By Andrea Hayes, MD, F.A.C.E.
Having practiced Endocrinology for more than 25 years, the most common disorder that I treat has been obesity.
With the knowledge that overweight or obesity represents the underlying contributing factor in multiple health conditions, I have always placed a strong focus on weight management as an essential component of any treatment regimen. The good news is that we have more tools than ever to address obesity beyond the dramatic and restrictive weight management programs of the past.
Historical Weight Management Approaches
I’d like to share a dramatic weight loss saga of a patient from 20 years ago. At the age of 54, Stuart had gained 100 pounds since he was 18. He required 15 medications to treat his multiple chronic conditions including diabetes, hypertension, high cholesterol, arthritis, sleep apnea and more.
I enrolled him in my intensive weight management program which required weekly visits with a dietician, meal replacements and intensive behavior modification. A year later, he beamed the day he walked into the office 100 pounds lighter, carrying his old belt which could have wrapped twice around his waist. I was also able to reduce his medications over time from 15 meds to just two.
Unfortunately, having achieved “victory,” Stuart did not continue the program. I ran into him at a restaurant a few years later. He had regained every pound he had lost and then some. His face had returned to the beet red color that I remembered prior to his weight loss and I cringed thinking how much effort we had all put into his weight loss all for naught.
Obviously, people can consume packaged, prepared and measured meals for some period of time but this rarely results in sustained weight loss. Going on any diet restrictive in certain food groups and/or calories can lead to a temporary caloric deficit and allow loss of fat. But the problem is how to maintain that weight loss.
Medical Advances Enhance Outcomes
At the time I met Stuart, we had virtually no safe and effective weight loss medications and almost all the treatments that were available to treat diabetes tended to promote weight gain, albeit with improved glycemic control. In 2005 we saw the first availability of a novel class of anti-diabetic agents termed GLP-1 drugs. GLP-1 stand for glucagon like peptide 1. This drug category causes 4 major metabolic actions:
• Increased insulin production in response to a meal
• Reduction in glucagon production in response to a meal
• SLOWING DOWN OF GASTRIC EMPTYING (leading to a sustained feeling of fullness)
• REDUCTION IN APPETITE (by working on the satiety center in the brain)
Since 2005 this class of drug has exploded allowing for more convenient dosing, more efficacy in the treatment of diabetes, improved weight loss, and fewer side effects. The American Diabetes Association now recommends considering a drug from this class as first line therapy for patients who meet certain criteria. Drugs approved to treat Type 2 Diabetes go by brand names that include Victoza, Trulicity and of course, Ozempic. Other formulations of GLP-1 drugs are approved to treat weight loss in general.
Ozempic Fever Goes Mainstream
Unless you’ve been living under a rock, you’ve probably heard of Ozempic. Thanks to the Kardashians, other celebrities and social media, demand for the drug has skyrocketed. The drug has literally flown off the shelves of pharmacies creating shortages across the country. Now, patients with diabetes who need the drug are left waiting for weeks or months to get their prescriptions filled. As a result, Ozempic’s manufacturer, NovoNordisk, is opening more production plants to catch up to demand.
I have seen many patients successfully lose weight and gain improved diabetes control with this medication. I have also witnessed many non-diabetics achieve success with sustained weight loss while using this pharmaceutical. As with any drug, there are side effects that you should consider with the advice of your healthcare provider. And, as it stands today, there are issues related to availability and cost that could be barriers for many.
Despite the current obstacles, I believe potential of this class of drug is tremendous. When you consider that 1 out of 3 Americans is obese, having an effective medicine to reduce weight could have a significant impact on the overall health of millions of Americans.
We know from experience that behavior modification doesn’t work for most people for sustaining weight loss over the long term. We now have tools that truly will prolong lives not only through weight loss but also reducing the risk of cardiovascular disease. The challenges of production, access and cost remain issues for now. However, I believe that due to its potential impact on the quality of life of so many Americans, this class of drug may live up to its current hype over the long term. If you are interested in exploring this class of drug, please be sure to consult with your healthcare provider.
Andrea Hayes MD received her Type 1 diagnosis at age 15. She is a board-certified endocrinologist who has been in practice for 25 years. She offers prompt appointments for patients in home, local office or via telehealth.
For more information, call 239-641-8199 or visit: naplesdiabetesconcierge.com
Naples Diabetes Concierge
239-641-8199
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