Are we losing sight of overall health? Here’s what the science says

The craze for brand new medication within the GLP-1 (Glucagon-like peptide 1) and GIP (Gastric inhibitory polypeptide) analog class, higher recognized beneath the commerce names Ozempic and Wegovy, is exceptional, nevertheless it’s not completely unprecedented within the historical past of pharmaceutical blockbusters.

The amount of prescriptions and the funds allotted to them by public medical insurance schemes are exploding, as are the earnings of the businesses that manufacture them.

A part of the recognition of those medication owes to social networks, however these should not all the time the perfect supply for well being data. In the case of the topic of weight reduction, each fantasy and prejudice come into play. This works to the detriment of everybody’s well-being, however significantly those that are already stigmatized.

As specialists within the philosophy of drugs (Université de Montréal), diet and meals science (Université Laval), the sociology of medicine (Université de Montréal) and endocrinology (Institut de recherches cliniques de Montréal), we really feel it is necessary to step again and take inventory of each the guarantees and the restrictions of those new therapies.

The very best of each worlds

GLP-1/GIP analogs have been initially developed to manage glycemia (blood sugar ranges) in individuals with Kind 2 diabetes, thereby stopping the issues related to this illness. When research have been carried out to evaluate their security and efficacy, it was found that these medication additionally led to weight reduction. This prompted new analysis which confirmed that at greater doses, the medication might result in very important weight reduction, from 15 to 25% of the beginning weight.

The mode of motion of those medication on blood sugar regulation is obvious: they simulate incretin hormones which, in flip, improve insulin secretion. Weight reduction, however, was solely defined after the actual fact: along with the pancreas, these molecules additionally act on the mind by regulating the feeling of satiety and, not directly, on the abdomen by slowing gastric emptying. These two mixed results scale back urge for food and result in weight discount.

That is how a brand new use for the drug appeared, at which level the corporate Novo Nordisk started advertising and marketing the identical drug beneath two completely different names: Ozempic to deal with Kind 2 diabetes, and Wegovy to handle weight problems.

A brand new period

GLP-1/GIP analogs are a welcome therapeutic breakthrough at a time when the prevalence of Kind 2 diabetes and weight problems is exploding and affecting individuals youthful and youthful.

These illnesses significantly have an effect on ladies, members of racialized teams and socio-economically deprived populations. The bodily and psychological struggling these trigger and the prices related to treating them are each appreciable. So the arrival of latest weapons within the therapeutic arsenal is a supply of hope.

Draconian modifications in life-style are actually efficient. However they’re very troublesome to implement and keep over time for causes that transcend the person sphere; on the one hand, genetic predisposition performs a serious position within the improvement of Kind 2 diabetes and weight problems; on the opposite, as a result of these situations are multifactorial, administration of them have to be complete to be efficient and lengthy lasting: it should mix medical interventions but additionally dietary, practical, psycho-social, environmental and even institutional interventions.

Help providers of this sort do exist, however solely in giant college hospital facilities to which many individuals do not need entry. Nor do many individuals have easy accessibility to wholesome and various meals choices, sports activities amenities or social and psychological help.

Treating the consequences however not the causes

To be efficient over the long run, GLP-1/GIP analogs have to be taken constantly: with out drastic life-style modifications, the load that was misplaced is regained inside a 12 months of stopping, and glycemic management is compromised as soon as once more.

In different phrases, the medication deal with the consequences of Kind 2 diabetes and weight problems however not their causes. And but a few of these causes are modifiable: for instance, in keeping with Statistics Canada, lower than half the Canadian inhabitants (49.2% for adults; 43.9% for younger individuals and kids) achieves the beneficial quantity of weekly bodily exercise. In line with the identical supply, meals insecurity impacts round 14% of the Québec inhabitants (22% in Alberta).

Pharmacological remedy, even when it permits a person to eat much less, doesn’t essentially imply that individual will eat higher. Equally, shedding weight doesn’t imply one will change into extra energetic or more healthy. So these new medication don’t treatment Kind 2 diabetes or weight problems. Nor do they stop these illnesses from growing, though they do assist to restrict the numerous issues to which they offer rise.

Prescribe and deal with

A drug reminiscent of Mounjaro is as efficient at weight reduction as bariatric surgical procedure. A lot simpler to manage and far much less dangerous, it could possibly be an actual recreation changer within the remedy of weight problems. Prescribed immediately by household docs and allotted in pharmacies, it might even be rather more accessible and simpler to manage for many who want it.

This raises the query of prices and reimbursement, however not solely that: prescribing isn’t the identical as treating. Right here, the producers are following the suggestions of the well being authorities: this remedy have to be preceded by a cautious evaluation, then administration, and above all a detailed and common monitoring of weight loss plan, bodily exercise, psychological well being, and if essential, socio-economic help.

This requires not solely time that GPs do not need, but additionally co-ordination with different gamers within the health-care community. The issue isn’t whether or not the remedy will probably be efficient, however what can occur whether it is. Dropping 25% of your physique weight in only a few months has severe penalties, which aren’t all the time helpful: it includes a lack of physique fats, but additionally of muscle mass, which is related to intense fatigue. Nor ought to we underestimate the problem of adapting bodily and psychologically to a physique transformation of this scale. Reducing weight would not remedy all the pieces, and expectations should stay sensible.

What classes can we study?

The scientific effectiveness of GLP-1/GIP analogs in lowering the issues related to Kind 2 diabetes and weight problems is indeniable. Nevertheless, these medication should not appropriate for everybody, and they’re actually not miracle cures that can make it doable for one to regain well being with out making any modifications to life-style or surroundings.

We should keep in mind that their success, each business and medical, can be the results of a failure: that of our societies to stop these illnesses, to advertise wholesome existence and to develop environments conducive to the well being of all.

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