A new generation of anti-obesity drugs has shifted the treatment landscape, providing potent new therapies to achieve weight loss but sparking debate about how best to use them and the proper place for lifestyle-based interventions that long had been center stage.
The drugs, called GLP-1 receptor agonists, were developed to treat Type 2 diabetes, the prevalence of which has skyrocketed in recent decades along with rates of obesity in America. Besides blood sugar control, however, these medications result in weight loss, an effect that has caught the eye of both the public and drug makers, who have moved to create specific formulations to help patients shed pounds.
Overall these compounds have proven startlingly effective, shown to help patients shed 10 percent to 22 percent of body weight in their first year of use. They work by mimicking a hormone called glucagon-like peptide-1, which slows digestion and depresses appetite. The treatments have been greeted as a godsend by patients discouraged after years of ineffective dieting and as a potent new option by some obesity specialists whose toolkit has long been restricted to bariatric surgery — effective but invasive and in many cases irreversible — older, less effective medications, and lifestyle-based approaches such as diet and exercise that have so far proven to be effective over the long term for just about 10 percent of patients.
Fatima Cody Stanford, an obesity specialist at Massachusetts General Hospital and associate professor of medicine and pediatrics at Harvard Medical School, said that for most patients with severe obesity, lifestyle approaches aren’t up to the task. She described them as akin to trying to clear a major snowstorm with a shovel instead of a snowplow. The new medications, particularly when coupled with bariatric surgery, are tools of appropriate power to address a problem that has proven resistant to change and comes with increased risk of life-threatening conditions such as high blood pressure, diabetes, and fatty liver disease, she said.