Weight loss drugs have been around for years but have experienced a boom recent that is causing shortages in some of them, such as Ozempic (whose active ingredient is semaglutide), even when they are not indicated for weight loss. Nevertheless, its use still carries some obsolete concepts, myths and shadows that need to be clarified.
This is what the ECRI (Emergency Care Research Institute), an American non-profit institution that seeks to improve the quality of medical care throughout the globe, with a position on weight loss drugs that warns about outdated notions and confusions that are frequent when treating overweight and obesity.
One of these notions is precisely that losing weight is primarily aesthetic, a reason used by health insurers for not financing them but also by doctors for not prescribing them.
[Fármacos para tratar la obesidad: cómo y cuándo deben utilizarse]
However, WHO figures warn that 40% of adults worldwide are overweight and 13% obese (and this has tripled in the last half century). In Spain, 30.6% of men and 44.9% of women fall within the definition of overweight according to the European Health Survey in Spain 2020. In the case of obesity, it affects 15.5% of men and 16.5% of women.
The relationship between overweight and obesity with health problems is well known. From cardiovascular diseases to cancer through diabetes, fatty liver and even severe illness from Covid-19, weight plays a crucial role in all of them.
Despite these figures, the use of these drugs to lose weight was almost residual. A study in veterans of the United States Army pointed out, in 2015, that only 2% of the people for whom they would be indicated were using them. Another study carried out in insurance companies in the first decade of the 21st century pointed out that the majority of patients abandoned treatment within 30 days.
abandonment of medication
The perception of ineffectiveness accompanied the classic drugs (which are, in the US, orlistat, phentermine-topiramate, naltrexone-bupropion and liraglutide), confirms this position. This vision, based on obsolete evidence, conditioned its prescription. However, meta-analyses versus placebo have concluded that, at one year, They can make you lose between 3 and 9 kilos if they are accompanied by a healthy diet and exercise..
Two other drugs emerged in 2022, semaglutide and tirzepatide (the latter is only approved for type 2 diabetes). Of the first, a systematic review of studies has pointed to an average loss of 12 kilos in patients without diabetes. The second is estimated to increase between 10 and 15% of the total weight lost.
[Así es la última ‘píldora para adelgazar’: se pierde un 15% de peso, evita la diabetes y está en España]
These figures are not obtained at the first exchange. One of the reasons for stopping medication, this report explains, is unrealistic expectations of rapid weight loss. Not observing changes after a few weeks can cause frustration and abandonment of treatment or the diet and exercise habits that should accompany its consumption.
On the other hand, there is the opposite perception: that weight loss can only be achieved with proper nutrition and exercise. Although this may be true in part of the population, there is another for which it is not.
In fact, the report, authored by ECRI’s Director of Scientific Quality, Alfredo I. Penzo-Mendez, states that this is one of the “most damaging” myths related to weight loss, warning that half of the population Americans (where overweight affects more than 70% of people) try to lose weight every year but many fail, and the myths they try to dispel play an important role in that failure.
[El lado oscuro del ‘fármaco milagro’ para perder 10 kilos en tres meses: “Me da asco la comida”]
It is not only about losing weight but also about maintaining that milestone over time. Many—in fact, most—people who adhere to an evidence-based diet and exercise program may lose weight at first but gain it later.
The fault is usually move from a program of activities to assume a lifestyleand there is scientific evidence that this transition requires complex cognitive skills that many do not acquire on their own.
ECRI’s position ends with the perception that the weight loss generated by these drugs is low in relation to their high price. This may be true in the United States, where these drugs can reach prices of more than $1,000 a month, a figure that only the wealthy can afford.
Penzo-Mendez says the case of weight-loss drugs illustrates “the need for continued re-evaluation of evidence-based medicine to prevent outdated perceptions from taking root, address gaps in the evidence, and evaluate emerging interventions.”
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