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Obesity and GLP-1 RAs

Tamis Bright
DOI: 10.1136/jim-2021-002268 Published 23 December 2021
Tamis Bright
Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
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In this issue of the Journal of Investigative Medicine, Singh et al review the important addition of the glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for the treatment of obesity and specifically discuss semaglutide for weight management. Despite the dire and costly outcomes of obesity, the USA and much of the world have failed for years to practice healthy eating and exercise. The 2017–2018 National Health and Nutrition Examination Survey (NHANES) estimated that 42.5% of US adults aged 20 and over have obesity and an additional 31.1% are overweight, impacting 73.6% of the adult population.1

Having excessive weight has now become the “norm” with those overweight or obese far exceeding those of appropriate body weight. As discussed in this review, obesity is of critical concern because it contributes to the development of the top two leading causes of death, heart disease and cancer,2 as well as a host of other medical conditions such as diabetes and hypertension. For 2020, COVID-19 was the third most common cause of death2 and obesity is a known risk factor for mortality from COVID-19 as well.3 Effective treatments have been lacking. A multitude of diets have come and gone with high dropout rates and very poor long-term weight loss sustainability. A recent meta-analysis with 21,942 patients showed a minimal weight loss of 2.0 kg compared with the usual diet for up to 12 months, with trivial differences between diets.4 Consequently, treatment with medications and surgical options have now come to the forefront. Usually, surgery is reserved for those with the most excessive obesity due to the invasive nature and side effects, leaving the vast majority of the population with limited medical options to reduce weight. For long-term weight management, orlistat, phentermine/topiramate, and naltrexone/bupropion have been available since 1999, 2012, and 2014, respectively, but have not had widespread use due to cost and concerns over safety and efficacy.5

The most recent class of medication, the GLP-1 RAs, has been a welcome addition to our armamentarium to treat obesity. Initially designed for glucose lowering, recently their indication has been expanded to include weight reduction in non-diabetic populations. There is extensive experience with GLP-1 RAs with diabetes and these medications have now become first-line therapies for long-term diabetes treatment not only for their glucose lowering but also due to their improvement in cardiac and renal outcomes.6 GLP-1RAs approved for treatment of obesity without diabetes, liraglutide and now semaglutide, have shown good tolerability with limited side effects, mainly nausea and vomiting, and excellent weight reduction especially in combination with behavioral modification.7–9 As noted by the authors, unfortunately GLP-1 RAs are currently expensive and not well-covered by insurance. Weight loss is associated with lower mortality and a decreased risk of diabetes, high blood pressure, hyperlipidemia, cardiovascular disease, and obstructive sleep apnea.10 Therefore, making these medications more affordable, as well as increasing research to develop additional weight loss medications, is essential.

Ethics statements

Patient consent for publication

Not applicable.

Ethics approval

This study does not involve human participants.

Footnotes

  • Contributors TB is the sole contributor.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

References

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    . Prevalence of overweight, obesity, and severe obesity among adults aged 20 and over: United States, 1960–1962 through 2017–2018. NCHS Health E-Stats 2020.
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    . Provisional Mortality Data - United States, 2020. MMWR Morb Mortal Wkly Rep 2021;70:519–22. [Erratum in: MMWR Morb Mortal Wkly Rep. 2021 Jun 18;70(24):900].doi:10.15585/mmwr.mm7014e1 pmid:http://www.ncbi.nlm.nih.gov/pubmed/33830988
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    1. Tartof SY ,
    2. Qian L ,
    3. Hong V , et al
    . Obesity and mortality among patients diagnosed with COVID-19: results from an integrated health care organization. Ann Intern Med 2020;173:773–81.doi:10.7326/M20-3742 pmid:http://www.ncbi.nlm.nih.gov/pubmed/32783686
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    1. Ge L ,
    2. Sadeghirad B ,
    3. Ball GDC , et al
    . Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials. BMJ 2020;369:m696. [Erratum in: BMJ. 2020 Aug 5;370:m3095]. doi:10.1136/bmj.m696 pmid:http://www.ncbi.nlm.nih.gov/pubmed/32238384
    OpenUrlAbstract/FREE Full Text
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    1. Saxon DR ,
    2. Iwamoto SJ ,
    3. Mettenbrink CJ , et al
    . Antiobesity medication use in 2.2 million adults across eight large health care organizations: 2009-2015. Obesity 2019;27:1975–81.doi:10.1002/oby.22581 pmid:http://www.ncbi.nlm.nih.gov/pubmed/31603630
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    1. Garber AJ ,
    2. Handelsman Y ,
    3. Grunberger G , et al
    . Consensus statement by the American association of clinical endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management algorithm - 2020 executive summary. Endocr Pract 2020;26:107–39.doi:10.4158/CS-2019-0472 pmid:http://www.ncbi.nlm.nih.gov/pubmed/32022600
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  7. ↵
    1. Garvey WT ,
    2. Birkenfeld AL ,
    3. Dicker D , et al
    . Efficacy and safety of liraglutide 3.0 Mg in individuals with overweight or obesity and type 2 diabetes treated with basal insulin: the scale insulin randomized controlled trial. Diabetes Care 2020;43:1085–93.doi:10.2337/dc19-1745 pmid:http://www.ncbi.nlm.nih.gov/pubmed/32139381
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  8. ↵
    1. Wilding JPH ,
    2. Batterham RL ,
    3. Calanna S , et al
    . Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med 2021;384:989–1002.doi:10.1056/NEJMoa2032183 pmid:http://www.ncbi.nlm.nih.gov/pubmed/33567185
    OpenUrlCrossRefPubMed
  9. ↵
    1. Wadden TA ,
    2. Bailey TS ,
    3. Billings LK , et al
    . Effect of subcutaneous semaglutide vs placebo as an adjunct to intensive behavioral therapy on body weight in adults with overweight or obesity: the step 3 randomized clinical trial. JAMA 2021;325:1403–13.doi:10.1001/jama.2021.1831 pmid:http://www.ncbi.nlm.nih.gov/pubmed/33625476
    OpenUrlPubMed
  10. ↵
    1. Wolfe BM ,
    2. Kvach E ,
    3. Eckel RH
    . Treatment of obesity: weight loss and bariatric surgery. Circ Res 2016;118:1844–55.doi:10.1161/CIRCRESAHA.116.307591 pmid:http://www.ncbi.nlm.nih.gov/pubmed/27230645
    OpenUrlAbstract/FREE Full Text
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Journal of Investigative Medicine: 70 (1)
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Obesity and GLP-1 RAs
Tamis Bright
Journal of Investigative Medicine Jan 2022, 70 (1) 1-2; DOI: 10.1136/jim-2021-002268

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Obesity and GLP-1 RAs
Tamis Bright
Journal of Investigative Medicine Jan 2022, 70 (1) 1-2; DOI: 10.1136/jim-2021-002268
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Tamis Bright
Journal of Investigative Medicine Jan 2022, 70 (1) 1-2; DOI: 10.1136/jim-2021-002268
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