The last three decades of studies on obesity show that losing weight in a society like ours, with little activity and easy access to food for a part of the population, must be increasingly difficult for those who have reached levels of overweight or are already in a comorbid situation. For this reason, the release of drugs such as Wegovy, recently approved by Anvisa, it has been celebrated by specialists, who draw attention to the conscious use of this type of product.
The medicine offers a new perspective for those experiencing a chronic struggle with scale and should not be used by those of normal weight or to achieve aesthetic standards.
Paulo Augusto Carvalho Miranda, president of the Brazilian Society of Endocrinology and Metabology (SBEM), reiterates that obesity must be seen as a chronic disease. Advances in its treatment, among other things, are related to research on the reduction of cardiovascular damage in the population generated by the increasing weight gain in recent years.
Unlike the diet drugs of the 1990s, which hit the market without long-term testing and with little or no lasting results, this new generation promises significant losses and more safety.
Amphetamines and appetite suppressants are out of the picture and drugs where losing weight is only one of the benefits, since the initial goal is to treat diabetes, hypertension, high cholesterol, among other factors that help reduce cardiovascular diseases.
Released by Anvisa, Wegovy Injection contains semaglutide, the same active ingredient in Ozenpic, a low-dose injectable drug used to treat type 2 diabetes, and Rybelsus, also for diabetes, but orally.
The difference with Wegovy is the specific use in the treatment of obesity and overweight, and it is also an option for the youngest – it is indicated from 12 years of age. It may also be prescribed for patients whose weight loss leads to the control of comorbidities such as hypertension, diabetes, and dyslipidemia.
The new drug is for weekly use and is not yet for sale. “It still needs to meet a regulatory pathway for the drug to reach the market. Current use for the treatment of obesity is ‘off label’ [fora das condições aprovadas na bula]”, says Mirando.
In addition to glucose control, which is ideal for patients with type 2 diabetes, Wegovy helps treat the urge to overeat by reducing calorie intake during the day and, therefore, weight.
“Semaglutide acts on the regulation of gastrointestinal tract function, delaying the emptying rate of the stomach. It also acts on the modulation of insulin secretion by pancreatic cells and acts centrally, increasing the perception of satiety at the level of the hypothalamus”, explains the president of SBEM.
Miranda divides the history of slimming products into before and after the American regulation for drugs of this type in the 2000s. «Pharmacological theories on obesity already had multiple fields of study. long-term studies that often did not include efficacy and safety studies, particularly cardiovascular studies.”
Founder of the Severe Obesity Outpatient Clinic at the Hospital das Clínicas of the University of São Paulo (HC/USP), endocrinologist Alessandra Rascovski is optimistic, as the new generation of drugs proves safe for long-term use term (necessary in cases of obesity).
“A chronic disease is often treated with chronic medications. Unfortunately, people take some, lose weight, and then stop. But we also know that the intensity of the side effects gets worse if you keep using it on and off, it starts and stops,” says Rascovski.
The new drugs, according to her, lead only to gastrointestinal discomfort, without risks to vascular or mental health, so they are more viable for continuous use. Another benefit is that they act on the dopamine centers, which regulate the desire to overeat.
Rascovski, who is also a doctor at the Albert Einstein Israelite Hospital, says the drugs of the 1990s did more harm than good in treating obesity.
“I took my time on so-called ‘diet pills,’ which were actually derivatives of amphetamines. The side effects were mainly changes in mood and behavior, and individuals predisposed to psychiatric conditions ended up being more vulnerable.”
The second wave, already in the early 2000s, were adrenergic drugs, such as sibutramine, still used, but with risks for the patient. “Those who take sibutramine must sign a release form. Those with decompensated hypertension cannot use it,” says Rascovski.
Another is Orlistat, but its weight loss result is considered low, around 5% to 6% of your weight.
“It inhibits the absorption of fat from what we ate on a diet. When it was launched, it caused a lot of problems because, being sold without a prescription, people would take it and go party at the steakhouse and loosen up their guts too much,” [mas] it has an interesting use, especially for those with high cholesterol, because it ends up curing both,” says the doctor.
Last year, Anvisa released Contrave, a combination of bupropion and naltrexone, which is in the process of commercial release, like Wegovy.
Rascovski also points out that much of what has been achieved today in terms of drugs comes from knowledge gained through surgical treatment.
“That’s what was learned with bariatric surgery. The weight loss that occurred with it was faster, and so was the metabolic improvement. Glycemic, insulin, cholesterol levels…simply because the person lost pounds and he reduced his intake. And then, incretins or the gastrointestinal hormones that regulate hunger and satiety began to be studied a lot, “says the doctor.
In surgeries, the physiological part of the patient’s stomach was changed and its subsequent activity brought clues as to how weight gain works. “For example, the gastric fundus, where ghrelin is produced, was removed and it was realized that the main effect of the surgical outcome also involved changes in the microbiota and [que]it also ended up changing the GLP-1,” recalls Rascovski.
This knowledge is not limited to medications and also involves understanding the life weight trajectory of the obese person. “Self [o paciente] never weighed less than 70 kg, it is more difficult to maintain that weight. Obesity is a chronic disease and must be treated. It’s different than wanting to lose ‘two kilos’.”
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