Wegovy is meant to help people with weight problems so bad that the extra pounds are harming their health, but semaglutide is instead being used to help people achieve the “perfect body.”

Clarke noted an “Ozempic challenge” circulating on TikTok.

“It’s people who are at a pretty normal weight,” Clarke said of the TikTok videos. “Maybe they have like 10 pounds that they want to lose because of some reason. From what I’ve seen, it’s usually vanity purposes.”

“And so they’re using Ozempic, and I think that has a really big impact on people with diabetes because we’re not able to get the drug at this point,” Clarke said. “There are so many shortages, and there’s a lack of production for Ozempic with this increased demand because people are seeing that it works for weight loss very well.”

Lofton said that both uses of the drug are legitimate, and what’s really needed is for Novo Nordisk to resolve its production bottleneck and for insurers to cover semaglutide treatment.

Novo Nordisk has promised to resolve the semaglutide shortages within the first few months of 2023, Lofton said.

“We have about 40 million people with obesity/overweight, and we have about 11 million people in the U.S. with diabetes,” Lofton said.

“If the companies can’t meet the demand — which I’m glad the demand is great and people know about these drugs — then we really need to reevaluate how these pharmaceutical companies are allowing us, as well as insurance companies are allowing us, to have access to these much-needed drugs for multiple conditions,” Lofton said.

More information

The U.S. Food and Drug Administration has more on shortages of Wegovy and Ozempic.

 

 

SOURCES: Mila Clarke, blogger and activist; Holly Lofton, MD, obesity medicine specialist, NYU Langone Health, New York City

 

Source link

#Dieters #Scarce #Diabetes #Drug #Ozempic #Face #Side #Effects

New Guidelines for Kids With Obesity: What Parents Should Know

Post By Health , , , , , ,

Jan. 13, 2023 — The American Academy of Pediatrics last week issued their first new guidelines in 15 years for evaluating and treating kids and adolescents with overweight or obesity. 

If you only saw the headlines, you might think that when a youngster is a few pounds overweight, their pediatrician will prescribe a weight loss drug or bariatric surgery. The reality is much less alarming. The guidelines take a deep dive into evidence-based treatments at various levels.

“It’s a misunderstanding, it’s being sensationalized,” says Lori Fishman, PsyD, a child psychologist who specializes in pediatric weight management. “There’s so much more to the process. It’ll be a small percentage of kids who’ll even qualify for these treatments.” 

Treating the Whole Child

Before writing the guidelines, the AAP’s Subcommittee on Obesity spent years analyzing and synthesizing information from nearly 400 studies. 

“We now have more information than ever that supports that obesity is a chronic, complex disease that requires a whole-child approach,” says Sarah Hampl, MD, one of two lead authors of the guidelines. “And many kids will not outgrow it, so it’s important to identify children with obesity early and offer them evidence-based treatments.”

In the new guidelines, treatment of overweight and obesity doesn’t mean putting a kid on a diet and expecting their parents to manage it. Instead, multi-pronged approaches might include nutrition support, physical activity specialists, behavioral therapy, medications for adolescents 12 and up, and surgery for teenagers with severe obesity. 

Before starting any of these evidence-based treatments, the guidelines remind pediatricians to consider each child’s individual circumstances — their living situation, their access to healthy food, and more.

“As pediatricians, we ought to be especially mindful of the influences that child and family are surrounded by,” Hampl says. “We should help guide them, whether it’s to local resources for healthy food or support for a child who’s being bullied.”

Because obesity is often stigmatized, the pediatricians’ group also included guidance for pediatricians to help them examine their own biases. It calls on them to acknowledge the myriad genetic and environmental factors that contribute to obesity and treat children and their parents with respect and sensitivity.

The Rise of Childhood Obesity

For kids 2-18, obesity is defined as having a BMI at or above the 95th percentile for a child’s age and sex. Rates of pediatric obesity have more than tripled since the 1960s, from 5% to nearly 20%. Just last month, the CDC released updated growth charts to take into account how many more children and adolescents now have severe obesity, well beyond the 95th percentile. By 2018, more than 4.5 million kids qualified, but the old charts didn’t go high enough.

