Obesity is a complex, chronic disease and not simply a cosmetic concern. Having excess fat comes with numerous negative heath consequences, including increased risk for cardiovascular disease, chronic respiratory diseases, Type 2 diabetes, cancer and dementia.
It is also a leading cause of death. Obesity is one of the most important public health issues in the world today. It is estimated that nearly three billion people are overweight or obese. In Malta, as of 2021, an alarming 65% of adults were overweight or obese. Despite it being a such as serious global issue, to date no public health campaigns have slowed the growth of obesity in any nation.
In 2021 the drug semaglutide was approved specifically to treat obesity. Semaglutide belongs to a class of medications known as GLP-1 agonists. These drugs were originally prescribed to treat Type 2 diabetes, as they help improve blood sugar levels. This, together with the slowing of stomach emptying and increased feelings of fullness. In combination with lifestyle changes semaglutide also leads to significant weight loss and significantly reduced riskof cardiovascular events like heart attacks.
There are currently three such medications specifically approved for weight loss: liraglutide (trade name Saxenda), semaglutide (trade name Wegovy; Ozempic when prescribed for diabetes) and tirzepatide (trade name Zepound; Mounjaro when prescribed for diabetes).
Despite being on the market for a relatively short time the popularity of these drugs has boomed due to their undeniable and rapid weight loss results. Although losing excess fat, particularly visceral fat, has numerous health benefits it is important to note that these medications do not solely reduce fat but also cause a significant loss in lean mass – muscle and bone.
This fact highlights two crucial points. Firstly these drugs are not suitable for weight loss in all patients, and secondly they form just one part of the treatment plan to tackle obesity.
The benefits of weight loss versus lean mass must be weighed out – the overall effect on body composition must be beneficial. Particularly as we age, it is vital to maintain bone density and muscle mass as these tissues ultimately allow us to maintain functionality and therefore independence and quality of life as we get older.
Decreased bone density causes a significant increase in death from any cause – for example up to one third of people over the age of 65 who fracture their hip will be dead within a year. In terms of muscle mass, we must do everything we can to preserve muscle mass not least because of its obvious role in movement and strength but also because it plays an extremely important role in our metabolism, particularly as it acts a ‘sink’ for excess glucose. Therefore whereas for obese people with substantial muscle mass such medications may be the correct approach, it is not the ideal strategy for an obese person with low muscle mass (sarcopenia).
Should an individual be the correct candidate for using these medications as part of a weight loss strategy, efforts must always be made to minimise lean mass loss. There are two crucial ways in which this is done:
- Consume sufficient amounts of protein (about 2g of protein per kg of body mass) – ensuring you eat enough protein throughout the day by consuming high amounts of protein with every meal and, if necessary, supplementing with protein shakes to help preserve muscle mass.
- Regular resistance training (at least two sessions per week) – in the form of bodyweight exercises and/or weight training, is critical in helping slow any loss in muscle mass as well as maintain bone density.
Additionally, it is important to practice healthy lifestyle practices. In terms of diet, apart from sufficient amounts of protein it is important to note that these drugs slow down digestion and make you feel full quicker. Certain foods may need to be avoided in order to avoid gastrointestinal issues and nutrient rich foods must be prioritised in order to prevent malnutrition. As for exercise, whilst strength training is crucial to maintaining muscle mass and bone strength, getting regular aerobic exercise remains important as it is for all individuals. These drugs are not a free pass to ignoring healthy lifestyle practices.
Like all drugs these medications also carry the risk of side effects which include gastrointestinal, headaches and fatigue.
Careful monitoring and guidance by a medical specialist while on these drugs is essential. They clearly have a potent and direct effect on improving blood sugar control and reducing excess body weight along with other secondary benefits as result of the drastic weight loss such as lowering risk of heart disease, heart failure, stroke and kidney disease. Individuals must be assessed by a medical specialist in order to determine whether these drugs are the correct strategy to achieve a healthier weight.
