white coat, black art26:30Ozempic: Good, evil and the future
Despite widely publicized reports of rare but serious side effects, obesity doctors say Ozempic and similar drugs have the potential to improve medical help for a chronic disease that patients have for too long been forced to deal with. heal on their own.
“There are still some aspects of our health care community that say, ‘this is not important, weight loss is not important; it’s just a cosmetic issue and you’re not really improving the health of these people,'” said Dr. Daniel Drucker. , a physician-scientist whose research helped pave the way for Ozempic, one of several brands of a drug known as semaglutide. “But now I think that argument will be ruled out.”
Ozempic and other drugs in its class are known as glucagon-like peptides or GLPs. Because LPGs act to stimulate insulin secretion, they were first approved for use as a diabetes drug in 2005, said Drucker, senior scientist at the Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital in Toronto.
But it was actually in the late 1990s when Drucker’s lab, as well as Dr. Steve Bloom’s in the United Kingdom, began publishing what they had observed in clinical trials: that patients treated with GLP drugs for their diabetes were also losing weight. weight.
Now new data shows that semaglutide also reduces rates of heart attacks, strokes and death in people with preexisting cardiovascular conditions, Drucker said. White coat, black art Host Dr. Brian Goldman believes it will “change the conversation about the importance of treating people with obesity.”
‘Not feeling hungry all the time’
Michael Morris, 58, says he has been struggling with his weight since he was a teenager.
“I’ve always had ups and downs, yo-yo, on every diet,” she said. When he needed a CPAP machine for sleep apnea about 18 months ago, he ended up on a program that supported him through some dietary changes to help address the apnea, along with his high blood pressure and cholesterol levels, and your prediabetic blood sugar level. . When Morris met with a doctor, he asked him about Ozempic and the two agreed he could try it.
Since then, Morris said he has gradually lost about 40 pounds and has also seen improvements in his other conditions.
“It’s like it changes… the way you think about food, like you’re not hungry or hungry all the time,” she said.
Before Ozempic, Morris said he could never tell when it was full.
“I know it’s probably hard for people to understand. I would eat things and then I would keep eating, and then it would get to the point where it would make me feel bad. And then I would be like, ‘Oh, me.’ I won’t do that again.
“I guess food is like an addiction for me. And if you’re an alcoholic, people don’t say, ‘Oh, I’m just trying not to drink.’ There are programs and stuff.”
The genetic component.
Dr. Sasha High, an internal medicine and obesity physician who works in private practice in Toronto, says it’s important to understand that not everyone experiences food the same way.
“We know that between 50 and 70 percent of obesity is genetically determined and the genes involved are genes of the central nervous system, that is, genes that control factors in our brain,” he said. These affect how the brain responds to the foods around us, whether we crave sugar or salty foods, and whether we enjoy exercise. “All of that is determined by our physiology.”
That doesn’t mean weight is set in stone, High said, but it does mean there’s a variety of what your body shape will look like, determined by your genetics and then your lifestyle choices.
When he started working in the obesity area in 2012, High said there wasn’t much doctors could offer beyond telling patients to eat less, exercise more and count calories.
That message is discouraging for people who have struggled with obesity for a long time, he said.
“The problem is not that they don’t understand that they need to do that. The problem is that life gets in the way and stressors come and we eat because we’re bored and we eat because we’re sad and we eat because it’s 9:00 at night and We’ve had a stressful day.”
Drucker said GLP medications work in two ways to tell patients they are not hungry. First, they tell the brain to physically slow down stomach emptying, and second, they affect the brain’s hunger signals, suppressing appetite.
Some of Drucker’s research was done in partnership with companies that make or are working on weight-loss drugs, including Pfizer and Novo Nordisk.
On November 11, the New England Journal of Medicine reported the results of a study on the safety of semaglutide in people with obesity who also had cardiovascular disease, Drucker said. On average, patients received semaglutide or a placebo for 34 months.
“It showed not only weight loss but also reduced rates of heart attacks, strokes and death.”
However, some patients have experienced serious side effects, such as stomach paralysis and malnutrition.
Pamela Cole is one of those patients. The 38-year-old man from Marmora, Ont., initially responded well to the medication. But when his doctor increased his dose about eight months later, he began having flu-like symptoms that got worse from there.
“It continued to get worse to the point where I couldn’t eat anything without feeling severe stomach pain,” Cole said. He ended up visiting the hospital four or five times in the span of two weeks, she said.
During the last of those visits, she was treated for very low potassium levels that were affecting her kidney and liver function. A specialist eventually recommended that she stop Ozempic, and after doing so, her symptoms disappeared.
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In a statement, Ozempic’s maker Novo Nordisk told CBC that it stands behind the safety and effectiveness of all of its GLP-1 medications when used by appropriate patients in accordance with product labeling and approved indications.
Drucker said Cole’s experience is atypical compared to the findings of eight large cardiovascular safety trials (some with more than 10,000 subjects) that were conducted over periods of two to six years.
“And what we see overall are favorable results. In those trials, we see a reduction in heart attacks, strokes, cardiovascular death… and we don’t see an increase in cancer or an increase in pancreatitis,” he said.
However, he said it is important to be cautious.
“With newer, more powerful drugs and the growing patient population, there is always the possibility of seeing something we haven’t seen before.”
Dr. Nav Persaud, a family physician at St. Michael’s Hospital in Toronto, told CBC in January that it wouldn’t be the first time the side effects of a weight-loss drug turned out to be more serious than expected.
“We’ve seen it happen many times that there were these wonder drugs advertised that turned out not to work or to harm and kill people,” he said.
In France, a diet drug called Mediator started as a treatment for type 2 diabetes It was withdrawn from the market in 2009 after being blamed for thousands of deaths from heart valve problems.
Dr. Sean Wharton is an internal medicine specialist at Michael Garron Hospital in Toronto and an assistant professor at the University of Toronto researching obesity medicine. He compares the difficulty people face in accessing medical help for obesity to the experience many people with mental health problems have with the expectation of “being happier.”
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However, until weight-loss drugs become much more accessible, he said he doesn’t think they will make much of a dent in the obesity epidemic. Ozempic has been in short supply since its popularity skyrocketed. More than 3.5 million prescriptions were filled. in Canadian pharmacies last year The very nature of an injectable drug that is expensive to make, ship and store means that only people with financial resources or particularly good drug plans can get it, said Wharton, who has done paid research for Novo Nordisk. .
In September, the New England Journal of Medicine released data from Wharton phase two trial showing that a once-daily pill called orforglipron resulted in a weight reduction of at least 10 percent after 36 weeks in between 46 and 75 percent of participants.
Drucker said GLP medications will not eliminate the need to address access to healthy, affordable food, to design cities that are easier to navigate on foot or by bike, or to promote healthy habits around diet or exercise.
“But if you’re sitting across the desk from someone who is living with obesity and is at increased risk for heart disease, kidney disease, liver disease, and cancer, I think BPL medications are a very useful option.”