next-level health: obesity – the hidden pandemic and new answers

it seems like everywhere you look, you see ads for ozempic. it and related drugs ozempic/wegovy (novo nordisk) and zepbound/mounjaro (eli lilly) are the greatest blockbuster approvals of the last 20 to 30 years. ozempic has made novo nearly $14 billion (usd) and has basically driven the entire economic growth of denmark .

researchers noticed a very important trend in patients participating in clinical trials: they lost weight. it turned out this effect was independent of whether or not they had diabetes, and that it was significant. up to 20 per cent in some cases . glp-1 medications also work directly on the brain to increase fullness and desire to eat, allowing people to consume less calories without increased hunger.

in recent years, we’ve begun to realize obesity is a complex, progressive, real, and treatable chronic disease. a reported 26.6% of canadians struggle with obesity .

many doctors still default to telling patients to eat less and exercise, but we now know that is not effective. science has shown that weight management is centred in the brain and influenced by an individual’s genes and environment, and yes, even your postal code can play a role . even zero calorie artificial sweeteners can cause weight gain ! obesity is far more complex than many appreciate.

issues with glp-1 medications

1. if you get off the drug you tend to put the weight back on (not surprisingly, given that obesity is a chronic disease!)
2. people report a dissatisfaction of not enjoying food anymore
3. there is an associated lean muscle loss with fat loss
4. adherence to the drugs falls off for some after 3+ months.

let’s be clear. these drugs are helping people, improving their health, and may even extend lives. a new study has shown the drugs reduce major adverse cardiovascular events, such as heart attacks and strokes in those who have established heart disease, the highest-risk population.

they have also been shown to reduce addiction cravings , such as alcohol, opening the door to a potentially very interesting answer for treating patients with substance abuse issues.

comprehensive approaches to obesity treatment

while the drugs’ effects are potent, obesity requires a comprehensive approach to treatment, tailored to meet each patient’s needs. updated clinical practice guidelines (cpgs) published in 2020 for obesity management include three pillars of obesity management that support nutrition and activity: psychological intervention, pharmacological therapy, and bariatric surgery.

multimodal treatments such as cognitive behavioural therapy (cbt) and virtual telemedicine services like medical weight management center of canada (mwm) , have been shown to improve outcomes with behavioural support, which in turn has resulted in better mental, physical, and metabolic health outcomes.

the economic and health burden of obesity in canada

the health outcomes associated with obesity put a significant burden on our healthcare system and the overall economy. obesity has been shown to negatively affect outcomes in type 2 diabetes mellitus (t2dm), cardiovascular diseases (cvd), metabolic syndrome (mets), chronic kidney disease (ckd), hyperlipidemia, hypertension, metabolic dysfunction-associated steatotic liver disease (masld), certain types of cancer, obstructive sleep apnea, osteoarthritis, depression, and many more.

treating these conditions associated in patients with obesity is estimated to have a 30 per cent higher medical cost than patients with a normal bmi. and yet, we are ignoring the underlying problem.

we know that a five to 10 per cent weight reduction can improve many of these medical conditions, however, obesity is still not prioritized for treatment. patients who have access to obesity treatment are healthier and happier, and report improved health related quality of life scores as their weight decreases . for people with obesity, their weight is likely the largest predictor of negative outcomes to their overall wellbeing.

the future of obesity treatment

for obesity as a disease, this is just the beginning. the canadian guidelines are being adopted in other countries across the globe. there are new glp-1 drugs for weight loss in the pipeline that are oral formulations , so you won’t have to inject them, and ones that target other parts of the pathway that are more and more effective for weight loss.

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next-level health: obesity – the hidden pandemic and new answers

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