Ozempic: Obesity is not just a matter of choices; understand – 03/31/2023 – Balance

The new generation of slimming drugs has changed a scenario that used to be oppressive for a significant portion of the population. If before obesity was seen as a merely behavioral factor, the class of drugs that simulate hormones in the human body show that weight is not the only result of our choices.

Promoting weight loss in short periods through continuous use and medical follow-up, drugs based on semaglutide and liraglutide, for example, show the chronic pathological aspect of obesity and overweight.

“Not everyone who is skinny is thin because they eat little and not everyone who is fat is fat because they eat a lot,” says psychiatrist Denise Cardoso, member of the Committee on Eating Disorders of the ABP (Brazilian Association of Psychiatry).

Specialists in obesity and mental health, however, have always encountered resistance and prejudice in relation to the premise that the difficulty in losing weight is mainly the result of metabolism and environmental factors, and not a product of character or choices.

“Obesity needs to be seen as a disease, because it is related to the emotional state, the role that food has in the patient’s metabolism. Lack of sleep, hormonal changes, the whole issue involved in weight”, points out Cardoso.

The arrival of liraglutide (commercially sold as Saxenda) to the market ushered in greater acceptance of the concept. The movement gained strength with the release of semaglutide, a molecule that mimics the hormone GLP-1 and informs the brain that the body is satiated.

Cardoso says that it is common for patients to arrive at the office unmotivated and with guilt for not being able to follow diets. “So when he starts to lose weight, self-esteem improves, adherence improves, because he sees results. Semaglutide is a drug that, in general, makes patients in the office lose about 15% of their weight, it’s very fast” , he says.

The substance is the basis of Ozempic, approved in 2018 by Anvisa (National Health Surveillance Agency) to treat type 2 diabetes. The drug is also the active ingredient of Wegovy, approved more than four years later for the treatment of associated obesity or overweight. to comorbidities.

Glaucia Carneiro, associate professor of Endocrinology and responsible for the obesity laboratory at Unifesp (Federal University of São Paulo), says that the stigma of obesity is very present, even among physicians.

“It was only in 2013 that obesity was recognized as a disease, so it was a little late in medicine. Now, ten years later, with the arrival of effective drugs, which act directly on the cause, patients themselves are also recognizing that it is a disease, which is not misconduct or character”, he indicates.

The other side of the coin is the worsening of extreme thinness due to the function deviation given to the product by those who seek weight loss without medical advice, a practice encouraged by celebrities.

The drug did not go unnoticed at this year’s Oscars, for example. Comedian Jimmy Kimmel made fun of the new rapid weight loss craze among Hollywood stars. “Everyone looks so beautiful. When I look around this room, I can’t help but wonder, ‘Is Ozempic right for me? ‘” he said.

Nutritionist Cecília Lacroix de Oliveira, associate professor at the Institute of Nutrition at Uerj (University of the State of Rio de Janeiro), points out, however, that it was not the emergence of new medications that caused this obsession with too-thin bodies.

“This already existed. What happens is that people who have no indication of semaglutide are using this medication to reach their goals more quickly, since this medication does not have a controlled prescription”, he points out.

Those who really need medication to lose weight should be aware that the treatment is multidisciplinary.

“Medication can help, but to treat obesity it is very important to have follow-up from a psychological, nutritional point of view, also in relation to physical exercise, and with an endocrinologist who will prescribe semaglutide”, says Lacroix.

The substance acts in a region of the brain called the hypothalamus. The revolution of these drugs occurs as a result of the action on mechanisms that make the body better understand satiety and have the emptying of the stomach inhibited.

“It’s a very complex drug that comes to help behavior. Now we can’t trivialize it, wanting to treat people with normal weight”, points out Carneiro, a professor at Unifesp.

There are, however, doubts about the long-term results of the drugs. In social network groups aimed at exchanging experiences about Ozempic, reports vary. In some the weight loss seems to plateau after a while. Others can’t even lose weight. There are still those who leave aside eating patterns that involve the consumption of alcoholic beverages and foods rich in fats.

Among those who report side effects, stories range from nausea to fainting – many of them caused by self-medication and lack of a balanced diet as part of the treatment.

Driver Mônica de Marco, 42, weighed 145 kg when she learned that her brother-in-law had lost 15 kg with two injections of Ozempic. “I started taking it alone and then I looked for an endocrinologist, because in the first pen I didn’t lose anything, no weight and I felt really bad, I thought I was going to die. I started to lose weight from the second onwards. I lost 42 kilos”, she says.

His first treatment attempt relied on sibutramine, but without result. At the doctor, de Marco discovered that he would need to combine an anxiolytic with semaglutide to overcome his craving for sweets. “You completely lose hunger,” he reports. For the driver, the biggest problem with the medicine is the price.

The expectation of specialists is that the values ​​decrease with the emergence of similar drugs and the breaking of patents, enabling access and incorporation into the Brazilian public health system.

Psychiatrist Denise Cardoso believes that soon users and doctors will have good news regarding the cost of the substance. “Twenty years ago, insulins were very expensive. When I was a resident, I thought we would never be able to use and prescribe them for everyone, but today the price is very affordable”, she says.