Reducing the weight of patients up to 20 %, new anti-obesity treatments are revolutionizing the care of people in severe obesity. It is unheard of for drug treatments, but it is still necessary to highlight their limits.
These drugs, which include the NOVO Nordisk semaglutide (Ozempic/Wegovy) and the shooting (Mounjaro) by Eli Lilly, accentuate the action of a hormone, called “Glucagon-Like Peptide 1” (GLP-1). This acts on the secretion of insulin, which explains why these treatments were first developed against diabetes. But GLP-1 plays more broadly on the feeling of satiety, via brain mechanisms.
These drugs can therefore profoundly change the patient’s relationship to their diet, by reducing their appetite via an improvement in their ability to be full.
Revolutionary drugs?
According to obesity specialists, it is a historic advance to help lose weight. Until then, surgery remained the main therapy offered to people whose obesity is severe and resists changes in lifestyle.
Obesity was one of the only chronic diseases for which there were very few drugs.
These new treatments “cover an unwanted major need: obesity was one of the only chronic diseases for which there were very few drugs,” Emmanuel Disse, endocrinologist at the Civil Hospices in Lyon, told AFP. During clinical trials, these drugs have decreased the weight of patients on average 15 % to 20 %. It is slightly less than surgery, but it is unheard of for drug treatments, in essence less invasive.
Scientific progress, but not magical
Experts are however unanimous: GLP-1 are not miraculous molecules. First, they frequently cause side effects. On the other hand, it is allowed to assert that the serious effects are rather rare unlike previous and appetite suppressant medicines.
A vast study, carried out from the health data of hundreds of thousands of American veterans and published in January in Nature Medicine, showed that GLP-1s are not associated with an increased risk of cardiac disorders or suicidal ideas, as had been advanced. But, some serious risks, such as pancreas attacks, exist in a limited way. And these drugs often cause painful effects such as nausea, sleep disorders, or migraines, which are not serious in itself, but which can be unbearable for patients.
GLP-1s also do not work every time: some patients do not lose weight. Their effects do not persist in the event of a stop, which makes life treatments for life. And, for the time being, they only administer themselves in injectable form, while a pill would make their grip much easier.
The list of beneficiaries is limited
Because of these limits, GLP-1s must be reserved for people whose overweight is important, and in the context of broader management of their obesity: physical activity, change of diet …
Not all authorities put the cursor in the same place: France recommends them for a BMI greater than 35, while the United States only set out for 30. The experts interviewed by AFP point out that it is probably an economic choice, and not only medical. France, whose social security system reimburses many treatments with public money, is logically more restrictive.
For the future
“We will quickly go to more effective drugs, with fewer side effects, cheaper, and easier to take,” sums up AFP Steven O’Rahilly, director of the Metabolism Institute at the University of Cambridge. “But the difficulty may be to combine these four factors in a single treatment. »»
The therapeutic arsenal is already completing. Published on Saturday in Lancet, a clinical trial still in early phase, shows that Amycretine, a molecule close to GLP-1 but with a little wider functioning, could be even more effective.
Another large research track concerns new GLP-1 applications outside of obesity: they seem to be linked to improvements in many pathologies, such as dementias or addictions. It remains to be seen whether this is a direct effect of these drugs, or benefits related to improving diabetes or obesity.