If these trends continue, researchers estimate that 57% of children aged 2 to 19 will have obesity by the time they hit 35. And the pandemic has only made things worse.

“It’s about much more than what we eat and drink or how physically active we are,” Hampl says. Risk factors for obesity include genetics, socioeconomics, race and ethnicity, government policies, a child’s environment, neighborhood, and school, and even their exposure to unhealthy food marketing. Because each child is so different, these factors combine in unique ways.

You can see an example of the variability in Jill’s family. She’s a New Jersey mom with two teenage sons. For privacy reasons, we’re using only her first name. 

“I have two children who I raised the same way, who were offered the same foods, and yet one weighs 80 pounds more than the other,” she says. “My 16-year-old is happy to choose fruit over a cookie. He’s able to stop, to not eat another bite. The 14-year-old will eat cookies until they’re gone.”

No More Watch and Wait

The last set of guidelines, from 2007, called for pediatricians to monitor kids with obesity via “watchful waiting.” It would give children a chance to outgrow their excess pounds before being treated. Research conducted since then shows that’s not effective. 

“The risk of watching and waiting, in my experience, is that a 10-pound-overweight child a year later might be 30 pounds overweight,” says Fishman. “That’s a lot harder to tackle.”

In the new guidelines, the AAP stresses the urgency of treating children with overweight and obesity as soon as it’s diagnosed. Instead of hoping a growth spurt might take care of the problem, pediatricians should move quickly, “at the highest level of intensity appropriate for and available to the child.”

By guiding children and their families to adopt healthier habits early, it may help to reduce some of the weight-related health issues that have also increased in the last few decades. Just within the 21st century, diabetes rates for children and teenagers have skyrocketed — between 2001 and 2017, the number of kids with type 2 went up an astonishing 95%.

“Now we understand the consequences of untreated obesity, especially severe obesity,” says Mary Ellen Vajravelu, MD, a doctor-scientist at the Center for Pediatric Research in Obesity and Metabolism in Pittsburgh. “That includes type 2 diabetes, fatty liver disease, high blood pressure, high cholesterol. It’s important to treat obesity in childhood to avoid the complications we’re seeing in young adults.”

Also important: Reversing the trend while a child is young can help them avoid the emotional impact of growing up with obesity. 

“I saw the recommendations and thought, ‘How different would my life have been for the past 35 years if they had treated my obesity when I was a child?” says Heather, the mother of a 10-year-old in Florida. She’s been carrying shame and limiting herself since childhood, for instance by avoiding activities where her size might prove embarrassing. “For kids who are struggling, I think it’ll be life-changing.”

What the Guidelines Really Say

In a world where fat-shaming is rampant, parents often want to protect their children by encouraging them to lose weight — but parental pressure adds another layer of bad feelings. The AAP advises against putting a child on a diet or restricting their access to food without professional help. Guidelines recommend that pediatricians:

  • Treat obesity as a chronic disease. That calls for long-term care strategies and ongoing monitoring.
  • Implement a model known as the “medical home.” It takes treatment beyond the exam room to shape behavior and lifestyle changes. Pediatricians should build partnerships with families in their care and serve as a care coordinator, working with a team that may include obesity treatment specialists, dietitians, psychologists, nurses, exercise specialists, and social workers.
  • Use a patient-centered counseling style called motivational interviewing. Rather than a doctor prescribing changes for a child’s family to figure out, the process guides families to identify which behaviors to adjust based on their own priorities and goals — that might mean cutting back on sugary drinks or walking together after dinner. Research has shown it takes less than 5 hours of motivational interviewing with a pediatrician or dietitian to help bring down BMI.
  • Opt for an approach called intensive health behavior and lifestyle treatment (IHBLT) whenever feasible. As the name suggests, it’s an intense treatment that calls for at least 26 hours of face-to-face, family counseling on nutrition and exercise over a period of 3 to 12 months. More sessions produce larger reductions in BMI, with 52 hours or more over the same duration having the greatest impact. Unfortunately this treatment program isn’t available everywhere, and for many families the time and financial demands put it out of reach.
  • Offer approved weight loss drugs to adolescents 12 years and older who have obesity. Medication should always be used together with nutrition and exercise therapies.
  • Refer adolescents 13 and up with severe obesity for possible weight loss surgery. That referral should be to a surgical center with experience in working with adolescents and their families, where the teen would undergo a thorough screening process.

