A New Generation of Weight Loss Drugs Makes Bold Promises, But Who Really Wins

In the months after having her second child, Sarah found herself fed up. The 40-year-old Seattle resident was cutting carbs and sugar, and exercising regularly, but couldn’t seem to shed the pounds she had put on during pregnancy. So when an email newsletter mentioned a new weight-loss drug called Wegovy, Sarah decided to give it a try. Eight months later, she is out more than $10,000—and down more than 60 lbs.

“Wegovy made losing weight almost effortless,” Sarah, whose name has been changed to protect her identity, told Quartz. “I’m not hungry often anymore and it doesn’t take any willpower to eat less. I simply don’t have any desire to overeat.”

Sarah is one of 125,000 US-based patients now taking Wegovy (whose generic name is semaglutide), a member of a new class of weight-loss drugs. These drugs work differently than the appetite suppressants popular among previous generations of dieters. They are also hitting the market at a different moment: one in which people are more eager than ever for realistic, science-based methods for addressing excess weight, even as a growing faction of activists and doctors voice skepticism of weight as an accurate measure of health.

A new class of weight-loss drug

In the mid-1990s, experiments on Gila monster venom found it contained hormones that could help lower blood sugar. That led to the diabetes drug Ozempic, which ultimately went on the market in 2018. People on that drug discovered a funny side effect: They lost weight.

In 2021, that same compound was approved by the US Food and Drug Administration (FDA) under the name Wegovy for the express purpose of weight loss. Drugs like Wegovy work in more complex ways than simply suppressing appetite, and promise fewer (though not zero) side effects.

Like Wegovy, many of these drugs were originally approved for other conditions; liraglutide (brand name Saxenda for weight loss) was also originally approved as a diabetes drug (Victoza). In fact, semaglutide and liraglutide work similarly in the body: They’re known as GLP-1 receptor agonists because they activate receptors for the glucagon-like peptide-1 (GLP-1) hormone, reducing appetite by slowing digestion and the rate at which the body takes up glucose.

Perhaps most important, the new drug promise significant weight loss. “The previous weight loss drugs were just modestly effective,” says John Buse, an endocrinologist at the University of North Carolina School of Medicine. The average patient would lose 5% of their body weight, in some cases up to 8%. But with semaglutide, he says, “we’ve gotten the kind of weight loss that makes people pay attention: 10-15% of body weight. That’s the average weight loss—half of people are losing more than that. It’s a gamechanger in the conversation…now that we have medicines for which a substantial proportion of patients can expect to lose 30 to 50 lbs.”

In one 68-week pre-approval clinical trial, patients on Wegovy did indeed lose 14.9% of their body weight on average, compared with 2.4% for people on a placebo. (Although, as several writers and scholars have pointed out, the study was funded by Novo Nordisk, which makes Wegovy.) Given the average weight of trial participants—100 kg, or 220 lbs.—that meant weight loss of about 15 kg, or 33 lbs. Other drugs in development have had similar results. In a recent trial for one called tirzepatide from Eli Lilly, more than half of patients lost at least 20% of their body weight—50 lbs. in many cases.

What it takes to lose weight

This new class of drugs is entering a market that at first glance seems ripe for breakthrough. According to the US Centers for Disease Control and Prevention (CDC), 42% of Americans—70 million people—meet the criteria for obesity (having a BMI of 30 or more). At one point or another, most of those people will try a diet and exercise regimen to lose weight.

But a growing body of research shows that diets are not an effective way to lose weight and keep it off. “Obesity is a complex disease… ​for most people, lifestyle modifications, diet, and exercise are just not enough,” says Katherine Saunders, a doctor at the Comprehensive Weight Control Center at Weill Cornell Medicine and co-founder of Intellihealth, an app-based platform that brings evidence-based obesity treatment to patients.

In part because of that complexity, bariatric surgery has since 2009 been considered the standard of care for patients looking to lose a substantial amount of weight. But these procedures can be invasive and expensive, and can come with significant and long-lasting complications.

The dearth of other options leaves some patients and doctors excited about this new generation of drugs. “Right now, the field is really looking for more efficacy, number one. People will do almost anything to lose weight,” says Buse. “We have more than just surgery now for promoting substantial weight loss. The most exciting thing is that obesity is on the ropes.”

A complicated picture

While hopes are high, the realities of taking these drugs can be more complicated for patients. There are often side effects—the most common for semaglutide and liraglutide are diarrhea, vomiting, and nausea. On Wegovy, Sarah says she’s experienced diarrhea so severe that a few times she had to delay her next dose.

