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Editor's Note: See “Dr. Sanjay Gupta reports: Is Ozympic Right for You? Sunday, November 17 at 8 p.m. on
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Over the past year, the question has been coming from everywhere – from my patients and family members, from colleagues and passengers I've talked to on airplanes: Is Ozympic right for me? Or any of the blockbuster weight loss and diabetes drugs that have caught the world's attention recently? As I was filming my new documentary about the drugs, it became clear that many people at least considered taking GLP-1 drugs.
Although obesity is currently one of the most common diseases in developed countries, there is still much debate about how it is diagnosed and what exactly causes it. Some experts question the disease at all.
All of these topics were discussed in Copenhagen this spring with a Danish scientist, Dr. Jens Jules Holst, who helped me discover molecules that are currently revolutionizing the field of diabetes and weight loss. By now, you've definitely heard of Wegovi, Munjaro, Zepbone, and Ozympic. Some say Holst is a future Nobel laureate for this work, while others say he helped fuel the wildcat industry to find better solutions to diet and exercise.
Holst is a pleasant, energetic, fit and healthy 79-year-old who still rides his bike to work every day. The first goal of the international team of researchers was to find a molecule that could treat peptic ulcer disease, not diabetes or obesity, he explained. Although not ultimately beneficial for lesions, he told me, targeting GLP-1 significantly reduced blood sugar and body weight in a series of surprising findings. And best of all, for many people who struggled with obesity, these molecules seemed to work in the absence of anything else. He knew it helped him find something that could change.
When the first versions of these drugs were approved 20 years ago, you may be surprised to learn, there was little fanfare. In those early days no one had ever heard of them. Part of the reason is the internal handiwork among pharmaceutical executives who are never quite sure that people aren't injecting themselves to lose weight — and yes, among scientists like Holst, it's unclear exactly what they're being treated for.
Obesity: a disease in itself?
For starters, obesity is unquestionably linked to other diseases like type 2 diabetes, cancer, heart disease and stroke. However, that doesn't mean the connection is always there for everyone or that obesity itself is to blame. After all, there are many people who are obese but have no evidence of heart disease or diabetes. Their blood pressure is normal, and they do not take any medication. There are no abnormalities in their blood work or abnormalities in their normal body functions. Their only disease is a high BMI – too much weight for their height.
When I asked Karin Conde-Knapen, head of drug development for Novo Nordisk's Ozympic and Wegovy, about it, she smiled and said, “Yes, we call them 'happy fat'.” She added her worry. “These patients are on the verge of developing these other diseases.”
Conde-Knape suggests that obesity should still be classified as a disease because it will inevitably lead to problems – even if it doesn't now. As it stands, many major medical organizations, including the American Medical Association and the World Health Organization, agree with her, but it's still a wildly polarized topic that's becoming more urgent than ever when these drugs are introduced.
A Research Published this week in The Lancet, projects that by 2050, 43.1 million children and adolescents and 213 million adults in the United States will be overweight or obese. However, while we can measure the particle size of small lipid molecules and genotype tumors, it is remarkable that we still rely on an ancient method known as BMI to diagnose obesity.
BMI or Body mass indexIt is a formula that was first used 200 years ago when mathematicians – not doctors – were trying to determine the ideal weight for humans. Specifically, “quantifiable characteristics of the average person.”
In the first measurements, only European men were included – no women, no children. And a century later, in the 1950s, insurance companies realized that many of their claims came from obese people. Before then, however, there was no known relationship between BMI and general health. BMI doesn't even differentiate between muscle and fat mass. This is why the fittest, most chiseled and health conscious person you know can still be considered obese.
Holst, among others, says a better measure of obesity may be easier than using a tape measure to check your waist-to-hip ratio in addition to body mass index.
The debate over whether or not obesity should be considered a disease, especially when measured by BMI, will likely continue. But there is an area of agreement I've found with almost everyone I've spoken to on the subject: Just as depression and addiction are now defined as brain diseases, scientists are saying the same thing about obesity – for many people, obesity is not a choice or a reflection of a lack of interest. And, surprisingly, it may be this new class of medicine that really reinforces this point.
This is the reason.
GLP-1 molecules are defined as post-nutrient hormones, which means that the human body releases a substance after eating food. Together, they stimulate your pancreas to produce more insulin, control how quickly food moves through your intestines, and activate areas in the brain that make you feel full or satisfied.
As a neuroscientist, I find this last point particularly fascinating. Some people never really feel full no matter how many calories they consume. Instead, they have a constant, crazy food frenzy on their minds. Even though you're eating one meal, you're thinking about the next one instead of actually being full. That's one reason why you keep eating more calories than you need. For them, GLP-1 drugs actually silence the voices in their heads.
Holst is very focused on this particular mechanism of GLP-1 drugs, but worries that it may go too far.
Over coffee and pastries, he told me that these drugs seem to take away the joy of food for some people. It may be his biggest threat. He told me that people stop meeting when they know they won't be hungry for dinner. They can also tan very quickly and have associated skin and fatigue. For others, it's the loss of muscle mass that accompanies weight loss and puts them at greater risk for falls. The drugs work by slowing digestion, with terrible constipation becoming an unbearable side effect for some.
Consider this: More than half of those who start these medications eventually stop them. 12 weeks. For some, the drugs are too expensive and ultimately out of their financial reach. Others develop a tolerance to the drugs, and over time, they may stop working. But for many people, these side effects — including the loss of pleasure — are what keep them satisfied with the drugs.
And again, it was that lack of joy that particularly concerned Holst. “It's a heavy price to pay,” he said.
For now, the question remains: Who should take these drugs? should No Try these remedies?
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There's no doubt that for most people, regular exercise and a proper diet are still the best strategies for weight loss and overall health. High-fiber foods, for example, release more natural GLP-1. Among those who took GLP-1 drugs and those who stopped, those who were most likely to lose weight included lifestyle changes in a meaningful way.
Many people regain their weight after stopping the drugs, but importantly, not all people and not all lose weight. For those who could lose weight, these drugs were not a lifelong solution, but rather a catalyst to help reverse their obesity trajectory.
Yes, we have a lot of work to do to better define and assess obesity. That's what Holst wants me to know after decades of work on the topic. In the meantime, however, these drugs may finally offer a lifeline to those who have truly struggled for a long time.