Four weight-loss drugs that cut bodyweight by up to 10 per cent in a year were recommended for moderately overweight and obese adults who did not have luck with diet and exercise changes by a leading panel of doctors.
Doctors at the American Gastroenterological Association (AGA) — a top group of clinicians — are now recommending Wegovy, Saxenda, Qsymia and Contrave for the patients.
The treatments are administered either as injections — from daily to weekly — or as pills to be taken once a day or twice with meals.
They work by suppressing patients’ appetite to help curb bad eating habits, leading them to start to shed the extra pounds. The panel said they should be used only when other ‘lifestyle’ strategies had failed.
Today’s recommendation not only boosts the likelihood of them being prescribed by doctors, but also of insurance companies covering prescriptions written for patients.
It is the first time these drugs have been recommended for weight loss by the organization. Each are already approved for weight loss by the Food and Drug Administration (FDA).
Guidelines from the group including obesity experts came into effect today, with doctors now recommended to prescribe the drugs in situations where other lifestyle interventions have failed.
America has declared war on obesity with two in five adults in the country already considered obese, marking a surge of a quarter within a decade.
President Joe Biden has already laid out plans to mark America’s favorite foods with traffic light nutrition labels warning of their high fat and sugar content, and to tighten rules on which foods can claim to be ‘healthy’.+
In its recommendation, published Thursday, the AGA said the medications should be offered after other lifestyle interventions — such as low-calorie diets and exercise — had not led to significant weight loss.
They said they should be offered to adults with a body mass index (BMI) above 30kg/m2 — classifying them as obese.
But they said it should also be offered to adults with a BMI above 27kg/m2 — or moderately overweight — who also have a weight-related condition such as high blood pressure or heart disease.
The recommendation is for adults only, those over 18 years old, and does not include children.
How do the drugs help to trigger weight loss?
When we eat it triggers cells in the intestine to release a hormone called glucagon-like peptide-1 (GLP-1).
This travels to the hypothalamus — an almond-shaped structure in the center of the brain — where it binds to the receptors.
These suppress hunger and activate feelings of being full or saiety, stopping someone eating.
But naturally this system only lasts for about 30 seconds, before someone starts to feel hungry again.
Weight loss drugs like Wegovy and Saxenda work by triggering cells to release GLP-1.
But because they are longer lasting they trigger its release over more time, helping to enlarge cells.
The drug Qsymia works by reducing levels of leptin in the body, sometimes referred to as the hunger hormone.
It works by ensuring calorie consumption meets the body’s energy demands, keeping someone at their standard weight.
Contrave, on the other hand, works by reducing insulin resistance — allowing more sugar to be taken up from the blood.
It also boosts levels of dopamine in the brain — the feel-good hormone — helping someone avoid comfort eating.
The panel did not say how long patients should have tried lifestyle interventions before opting to use the drugs.
Lead author Dr Eduardo Grunvald, an obesity expert at the University of California, San Diego, said the recommendation was needed because lifestyle interventions alone do not always work.
‘Using medications as an option to assist with weight loss can improve weight-related complications like joint pain, diabetes, fatty liver and hypertension,’ he said in a statement.
The doctor also argued that obesity is a biological disease — meaning it is at least partly driven by genetics or food environments — rather than down to lifestyle factors such as overeating alone.
Dr Perica Davitkov, a gastroenterologist at the SSM Health Group in Ohio who was also involved in the recommendation, said this was the first time any diabetes drugs had been approved for weight loss by the AGA.
The FDA has already approved the drugs for treating weight loss.
When people eat food cells in the intestine start releasing a hormone called glucagon-like peptide-1 (GLP-1).
This travels to the hypothalamus — an almond-shaped structure in the center of the brain — where it binds to receptors.
These activate feeling of being full or satiety, leading to the suppression of hunger.
The mechanism tells the body to stop eating, but there is a catch. It normally only lasts for about 30 seconds.
Weight-loss drugs, however, seek to harness this system by prompting the release of GLP-1 even when someone has not been eating.
Because they act over a few hours patients have their hunger greatly reduces the period in which someone feels hungry, leading to a reduction in eating and therefore weight loss.
The AGA has recommended four drugs for patients struggling to reduce their obesity levels.
These were Selmaglutide, sold under the brand names Wegovy and made by Danish company Novo Nordisk, that can lead to someone losing up to 10 per cent of their body weight within a year according to clinical trials.
It works through injections given once a week, with a month’s course costing around $1,300 without insurance.
They also recommended the drug Liraglutide, sold under Saxenda and also made by Novo Nordisk, which triggers an around 4.8 per cent loss of bodyweight after a year of use.
Similarly, it is also given as an injection, but this must be administered once a day. It also costs about $1,300 a month before insurance coverage kicks in.
The recommendation also included two obesity-tackling drugs that are given as oral pills.
The first was Phentermine-topiramate ER, sold under Qsymia and made by Californian company Vivus, which leads to an 8.5 per cent weight loss after a year of use.
Doctors say patients should take one capsule a morning, at a cost from $98 a month at the cash price.
Unlike the injections, this works by reducing levels of the hormone leptin — which helps the body maintain its weight by prompting food intake — causing obese people to eat less.
The other was Naltrexone-Bupropion ER, sold under Contrave by Tennessee-based company Currax Pharmaceuticals, which can knock three per cent off a patient’s weight within a year.
It is given as two pills a day, one in the morning and one in the evening, at a cost of about $199 a month.
The above map shows the prevalence of self-reported obesity by state across the US in 2021. It was highest in Kentucky and West Virginia, but lowest in Hawaii and Colorado. Washington D.C., which is not yet a state, had the lowest rate
This works by reducing insulin resistance in cells, allowing more sugar to be taken up from the blood stream, and boosting dopamine levels — the ‘feel good’ hormone — reducing levels of comfort eating.
The recommendation for the drugs comes amid warnings that so many people are now using them for weight-loss that diabetes patients are struggling to get hold of them.
Wegovy was approved for treating type 2 diabetes in 2017, working to bring down someone’s blood sugar to help them manage the condition.
But last year it was also rubber-stamped for treating overweight or obese people.
Since then it has also been prescribed to people who are not considered to need the drug, but wish to lose a few pounds. This is known as off-label use, when an approved drug is used for an unapproved use.
The FDA has considered it to be in shortage since August this year.
Novo Nordisk which manufactures the drugs — has asked doctors in the US to stop starting new patients on the drugs following ‘unprecedented product demand and short-term manufacturing issues’.