Physicians can sometimes gloss over or downplay those effects. But a visit to dedicated Reddit pages for these drugs shows whole communities of patients struggling to adhere to the regimen when they’re feeling sick, and seeking support from a community to understand whether what seems like a severe reaction is normal. (Novo Nordisk did not respond to a request for comment.)

How well a patient can tolerate a drug “is something we think about quite a lot,” Saunders says. “We always start with lower doses and increase gradually as tolerated. Everyone is different. We keep in close touch with the patient and monitor them closely.”

And while these new drugs are relatively well-studied, there are still unknowns. They seem to help patients keep weight off more reliably than diet and exercise alone, but those benefits fade after people stop taking the drugs, and patients do often regain weight. There are also questions about long-term effects. In 1997, weight loss drug fenfluramine/phentermine (fen-phen) was pulled off the market after it was found to cause heart problems. More recently, Belviq (lorcaserin), which the FDA approved for weight loss in 2012, was pulled from the US market in 2020 because long-term use was found to increase the incidence of various types of cancers.

Even if a patient does want to go on one of these drugs, she might not be able to. Many patients keen to try Wegovy can’t access it at the moment, due to a supply chain issue that its manufacturer doesn’t expect to resolve until later this year. Even then, most US health insurers, including Medicare, do not cover drugs like Wegovy, and paying out of pocket can cost thousands of dollars per month. After Sarah’s doctor told her she doesn’t prescribe Wegovy, Sarah secured a prescription through an online health provider; she pays for it out of pocket.

The lack of insurance coverage is in spite of the fact that the American Medical Association declared obesity to be a disease in 2013. “The conversation around insurance coverage needs to be had with insurance companies, but also with employers,” says Kimberly Gudzune, the medical director for the American Board of Obesity Medicine. “It needs to be seen as an investment in your workforce.” The Treat and Reduce Obesity Act, which would expand Medicare to include obesity treatments, has been introduced to US Congress every year since 2012, but has never passed.

America’s love/hate relationship with weight

Though excess body fat was once considered a sign of wealth or fertility, over the past century a stigma has developed against larger bodies. Today doctors associate excess weight with medical conditions like heart disease, cancer, type 2 diabetes, sleep apnea, osteoarthritis, and depression. Studies also show that life is harder when you move through the world in a larger body. Fat people are less likely to be hired for a job, are paid less, are less likely to get married, and are less likely to be happy (though not if they’re living around other fat people). One 2006 study found that 46% of respondents would rather give up one year of life than be obese; 5% said they’d rather lose a limb.

The current state of research makes it impossible to unravel the full complexity of weight and health, but the conversation is starting to accommodate more nuance. Ubiquitous metrics such as body mass index are increasingly understood to be unreliable indicators (though doctors often still use them), and even the language around larger bodies is under review. Many physicians use “obese” to describe people who have excess weight or a BMI over 30, but activists are shying away from the word. “The reason…we are reluctant to use the words ‘overweight’ and ‘obesity’ is that they are made up, they can change,” says Tigress Osborn, a fat activist and chair of the National Association to Advance Fat Acceptance.

In fact, some research suggests that fat may have a protective effect on the body. “The body’s weight-regulating mechanism is about survival. It’s a system with more moving parts than we understand,” says Marilyn Wann, a fat activist and author of the book Fat!So? “Trying to remove weight from an individual or from the population is like trying to take a sledgehammer to the weather—we don’t know the unintended negative consequences we’re going to create.”

There are signs that in the future physicians may be more accepting of bodies of different sizes. But as weight loss drugs get more effective and more available, those cultural gains for body positivity (or body neutrality, or fat acceptance) may also be called into question.

A new relationship between doctors and patients

Overweight patients who come to see Shelly Crane might have an experience they’ve never had before. “I don’t initiate a weight-loss conversation with a patient,” says Crane, a family physician at Advocate Aurora Health in Milwaukee, Wisconsin. Most weight-loss programs come with more risk of harm than good, she says, and there’s not enough evidence that people who do lose weight are healthier in the end.

Crane doesn’t regularly prescribe new drugs for weight loss, though she says more patients are coming in and asking for them lately. Instead, she prefers to keep conversations focused on goals of care. “Patients say, ‘I know I need to lose weight,’ and I say, ‘Why do you think you need to lose weight? What would change in your life if your weight was lower?’” That gives her an opening to talk about health more broadly—how is the patient’s sleep? Their diet? Their mobility? “I try to stay in my sphere of what I’m able to do as a family doctor and really address the root of the health issue as much as I can.”