Medication and Surgery

Those last two recommendations have garnered most of the headlines, and it’s understandable. Medicating a child — or performing an operation that would permanently change their body — might seem extreme. But the research shows that for children with obesity and severe obesity, these treatments work.

“This isn’t for a kid who’s a little overweight,” says Fishman. “It’s obesity that’s limiting this child’s ability to function. When we face something this disabling, we want to attack it from every direction we can.”

Right now, only a handful of medications are approved to treat obesity in adolescents. Some are taken orally, while others, like the recently approved Wegovy, are injected. 

Jill, the New Jersey mom, is using Wegovy herself. 

“The fact that I’ve had success with it makes me more comfortable about approaching it as an option for my son,” she says. “And ultimately, it’s his choice. If he wants to see if he can just do things differently first, we’ll try that. A nutritionist’s guidance will be part of this for him regardless, so he can understand what’s involved. It’s not like he’ll get the shot and all of a sudden magic happens.”

Losing weight with medication can help remove some of the shame that often comes with obesity. Heather, the Florida mom, is also using an injectable drug.

“It’s all the morality stuff like, if you had more self-control, if you worked harder and really tried, if you just made the choice,” she says. “This pulls all the morality out of it. Obesity is a medical condition. It’s so clear. In the same way I take thyroxin because my thyroid doesn’t work well, this makes my insulin receptors work properly.”

For kids 13 and older with severe obesity — a BMI over 35, or 120% of the 95th percentile for age and sex — metabolic or bariatric surgery may be recommended. Of course, surgery is much more invasive than medication, with a greater risk of complications. The guidelines acknowledge this and stress the need for thorough screening before proceeding.

“The pediatrician would refer a child for evaluation. They wouldn’t say, ‘You definitely need to have surgery,’” Hampl says. “They’d say, ‘As your pediatrician, I feel that you would benefit from a comprehensive evaluation at a pediatric bariatric surgical center.’ These types of centers do a very thorough pre-op evaluation over at least 6 months, and then careful monitoring is done for years afterward.”

Weight loss surgery for adolescents does have certain drawbacks. Any surgery has the risk of complications, and some surgical patients do gain back a significant amount of weight. Some research suggests that adolescents who have the surgery are more likely to have alcohol problems later in life.

Even with those risks, for some teens surgery may prove life-saving.

“We know much more about the complications of obesity in adults, we know those are devastating,” says Hampl. “If we can prevent heart attacks, stroke, sleep apnea, diabetes, and other really serious medical complications, that in itself is a huge benefit to the person’s health.”

The Question of Equity

The guidelines point out that obesity has inequities baked into the condition. Risk factors increase depending on your economic status and your race. Access to treatment is lopsided. Some of the most effective treatments, like intensive health behavior and lifestyle treatment, aren’t available everywhere. Providers may not be in-network or even accept insurance. 

If the family of a child with overweight can’t access effective programs to help them build healthy habits, the child’s odds for developing obesity grow. As they get older and their BMI reaches the level of obesity or severe obesity, treatments like medication and surgery become an option. But they’re even more costly, which leaves many families with no help at all.

That’s why the guidelines also include policy recommendations aimed at covering comprehensive obesity prevention, evaluation, and treatment. They call attention to the ways unhealthy food is marketed, the effects of limited resources on a community, how socioeconomic and immigration status factor in, and the challenges posed by food insecurity.

“We hope the guidelines will serve as impetus to help improve access to care for all children with obesity,” Hampl says. “That includes everything from infrastructure and policy to systems change as well.”

For parents who struggle to help their children with overweight and obesity, having such an authoritative resource can pave the way to getting real help.

“It’s good that they issued these guidelines. I’m hoping, for my son and all the kids out there who are struggling, that it will help to have it recognized as something worthy of clinical, medical management,” Jill says. “It’s validating.” 

Source link

#Guidelines #Kids #Obesity #Parents