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Doctors can prescribe it for adults who have obesity, with a body mass index (BMI) of greater than 30; or overweight, with a BMI greater than 27 accompanied by weight-related medical problems such as high blood pressure, type 2 diabetes, or high cholesterol.

yalemedicine.org - Can New Weight-Loss Drugs Really Treat Obesity? - Yale Medicine

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[Originally published: Dec. 20, 2021. Updated: June 10, 2022]

There is no magic pill that will cure obesity, a condition that affects over 40% of adults in the United States. But there are new types of medicines that are potential game-changers. They are anti-obesity medications, and doctors say that part of what makes them unique is how they are prescribed: They are used to treat obesity as the chronic metabolic disease it is rather than perpetuating the misconception that obesity is a problem that can be overcome by willpower. One such medication that has been making headlines is called tirzepatide. According to a study published in June in The New England Journal of Medicine, use of the drug, a novel GIP/GLP-1 receptor agonist, in the trial resulted in more than a 20% weight reduction in those with obesity—an average of 52 pounds per person. “These results are an important step forward in potentially expanding effective therapeutic options for individuals with obesity,” says Ania Jastreboff, MD, PhD, a Yale Medicine adult and pediatric endocrinologist, and a nationally recognized obesity medicine expert. Tirzepatide has not yet been approved by the Food and Drug Administration (FDA) for use as an anti-obesity medication. It was, however, approved for the treatment of type 2 diabetes. The drug trial’s sponsor, Eli Lilly, is working with the FDA on a timeline for approval. Another weight-loss medication is called semaglutide (it’s available by prescription under the brand name Wegovy™), and it is given once a week by self-injection under the skin. It was approved by the FDA for the treatment of overweight and obesity in June 2021 (with similar medications being developed as well). Semaglutide doesn’t work for everyone, but when it’s successful, it can help someone shed 15% of their body weight. (If you weigh 200 pounds, for example, that would be 30 pounds.) “This medicine helps you feel full earlier,” says Dr. Jastreboff. “It means you will have little desire to reach for ‘seconds’ or a snack later.” Anti-obesity medications have been around for decades, and there are several currently in use. But semaglutide is the first of a new generation of highly effective hormone-based obesity medications. Semaglutide mimics a hormone called glucagon-like peptide-1 (GLP-1), which is secreted in the gut and targets receptors throughout the body, including the brain. When a person is eating, GLP-1 sends the brain the “I’m full” signal, Dr. Jastreboff says.

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Semaglutide also decreases “gastric emptying,” the process by which stomach contents are moved into the first part of the small intestine as part of the digestive process. “But this effect wanes over time,” says Dr. Jastreboff. “The main way semaglutide helps treat obesity is through its action in the brain.” The drug—and class of medications—is not new, though; this class of GLP-1 analogue medications has been used for over 15 years to treat type 2 diabetes (semaglutide specifically was FDA-approved in 2017 for diabetes). Individuals with type 2 diabetes secrete less GLP-1 in response to eating compared to those who do not have the condition. Experts believe that’s also true for people with obesity, Dr. Jastreboff explains. “With semaglutide, people are receiving more GLP-1, albeit in a synthetic form," she says. "They're essentially getting back more of that hormone, which helps them feel full.” For many people, the medication appears to work. The results of a clinical trial, published in The New England Journal of Medicine, showed that—in addition to the 12.5% mean weight reduction above the placebo group (which included lifestyle interventions only)—more than a third of the participants (many of whom weighed more than 200 pounds) lost 20% of their weight. We sat down with Dr. Jastreboff and her colleagues. They answered commonly asked questions about anti-obesity medications.

yalemedicine.org - Can New Weight-Loss Drugs Really Treat Obesity? - Yale Medicine

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