Crane was drawn to this approach by listening to her patients talk about experiencing size discrimination, and by following the work of fat activists such as Ragen Chastain and Aubrey Gordon. Though she’s been trained in a more integrative style of medicine, her approach toward body acceptance was also shaped by her discovery of intuitive eating during medical school. Since then, she’s been working on deprogramming herself and her colleagues from anti-fat bias.

Crane is part of a burgeoning movement among doctors to improve the treatment of larger patients. For some, that means skipping the dreaded weigh-in, a practice that is somewhat controversial within medicine. Medical organizations like the Association of American Medical Colleges also offer guidelines to reduce anti-fat bias among clinicians.

For doctors, the updated approach at least engenders trust, which can in turn get patients to seek medical care more frequently and improve their overall health. At most, it broadens the definition of what “healthy” means, and looks like.

Some fat activists see this shift as an important step. “The thing we hear most often from the public is, ‘I thought I had this thing, but all the doctor wanted to talk to me about is weight loss, and now the thing is worse,’” Osborn says. “It’s progress to have people in the medical establishment recognizing that there are other healthcare concerns besides weight, if weight is a healthcare concern.”

The hope is that this evolution continues. Activists want more people, in the medical profession and outside of it, to respect their autonomy. That becomes even more pressing in a possible future filled with weight-loss drugs—a future where a person can simply take a drug and stop being fat. “The ease with which I could become smaller—why should I? That should be up to me. Just like, if you believe it’s a medical disorder, the treatment I choose should be up to me,” Osborn says. “Like with anything else, if you believe fat is a disorder, we should let people decide whether people will get treated or not.”

“Fatness isn’t a problem to be solved in and of itself. It is not the root cause of all ills, as much as [medicine] would like to think it is,” Crane says. “We can help people live full, rich lives when we focus on goals of care and not on weight.”

By Alexandra Ossola

Source: A new generation of weight loss drugs makes bold promises, but who really wins? — Quartz

More contents:

The COVID-19 Symptoms Doctors Are Seeing The Most Right Now

More than a year into the coronavirus pandemic, experts have unraveled so many mysteries about how to treat the virus and prevent it. But at the same time, SARS-CoV-2 is always changing as new variants emerge. And accordingly, the ways in which the virus affects people seem to be shifting as well.

Here’s a quick rundown of some of the most common COVID-19 symptoms doctors are seeing right now, and how vaccines and variants fit into this picture.

The most common symptoms — such as cough, fever, and loss of taste and smell — are all still pretty much the same.

Since the COVID-19 pandemic began, the most common symptoms of the virus included a cough (often dry), shortness of breath, a fever of 100 degrees or higher, and the sudden loss of taste and smell.

Those, however, are by no means the only frequent symptoms. People also report everything from headaches to diarrhea, all of which are listed on the Centers for Disease Control and Prevention’s rundown of common possible symptoms.

For the most part, that list of the most common symptoms hasn’t really changed. “The symptoms are really the same as before. It’s the headache, cough, fatigue, runny nose, fever — those kind of generalized flu-like symptoms,” said Jonathan Leizman, chief medical officer of Premise Health, a health care company headquartered in Tennessee.

The emergency warning signs of COVID-19 have also stayed pretty much the same. Those include issues like trouble breathing, persistent chest pain or pressure, and new mental confusion.

With the delta variant, some people’s symptoms might look more like a common cold.

The delta variant (B.1.617.2) is circulating widely around the globe and is now the main strain here in the United States; it’s hitting areas with high numbers of unvaccinated Americans particularly hard.

There is some initial evidence that the symptoms associated with delta might be a bit different than those with the original SARS-CoV-2 virus, though experts caution that it remains too early to say definitively.

“The information we’re getting from the U.K. and Europe and some initial surveys here in the United States is that the delta virus infection seems to be more likely to produce symptoms that are more typical of a common cold,” said William Powderly, co-director of the Division of Infectious Diseases at Washington University School of Medicine in St. Louis, which has recently seen a big uptick in COVID-19 cases and hospitalizations. “That’s a sore throat, mild cough and nasal congestion.”

“The symptoms we were seeing earlier on, which were much more like lower respiratory and fever, are less common,” Powderly added. “That isn’t to say they don’t happen. But there does seem to be a shift in the frequency and type of symptoms being reported.”

Experts don’t yet understand why the symptoms might be slightly different. It could be simply that there are now more infections in younger people, Powderly said. At the same time, researchers are exploring how variants classified as “of concern” and “of interest” — including delta but also lambda and others — might be different in terms of their ability to be transmitted or to make people more or less sick.

