Incidence of obesity is on the rise globally. In India almost one out of 3 to 5 would have some degree of excess weight. The reasons are many and hence obesity is known as a multifactorial disease.
Genetics can contribute to obesity. Environmental factors such as preservatives, pesticides, etc. are the known endocrine disrupters. Environmental factors also have impact on epigenetics. Life style does play a role in aggravating the grade of obesity. Diet and life style change as a treatment of obesity has been attempted over many decades but could never give a long-lasting sustained success. The obvious reason being the body’s physiological response which gains the weight back. Hence, treating the root cause, that is the hormones of metabolism, is important for long-term control of weight.
Bariatric surgery was the only known and accepted treatment of obesity which could improve the hormones and metabolism. Bariatric surgery is known to reduce the hunger hormone Ghrelin and increase the GLP1 hormones. These hormones increase metabolism and help in weight loss. Researchers always attempted to create anti Ghrelin hormones but still it is not successful. The other attempt was to create a hormone which would work like GLP1 hormone. The newer medications or injections are the hormones like GLP! And hence are called hormone analogues/ GLP1 analogues. Like GLP1, there exist many hormones in the body like glucagon, GIP, amylin etc. which also have impact on hunger, appetite, and weight loss. Newer injections may have a single hormone or a combination of these.
Which drugs are known as weight loss medications /injections :
Injections like Liraglutide, Dulaglutide, Semaglutide , Tirzepatide etc are the newer medications for weight loss known as Victoza, Trulicity, Wegovy, Ozempic, saxenda, Mounjaro. There are some oral medications available like topiramate with phenteramine and bupropion with naltrexone.
How effective are these medications or injections?
These medications are effective and can give 5 to 15% weight loss based on various factors. It is necessary to follow a healthier and nutritious diet with these medications to minimise the side effects of these medications. The result of these remains variable and not the same for everyone. Majority of patients lose up to 5% weight.
What are the precautions before starting these medications and what are the side effects?
Patients may experience bloating, acidity, symptoms of reflux, some people may develop constipation or diarrhoea. Those with preexisting reflux, acidity or bowel disturbances should consult their doctor before starting these medications.
Incidence of thyroid cancer is reported with these medications, even though low. Those with thyroid disorders should consult their doctor and get thorough evaluation prior to initiation of therapy with these new medications. Those looking for conception/ pregnancy should avoid these medications or strictly use contraception while on these drugs.
Pancreatitis and gall stone disease are seen after the use of these weight loss injections. They should be best avoided in patients with history of gall stone disease, biliary diseases and those with history of pancreatitis.
A small number of patients have also reported changes in the mood, depression, anxiety, and suicidal thoughts after the use of these newer injections. Those with existing mood disorders or those on psychiatric medications should be screened prior to the use of these medications.
The drugs work by slowing the stomach movement, also known as delayed gastric emptying. A condition called gastroparesis has been reported which means the stomach start remaining paralysed and food remains in the stomach for longer period. This may give rise to bad breath, reflux and sometimes vomiting or reflux during sleep may be dangerous. Those with severe sleep apnoea should avoid heavy meal at bed time and should consult their doctors. The medications should be stopped two weeks prior to any surgery or anaesthesia for fear of vomiting and aspiration.
How long should one use these medications? Can someone stop these medications after achieving satisfactory weight loss?
It has been reported that if the medications are discontinued, there is increase in hunger, slowing of metabolism and rapid weight regain. Hence it appears that these medications have to be continued for life time, even though long- term side effects and safety is still yet to be known.
In simple language, these are just like a blood pressure or diabetes medications. The effect is seen till you consume those medications. Obesity being a chronic genetic, metabolic disease the treatment has to be continued ever.
Are these medications cost effective? Are they covered in insurance?
It appears that the medications cost around 20000 to 40000 Rs per month if you consider all the supplementary medications like statins, other medications, treatment of symptoms of side effects and protein and vitamin supplements. One may calculate the cost over a few years.
At present these are out patient treatments and hence not covered under insurance. Only bariatric surgery is covered under insurance and is known to be most cost effective as compared to these medications.
LOC or Laparo Obeso centre has been a comprehensive clinic and hospital offering the complete spectrum for weight loss since last 22 years. A team of well qualified experts at LOC Hospital offer all types of treatments including dietary modification, life style changes, endoscopic treatments like balloon, swallow balloon, bariatric surgery of all types so as to offer optimal weight loss to everyone.
