2024-07-13 00:14:27
Lesa Walton suffered from rheumatoid arthritis for years. “I was getting sicker and sicker,” said Walton, 57, who lives in Wenatchee, Washington. She also had high blood pressure and was obese. Doctors told him diet and exercise, which he did without success.
Then he found a doctor who prescribed Wegovy, a new anti-obesity drug. Not only did he lose more than 20 kilos, he said; His arthritis disappeared and he no longer needed pills to lower his blood pressure.
His doctor, Stefie Deeds, an internist and specialist in obesity medicine, said Walton is an example of a movement in medicine called “obesity first”. The idea is to treat obesity and as it is controlled, supporters say, the patient’s other chronic diseases tend to improve or disappear.
As Caroline M. Apovian, an obesity medicine specialist at Brigham and Women’s Hospital in Boston, says“You get weight loss and high blood pressure, fatty liver, diabetes, high cholesterol and high triglycerides are treated.”
Others are skeptical. The new drugs are expensive and many of the other potential benefits have not been demonstrated in rigorous studies.
Gordon Guyatt, a clinical trials expert at McMaster University in Ontario, said the prudent approach is to use drugs – often inexpensive types – that have been well-tested and shown to treat problems often associated with obesity, such as for example high blood pressure, high cholesterol levels, arthritis and sleep apnea.
Susan Z. Yanovski, co-director of the Office of Obesity Research at the US National Institute of Diabetes and Digestive and Kidney Diseases, said when Novo Nordisk conducted a clinical trial of Wegovy in people with heart disease, Cardiac complications decreased early during treatment, before patients lost much weight.
Participants who took Wegovy and lost very little weight had the same improvements in kidney function as those who lost a lot. A recent study by Novo Nordisk that tested Ozempic in people with diabetes and kidney disease found the same thing: Kidney function was better preserved in the group taking Ozempic, an effect that was independent of weight loss.
Much of the effect may be the drugs’ ability to reduce inflammation, said Daniel Drucker, an obesity researcher at the Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital in Toronto, who was involved in the discovery of the new drugs and is a consultant to the companies that make them.
Novo Nordisk found in another clinical trial that Wegovy improved physical functioning – such as exercise capacity – in people with diabetes and heart failure. Eli Lilly found that Zepbound can help with sleep apnea. Other trials are underway testing anti-obesity drugs as treatments for depression, addiction, schizophrenia, Parkinson’s disease and Alzheimer’s disease.
But some urge caution toward “obesity first” treatments, including representatives from Eli Lilly and Novo Nordisk, saying it is wise to wait for clinical results.
Scott Hagan, a primary care physician in Seattle, practices an “end obesity” approach.
If a patient comes in with obesity and obesity-related illnesses, you start by treating the associated problems with medications that you know can work. Only if the associated problems do not improve will he discuss the possibility of trying obesity medication, Hagan said.
People with obesity, He added, they usually have a long history of strained relationships with doctors who blame them for their weight.
“My priority is to establish trust in a relationship“, said.
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