The newer coronavirus variants could be making people sicker.

While some people infected with the delta variant have symptoms that are in line with a common cold, there is also preliminary evidence suggesting that other people’s symptoms may be “more intensely felt” with delta, Leizman said.

“We have seen that hospitalization rates are seemingly increased in younger populations with the delta variant,” he offered as an example.

But at this point, there’s no scientific consensus on whether the delta variant is likely to make people sicker than the initial strain, simply because it (and other variants) are so new. The best we have at this point are one-off studies, surveys or even just anecdotal information from the field.

“There’s now data coming out of England and Scotland showing that the severity of the disease may be increased, and it may be leading to an increased risk of hospitalization,” said Carlos Malvestutto, an infectious disease specialist at Ohio State University’s Wexner Medical Center.

“People who are not vaccinated are particularly vulnerable because the new variants — and particularly the delta variant — transmits faster and may be causing more severe disease,” Malvestutto added.

Symptoms tend to be mild in those who are fully vaccinated.

While the vast majority of new cases and hospitalizations occur in those who have not been vaccinated against COVID-19 (around 99% of new infections in some parts of the country), so-called “breakthrough cases” do occur among those who’ve received both shots of either of the Pfizer-BioNTech or Moderna vaccines or the Johnson & Johnson single-dose vaccine.

But the symptoms people experience in those instances tend to be relatively mild, according to the data that’s available at this point. About a third of people who got infected after being fully vaccinated were totally asymptomatic, for example.

The CDC now only tracks breakthrough cases that result in hospitalization or death, so there’s just not really robust data looking at how many people experience milder symptoms post-vaccine (or no symptoms at all), nor is there clarity about what variant those people may have caught. Still, there have been high-profile breakthrough infections in the news, like the New York Yankees cluster or entertainment reporter Catt Sadler, who recently said she had contracted COVID-19 after vaccination.

Ultimately, however, the goal of vaccination is not only to reduce transmission but to also drastically reduce hospitalizations and deaths — and the vaccines have done just that.

“The vast majority of individuals who are fully vaccinated do not have those severe consequences of disease, which makes us think the symptoms might be more mild in general for individuals who are fully vaccinated,” Leizman said.

Breakthrough cases also remain rare. As of mid-July, the CDC said that more than 157 million people in the United States had been fully vaccinated. There have been about 5,000 patients with COVID-19 vaccine breakthrough infections who were hospitalized or who died — though not all of those cases were directly attributed to COVID-19.

Which is why health experts are adamant that getting vaccinated is the best thing people can do to keep themselves and others safe — and to avoid developing any kind of symptoms at all.

“I’m in a state where we’re seeing a significant uptick in hospitalized patients … and they’re all people who have not been vaccinated, which is really hard and devastating, because these are completely preventable,” Powderly said.

Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.

Source: The COVID-19 Symptoms Doctors Are Seeing The Most Right Now | HuffPost UK Wellness

.

References :

The Delta SARS-CoV-2 variant first appeared in India in October 2020. This is the fastest-growing variant and is currently outpacing all other variants. This variant contains the “eek” mutation in the Spike protein, which helps the virus evade certain antibodies.  As a result, the Delta variant has shown significantly increased transmission.

This variant is responsible for the dramatic increase in COVID-19 cases in India over the past several months. Additionally, this variant has been identified in over 98 countries across the world as of July 2, 2021. Both the Pfizer/BioNTech (88%) and the AstraZeneca/Vaxzevria (67%) vaccine demonstrated protection was retained against severe disease caused by the Delta variant. Data is still limited relating to vaccine efficacy and the delta variant.

  1. Global Initiative on Sharing All Influenza Data (GISAID)
  2. Network for Genomics Surveillance in South Africa 
  3. Journal- Increased transmissibility and global spread of SARS-CoV-2 variants of concern as at June 2021
  4. Journal- Effectiveness of COVID-19 vaccines against hospital admission with the Delta (B.1.617.2) variant
  5. Sheikh A, McMenamin J, Taylor B, Robertson C. SARS-CoV-2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness. 

 

Hot Tub Health Kick: Why a Long Bath is Almost As Good For You As a Long Run

A soak in a hot tub could be just the thing to relax you after a long day. The warm, bubbly water also eases aches and pains from conditions like arthritis, low back pain, and fibromyalgia.

But hot tubs might not be safe for some people, including pregnant women and those with heart disease. And when they aren’t cleaned well, they pose risks to even healthy people.

