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Does the Advent of New Weight Loss Drugs Render Natural Weight Loss Measures Obsolete?

Does the Advent of New Weight Loss Drugs Render Natural Weight Loss Measures Obsolete?
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From Ronald Hoffman, MD

Finding safe and truly effective weight loss drugs has long been the Holy Grail of Big Pharma. Along with cures for cancer, Alzheimer’s, and other scourges, a panacea for obesity ranks high among its priorities. With over half of Americans exceeding optimal weight, and amid a worldwide trend of surging pounds, a breakthrough would be a big deal.

Previous attempts have foundered. Drugs were minimally effective, or if they worked, they did so at the cost of unacceptable GI symptoms, cardiovascular danger, or speedy jitters.

The humble Gila monster spawned a revolution. Able to fast for long periods of time in harsh desert conditions, its metabolism yielded to researchers the secret sauce that resulted in GLP-1 agonists like the semaglutides, drugs that reverse insulin resistance, slow gastric emptying resulting in a feeling of fullness, and trigger satiety in the brain.

Originally intended only for diabetics, the new class of drugs had a fortuitous side effect: Patients reliably lost weight, on the order of 15% of their bulk, within a year or so on average. Soon, their potential as weight loss drugs was realized.

I’m seeing it in my practice. The other day, one of my regular patients, who lives in Europe, came in for her annual. I was taken aback by her appearance. For years she had struggled to shed an extra 15 or 20 pounds. I had counseled acceptance, since she was otherwise healthy. But now she was transformed. I said: “You look amazing! Don’t tell me—you took . . .” “Yes,” she cut me off, “Ozempic.”

All told, she dropped 35 pounds in just under 18 months. She related how she had felt sick and exhausted when she started the weekly shots; she was nauseous all the time and alternated between diarrhea and constipation. But so determined was she to lose weight that she persevered. Fortunately, the symptoms mostly abated after a few months.

I asked her how she got a hold of it, given that it’s approved only for diabetics, people with a really high BMI, or those whose medical conditions urgently call for weight loss. Merely shaving off a few undesirable pounds for aesthetic reasons is still considered an “off-label” indication for Ozempic. Besides, there are worldwide shortages caused by intense demand. When not covered by insurance, these drugs retail for around $1400 per month.

She said she has a connection in Europe, where Ozempic costs only $300-400 per month. She’s well off, so the prospect of staying on it for years doesn’t daunt her.

But she illustrates a fundamental problem with these drugs: with such dramatic weight loss, you’re bound to use significant lean body mass. And muscle reserve is an important hedge against sarcopenia, the process by which the aging physique inexorably marches toward frailty.

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