With the rise in obesity each year, there is going to be an ever-growing demand for how effectively we can beat obesity. India has about 70 % of the population as obese and more than 30% with metabolic disorders. The National Family Health Survey-5 study (2019) of India has found that about 44.02% of men and 41.16% of women in India were overweight or obese. The study also found that abdominal obesity was prevalent in women, with 40% of women and 12% of men being abdominally obese. Many factors contribute to obesity, like age, socioeconomic status, urban residency, unclean cooking fuels, the rise of easily accessible ultra-processed foods, anda lack of infrastructures that promote physical activity. At the same time, some factors are controllable while others aren’t. Abdominal obesity is one of the risk factors for cardiovascular disease and type 2 diabetes. Losing 10-12% of body fat can help improve insulin sensitivity and manage type 2 diabetes.
Various diets and exercise and lifestyle interventions are being implemented and are being successful in managing obesity in some, while others fail to maintain and lose weight despite all the will power, with such physical and mental challenges burdening the obese masses, the world of science and medicine has also given us a new hope of tackling obesity with weight loss drugs and injection. With its high demand today, weight loss injections are the holy grail for weight loss.
Let’s understand what weight loss injections are; they are medical injections used to help obese patients lose and manage weight. They were originally designed to treat diabetes for blood sugar management, but due to their appetite-suppressing properties, they are being used for weight management. These weight loss injections have active compounds like semaglutide that mimic hormones present in our body called Glucagon-like peptide-1 (GLP-1), or are known as GLP1-1 agonists. They act by suppressing and regulating hormones that signal hunger and satiety, and appetite.
TYPES OF WEIGHT LOSS INJECTIONS:
- SEMAGLUTIDE: Glucagon-like peptide-1 (GLP-1) agonist (that activates receptors in the organ to produce a physiological response), was originally intended to be used for diabetes as Ozempic, is now being used for weight management under the name Wegovy.
- LIRAGLUTIDE also comes under the brand name Saxenda, used for chronic weight management, which is also a GLP-1 agonist, a synthetic version of the human hormone.
- TRIZEPTIDE: Tirzepatide, an active ingredient in Zepbound, is approved under the trade name Mounjaro to help improve blood sugar in adults with type 2 diabetes mellitus and Zepbound is sold especially for weight management. They work on two hormones and activate receptors of hormones secreted from the intestine, glucagon-like peptide-1 (GLP1) and glucose-dependent insulinotropic polypeptide (GIP), known as incretin in the gut that helps to reduce appetite and food intake.
All of the above drugs are approved by the FDA for weight loss. Currently, Zepbound, Mounjaro are approved in India along with Wegovy. Wegovy is facing a shortage due to high demand globally. India is likely to develop another cost-effective weight loss drug shortly to combat the growing demand.
HOW DO WEIGHT LOSS INJECTIONS WORK?
These injections are self-administered once a week with an autoinjector. Ozempic and Wegovy are glucagon-like peptide-1 or GLP-1 agonists, which means that they stimulate the production of the hormone incretin present in the gut that helps people feel full longer by slowing the rate the stomach empties.
Incretins also have their receptor on the hypothalamus, a part of the brain that controls hunger signals, reducing hunger and cravings. They also act on the pancreas by stopping the effect of the glucagon hormone that increases blood sugar levels.
Novo Nordisk, a drugmaker company found that over the course of the 68-week of clinical trial, those who took Wegovy lost 14.9% of their body weight compared to the placebo. Also, it was seen that once a patient discontinues the drug, the weight lost is regained.
As there are many receptors present in the gut for GLP-1, which is mimicked by the weight loss injections and also due to its slow gastric emptying effect, there is potential for some gastric issues like acid reflux, vomiting and diarrhoea.
ELIGIBILITY AND SUITABILITY FOR WEIGHT LOSS INJECTIONS:
- BMI ≥ 27kg/m2 or with 1 or 2 comorbidities like hypertension, type 2 diabetes, sleep apnea, dyslipidemia, PCOS or Metabolic syndrome or cardiovascular disease
- BMI ≥ 30 kg/m² (obesity)
- Tried various dietary methods but was unsuccessful
- Willing to incorporate a healthy lifestyle change
FACTORS THAT MAY AFFECT SUITABILITY AND MAY NOT BE ELIGIBLE:
- Unstable blood sugar or low blood sugar
- Previously done bariatric surgery
- Allergic to the drug
- Taking insulin or being type 1 diabetic
- Breastfeeding
- Pregnancy
- History of pancreatitis
- Active gallbladder disease
- Thyroid disorder
A very important exclusion is the history of cancer, especially MCT, medullary thyroid carcinoma, and Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
A thorough medical history and nutritional assessment are a must. Asking your doubts and concerns just gives you a better picture and also helps the healthcare provider give a personalized approach.
POTENTIAL SIDE EFFECTS:
Like any other medication, it is also important to understand the potential downsides or side effects that might affect certain people. Although safe and effective when used under a professional guideline. Here are some possible side effects:
Some usual side effects include Nausea, vomiting, diarrhoea, and constipation.
Other potentially serious side effects include:
- Pancreatitis: This is due to inflammation of the pancreas, leading to severe stomach pain that may not go away with vomiting or passing stool
- Gallbladder stones: Gallbladder stones or cholelithiasis is seen in patients taking GLP, with some requiring gallbladder removal or cholecystectomy. The patient may experience pain in the upper stomach, fever, yellowing of the skin or eyes (jaundice), or clay-coloured stools.
- Acute renal injury: This could be due to loss of fluid and in case of severe dehydration during vomiting and diarrhoea, some cases of kidney failure have been reported in patients with preexisting renal disease. Thus, proper dose monitoring is crucial for such patients.
- Hypoglycaemia: Low blood sugar can be experienced and people with diabetes can be at risk. Symptoms include headache, dizziness, and blurred vision. Monitoring sugar levels at constant intervals is advised. Diabetes self-management is essential to optimize the effectiveness of therapy.
- Antibodies formation against semaglutide is seen in a few patients and hypersensitivity to the drug, including anaphylactic reactions, has been recorded.
If planning for surgery or any other treatment, it’s important to let the physician know the type of drugs prescribed to avoid potential side effects or drug reactions.
However, it’s crucial to consult the physician to understand the dosage, duration, and side effects to avoid any unwanted outcomes. In case of any side effects, immediately notify the physician and other healthcare providers so symptoms can be managed without any severe complications and alternative solutions can be advised.
WHEN TO CALL THE DOCTOR?
- Low blood sugar, feeling dizzy, light-headedness
- If you are unable to eat or drink due to severe stomach pain
- Stomach pain in the upper gastric region radiating to other parts
- Irregular heartbeat
- Severe dehydration due to vomiting and diarrhoea
- Mood changes
- Slurred speech or seizure
- Severe allergic reaction, which may manifest as rash, swelling or edema
Close monitoring, regular checks, and bloodwork are essential during the administration and course of the drug for achieving the best outcome. Weight loss injections, however, cannot be used for lifelong; weight loss can rebound once the drug usage is stopped. It’s important to acknowledge that successful and long-term weight loss can only be achieved with healthy lifestyle changes and weight loss drugs are just a bonus.
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