2023-11-06 03:11:29
The world of Medicine faces a new turning point: the long-awaited magic bullet against obesity is almost here. After a century of searching for that Holy Grail Drugs based on the imitation of glucagon-like peptide-1 give the first results.
The GLP-1 analogs, although more famous by their trade names Ozempic and Wegovy, are called to delete one of the pandemics of the 21st century: obesity and its effects more immediate, such as diabetes and the cardiovascular problems. In Spain alone, according to the Global Obesity Observatory, 37.8% of adults weigh more than recommended and 16% are obese.
Hay a lot of science behind these drugs, emphasizes Cristbal Morales, member of the Board of Directors of the Spanish Obesity Society (Seedo). We are in a new era in obesity controlthere are more than 150 clinical trials. It is a whole revolution of new molecules, he adds.
Since the first description of GLP-1 in an article in Proceedings of the National Academy of Sciences More than 40 years have passed until the current results. This long-awaited search has not only given way to drugs that control type 2 diabetes and weight lossbut they have become best-selling drugs capable of tackling the disease and also what causes it: poor nutrition, that is, the processing industry.
Antidiabetic drugs. Chronology
The weight losses are significant and with each new drug it is greater. It goes from 8% to 15%, points out Morales. Which in kilos translates into drops of more than 12 kilos in some patients.
But we go in parts. What is the secret of GLP-1? The compound contained in Ozempic (semaglutide) is a molecule that we already have in our body, but modified so that it takes longer to degrade and therefore can be used as a drug: it is GLP-1, which It is secreted in the intestine and sends signals to the brain and to the rest of the digestive tract, indicating that food has already arrived and that there is no need to eat more, explains Francisco Tinahones, researcher at CIBEROBN, Scientific Director of IBIMA and head of Endocrinology and Nutrition at the Virgen de la Victoria University Hospital (Mlaga). And he adds that It is an anorexigenic molecule.what kills appetite and it also relaxes the stomach, so you have a feeling of being full when eating food.
It reduces hunger and satiates, two key actions when you want to avoid excessive intake. Olga González, head of the Endocrinology Service at the Gregorio Marán Hospital in Madrid, offers more details: At the stomach level slows gastric emptying. When you eat a meal, it slows down the passage to the digestive tract and intestine, which provides a feeling of fullness. This is a very powerful mechanism in the first weeks of treatment, then it decreases.
In addition, González explains the other powerful mechanism: its ability to act on the satiety centers in the brain. The drug is capable of crossing the blood-brain barrierreach the central nervous system and act on the satiety and appetite centers, although the intrinsic pathways by which the medication relieves hunger are not known.
Antidiabetic drugs. Mechanism
However, let us not forget that these drugs were originally invented to combat diabetes and that weight loss observed in studies and throughout its use it could be considered a positive side effect.
Clotilde Vázquez, head of the Department of Endocrinology and Nutrition at the Jiménez Díaz Foundation in Madrid, remembers that when the first drug in this family was put on the market 20 years ago It represented a radical change in the treatment of type 2 diabetics., which generally in 90% of cases has associated obesity. These drugs represented a change, because unlike the previous ones, they improved diabetic control and also helped to lose weight.
In this sense, Vázquez does not hesitate to describe them, like the other experts consulted, as a family of super effective, super powerful drugs and on which there have been a large number of long-term studies on its effectiveness and activity.
Tinahones explains that Ozempic was marketed for the treatment of diabetes and the drug that has been approved for use in obese people is Wegovywhich is the same as Ozempic, but the maximum dose is 2.4 mg, while Ozempic is 1 mg the maximum dose of semaglutide.
Its use in Spain is explained by Gonzlez: Ozempic will not have obesity indication. The same molecule, semaglutide, at a dose of 2.4 mg, whose commercial name is Wegovi, is the one indicated for obesity. Last August, the Ministry of Health released the therapeutic positioning for obesity.
Morales and Vázquez point out that the revolution is not over yet. Given that obesity is a disease that involves the entire organism and its patients have other alterations, the use of this new generation of drugs will also bring other benefits to address them. They are very safe drugs that have also been shown to be cardioprotectores y renoprotectores. The most frequent side effects are limited to symptoms of the digestive system, which are greatly minimized by escalating the doses, says Vazquez.
Antidiabetic drugs. Medications
Beyond the management of type 2 diabetes, these have represented a before and after in the treatment of obesity, with results equivalent to surgical interventionsthus avoiding going through barytric surgery and the risks involved in going through the operating room, highlights Morales, who is one of the main recruiters in Spain of patients in the trials carried out by NovoNordisk and Lilly, the laboratories behind the main molecules.
Until now we had medications that produced discrete weight loss, but this therapeutic class makes subjects lose weight on average more than 15% of their body weight, which is clinically very significantsustain Tinahones.
The CIBEROBN researcher offers the explanation that contextualizes what is happening now in the body: Probably these signals that we had in our intestines to not eat more when we have taken an adequate amount, must have been downregulated during hominid evolution Due to the difficulty of obtaining food and this regulation at this time of indiscriminate access to food is like an evolutionary error that these drugs come to correct in a certain way.
Morales endorses a conclusion recently published in a Nature Medicine review on these molecules: With great power comes great responsibility. The phrase, famous for other reasons, reflects the sentiment of the medical community: We don’t need just one pillbut a national plan that addresses prevention and go to the origin of obesity.
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