Before you buy a hot tub for your backyard or step into those warm waters at the spa or gym, make sure you know a bit about their safety.

Health Benefits

Warm water soothes your body for a few reasons. The heat widens blood vessels, which sends nutrient-rich blood throughout your body. Warm water also brings down swelling and loosens tight muscles. And the water’s buoyancy takes weight off painful joints.

A dip in the hot tub might also help your mental state. Research shows they can promote relaxation and ease stress.

Hot Tub Risks

These warm water whirlpools can pose some risks if you’re not careful.

Infections

Between 2000 and 2014, outbreaks from treated pools and hot tubs were linked to more than 27,000 infections and eight deaths in the United States. When hot tubs aren’t cleaned well, their moist environment is the perfect breeding ground for bacteria.

Pseudomonas, one type of bacteria that thrives in hot tubs, causes infections of the hair follicles and skin. Symptoms include red, itchy bumps on the belly and areas covered by your bathing suit. These bumps can pop up anywhere from a few hours to a few days after you take a dip. The same bacteria cause an infection known as swimmer’s ear.

Other germs that live in hot tubs can also make you sick. Cryptosporidium causes GI infections with diarrhea. Legionella causes a severe type of pneumonia, or lung disease.

Hot Tub Use in Pregnancy

Hot tubs might not be safe for pregnant women because they increase body temperature. Research finds that pregnant women who use a hot tub more than once or for long periods of time are more likely to have babies with neural tube birth defects like spina bifida or anencephaly.

Avoid hot tubs if you can during those 9 months. If you do use a hot tub, turn down the temperature and limit your time in the water to less than 10 minutes.

Heart Risks

Be cautious when using a hot tub if you have heart disease. When you soak in hot water, your body can’t sweat. Your blood vessels instead need to widen to cool you off. This makes your blood pressure drop. In response to falling blood pressure, your heart rate speeds up.

This isn’t a problem for healthy people, but if you have heart disease, it can strain your heart.

Hot Tub Safety Tips

To stay safe, follow these tips:

Ask your doctor. If you’re pregnant or you have a health condition like heart disease, ask your doctor if it’s safe for you to get into a hot tub.

Check the cleanliness. Ask the hotel or gym how often they clean their hot tub, and whether they keep the pH and chlorine concentrations at levels the CDC recommends (a pH of 7.2-7.8, and a free chlorine concentration of at least 3 parts per million). If the water looks murky or slimy, don’t get in.

Avoid crowds. Stay away when a hot tub is full. More people equals more germs. About half of people say they don’t shower before they swim.

Turn down the heat. A temperature of 100 F should be safe for healthy adults. Anything over 104 could be dangerous. Turn it down another couple of degrees if you have a medical condition.

Limit your time. Don’t stay in the hot tub for longer than 10 minutes. If you feel dizzy, overheated, or unwell, get out right away.

Watch where you sit. Don’t sit too close to the heat source. Keep your head, arms, and upper chest out of the water to avoid overheating, especially if you’re pregnant.

Stay hydrated. Drink water while in the hot tub to cool off your body. Avoid alcohol, which can dehydrate you.

Don’t go from hot to cold. Don’t jump straight from the hot tub into the pool to cool off. The cold water could shock your system and spike your blood pressure.

Wash off afterward. Take off your bathing suit and shower with warm water and soap as soon as you finish.

By  Carol DerSarkissian, MD

Source:https://www.webmd.com

.

Safety

Sitting in water above normal body temperatures can cause drowsiness which may lead to unconsciousness and subsequently result in drowning. The U.S. Consumer Product Safety Commission (CPSC) recommends that water temperatures never exceed 40 degrees Celsius. A temperature of 37 degrees is considered safe for a healthy adult. Soaking in water above 39 degrees Celsius can cause fetal damage during the first three months of pregnancy.

It is also recommended to install residual-current devices for protection against electrocution. The greater danger associated with electrical shock in the water is that the person may be rendered immobile and unable to rescue themselves or to call for help and then drown.

Hot tubs and spas are equipped with drains that can create powerful suction and between 1980 and 1996, the CPSC had reports of more than 700 deaths in spas and hot tubs, about one-third of which were drownings to children under age five. In the same period 18 incidents were reported to the CPSC involving body part entrapment.

To reduce the risk of entrapment, US safety standards require that each spa have two drains for each pump, reducing the amount of suction. From 1999 to 2007 there were 26 reports to the CPSC concerning circulation entrapments hot tubs and spas, including three deaths.

.

References

 

%d bloggers like this: