New way forward for obesity treatment – new medication could give people with obesity the way to match their will

Obesity is a growing concern worldwide with 39% of men and 40% of women over the age of 18 being classified as overweight, and 13% of people are classified as obese.1 It is estimated that by 2025, 2.7 billion adults will be overweight, over 1 billion people will be obese, and 177 million adults will be severely affected by obesity.1

While the prevalence of obesity is so high, the struggle also lies in losing and maintaining weight loss. The Awareness, Care, and Treatment In Obesity MaNagement’ International Observation Study (ACTION-IO) found that the majority of people who are overweight make at least one serious weight loss attempt in their life. However almost 40% of people are able to lose at least 5% of their body weight, and only 29% were able to maintain that weight loss for at least a year.2

 

Recognising the problem is the first step

Worldwide there is a growing push towards recognising obesity as a disease, with the World Obesity Federation describing obesity as a medical condition that is caused by excess body weight in the form of fat.3 This fat can lead to severe health impairments when accumulated.3 Furthermore, the World Obesity Federation reiterates that obesity should be considered a disease as it is a chronic, relapsing condition that is caused by a variety of factors including an abundance of food, a sedentary lifestyle, and several environmental factors that interact with genetic susceptibility.4

The rising prevalence of obesity worldwide makes it one of the most important public health problems facing the world, according to the World Obesity Federation.1 In South Africa, obesity is ranked fifth as a risk factor for early death, above malnutrition and being underweight,5 yet it is still not managed as a disease in this country.

Furthermore, the World Obesity Federation states that recognising obesity as a disease may lead to numerous benefits, including reducing internalised stigma and changing public discourse about blame for the condition.4 Recognising obesity as a disease may also impact health care costs, especially in countries where health care costs are funded from insurance schemes.4

 

Treating obesity holistically and medically

Traditionally, the most common method used to treat obesity has been lifestyle changes such as a strict diet and increased physical activity. As more is uncovered about obesity and weight loss, this is changing. Obesity is a complex disease that is unique to each person and more and more health care professionals are looking at the importance of a health care team that caters to each individual’s needs.6 This team may include a registered dietician to help with an eating plan, a health care professional who specialises in weight management, and even a therapist to help explore any emotional factors that affect weight.6

 

Novo Nordisk, a leading global healthcare company, is proud to be launching its first anti-obesity product in South Africa.

This prescription medication may be able to help people with excess weight manage their weight, especially if traditional methods of treatment are not effective.7 The medication should only be used in conjunction with a low-calorie eating plan and increased physical activity.7 To learn more about the medication, patients will need to consult with their healthcare practitioner.

 

How it works

As obesity can be impacted by hormones, the medication focuses on targeting hormones to try and treat obesity.8 Tackling the hormonal causes of obesity is important in counteracting weight regain. The body has a set weight that it is genetically predisposed to, and when you begin losing weight your body’s natural survival instincts kick in to regain that weight.9 This weight regain occurs as there are changes to the hormonal signals within the body resulting in the hunger hormone (ghrelin) increasing and a decrease in the hormones telling the brain to stop eating or sending satiety signals.10 This makes maintaining weight loss difficult and weight regain is very common and can be discouraging when working hard to lose weight.

The medication contains a hormone that enhances the secretion of insulin as well as increasing the feeling of fullness during and between meals.11 It does so by acting on the appetite centres of the brain and also by slowing the emptying of the stomach.8 This appetite suppression and the slowing down of emptying the stomach are thought to be responsible for the weight loss effects.8

In summary, the medication increases the feeling of fullness and decreases hunger, which can lead to weight loss.12

 

Results

A one year study in 2011 took place in 126 sites in nine countries around the world and showed that the majority of patients on this new obesity treatment product achieved more than 5% weight loss while using the medication, in addition to a low-calorie diet and increased physical activity.13 On average, people lost around 9.5kg when using the medication.13 In addition, a three-year study found that more than 50% of patients achieved clinically meaningful weight loss in their first year on the medication and maintained it until their third year.14 The ACTION-IO Study found that maintaining a 5% weight loss over time can have a significant impact on health.2

Another study examined obesity and prediabetes and the effect the medication may have on diabetes. At the end of 3 years (160 weeks), the study found that only 2% of the participants on this anti-obesity medication were diagnosed with diabetes in comparison to 46% of participants on the placebo.15 Furthermore, it took 2.7 times longer for the participants on the medication to be diagnosed with diabetes.15 This shows that the medication might provide health benefits in terms of reduced risk of diabetes in people with obesity and prediabetes.15

 

Tackling obesity

Driven by a purpose to defeat obesity, diabetes, and related chronic conditions, Novo Nordisk has gained valuable insights in managing obesity and is committed to creating awareness around the subject in South Africa. Novo Nordisk has launched the Truth About Weight website aimed at tackling the myths about obesity and obesity treatment. The Truth About Weight website aims to break the stigma around obesity and weight loss and highlight the need for obesity to be treated as seriously as any other disease.

Speaking to a health care professional about your weight is an important step to take in identifying obesity and being overweight, and it is just as important as tackling the stigmas associated with obesity. Obesity can have many effects on a person’s life, from impacting physical health to mental and emotional health, and as such needs to be treated in a holistic way.

Help break the stigma around obesity, visit https://www.truthaboutweight.global/za/en.html for more information on obesity. #changingobesity #truthaboutweight

 

Facts about obesity

Burden of disease
  1. Obesity is one of the world’s largest health problems, spanning countries and people of all income levels.1
  2. According to the World Health Organisation, obesity has tripled since 1975 with 1.9 billion adults considered overweight and 650 million of theses adults considered obese.2
  3. In South Africa, 70% of women, 31% of men, and 13% of children are overweight or obese.3
  4. In 2017 4.7 million people worldwide died prematurely as a result of obesity, four times more than the number of people who died in car accidents and nearly five times more than the number of people who died from HIV/AIDS that year.1

 

Obesity
  1.  Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health.2
  2. Body Mass Index (BMI) is a tool that is used to classify adults as overweight or obese.2
  3. BMI is defined as a person’s weight in kilograms divided by the square of their height in metres (kg/m2).2
  4. A BMI between 25 and 29.9 shows that a person is carrying excess weight, and a BMI of 30 or over indicates a person may have obesity.4
  5. Obesity increases the risk of noncommunicable diseases such as stroke, heart disease, diabetes, musculoskeletal disorders, and some cancers.2
  6. One of the main causes of obesity is a lack of physical activity and an increased intake of energy-dense foods.2
  7. A faulty gene called the fat-mass and obesity-associated gene (FTO) can also be responsible for some cases of obesity.5 FTO impacts the amount of the ‘hunger’ hormone, ghrelin, a person produces, which could play a role in binge and emotional eating.5
  8. A lack of sleep also plays a role in obesity as it causes the body to increase the production of ghrelin, resulting in an increased appetite.5

 

Hormones
  1. Hormones play a large role in your weight as they affect your appetite and how you store fat.6
  2. Insulin is the main fat storage hormone in the body, it tells fat cells to store fat and prevents stored fat from being broken down.6
  3. Elevated insulin levels can lead to many health problems including obesity.6
  4. Leptin is considered a satiety hormone as it makes you feel full and reduces appetite.
  5. Impaired leptin signalling means the brain does not get the message to stop eating and so you continue to eat. 6
  6. When you lose weight, leptin levels decrease making you eat more as your brain thinks it is starving, which is part of why weight loss is so hard to maintain in the long run.6
  7. Ghrelin is the ‘hunger hormone’ and tells your body to eat when your stomach is full.6
  8. In obese people, ghrelin levels decrease only slightly after eating, meaning the brain does not get the signal to stop eating.
  9. Cortisol is a stress hormone and increased levels of cortisol can lead to overeating and weight gain.6
  10. Neuropeptide Y (NPY) is a hormone that stimulates appetite, particularly for carbs, and NPY levels are highest during fasting or food deprivation periods.6
  11. Stress also increases NPY levels and can lead to overeating and weight gain.6

 

GLP-1
  1. Glucagon-like peptide-1 (GLP-1) is another important satiety hormone produced in the gut when nutrients enter the intestines.6
  2. GLP-1 plays an important role in regulating appetite by making you feel full during and between meals, as well as by slowly emptying your stomach7 which may help you feel full for longer.
  3. This appetite regulation and stomach emptying slowing functions are thought to be responsible for the weight lowering effect of GLP-1.7
  4. Studies have found that the weight loss effects of natural GLP-1 are not significant enough to have a clinical impact on weight loss.7

 

Treating obesity
  1. Losing 5–10% of your body is enough to have a significant impact on your health, reducing your risk of suffering from any of the complications associated with overweight and obesity.8
  2. Set Point Theory states that every person has a certain ‘set’ weight that their body accepts and is genetically disposed to, so any attempts to lose weight results in the body’s survival instincts kicking in to regain weight to stay at that ‘set’ weight.9
  3. Crash dieting should be avoided as it could cause new health problems or vitamin deficiencies and can even make achieving weight loss more difficult.10
  4. It is recommended that people do approximately 150 minutes of moderate exercise a week to have a positive impact on their weight and health.11
  5. These hormonal changes may last for up to three years and may part of the reason why most people end up regaining lost weight in the long run.12
  6. Weight loss medications can also play an important role in losing weight and will be prescribed by healthcare professionals if dietary changes and exercise have not resulted in weight loss, or a person’s weight poses a significant health risk.10
References available on request