Weight loss medications are a controversial topic among healthcare professionals. Although there are those who defend that they can be used to treat conditions such as obesity while being relatively safe (especially the latest generation, since some older ones do have significant side effects and risks ), other doctors even question whether they are necessary in many cases.
The case of Wegovy and the new generation
A striking case is that of Wegovy . It is a drug made by Novo Nordisk from the active principle semaglutide (which regulates hormonal mechanisms of the body) that in clinical trials was shown to achieve weight loss of 15% on average and that was approved for use in the US by the FDA ( Food and Drug Administration ) in June of this year.
Well, when the drug became available in pharmacies, the demand was much higher than the manufacturer expected, causing an almost immediate shortage. The phenomenon has acquired such dimensions that groups have been created on social networks to inform about dispensaries that may have doses.
For many specialists, this demonstrated the need for drugs for this purpose that were safer and more effective than pre-existing ones (and which include, even today, amphetamines). Precisely, the problems associated with previous generations had been a poor incentive for pharmaceutical companies to undertake large investments in developing this type of drug.
Obesity as a chronic disease
In the last decades, there has been a progressive change in the western understanding of obesity, which is increasingly seen as a chronic disease, rather than as the result of a behavioral disorder; Likewise, several organisms have been redefining the new criteria for a patient to be considered obese (based on the body mass index). These changes in definition have important ramifications.
On the one hand, because the new paradigm requires greater medicalization and greater involvement of public and private health systems, with the economic baggage that this entails. On the other hand, this is an incentive for the development of pharmacological therapies.
The key is in the surname ‘chronic’. As more and more professionals and institutions have come to understand obesity as a chronic disease, the idea has spread that obesity needs a treatment that addresses the root of the problem rather than its consequences. so that a durable solution is offered to patients. If we add to this that 42% of adults in the United States meet the criteria to be considered medically obese according to the current definition of obesity from the US CDC ( Center for Disease Control ), it is easy to see the immense appeal of developing a therapy of regular use for years for Big Pharma.
Another part of the scientific community has gone in the opposite direction, considering that obesity defined on the basis of BMI does not have to be seen as a chronic disease in itself, but rather that this indicator has to be taken in context. This way of thinking does not exactly coincide with the approaches of certain social movements that fight against ‘gordofobia’ and call for the demedicalization of the disease (such as body positive ) but rather advocate giving it a different definition taking into account the overall health of the patient ( for example, arguing that, according to research published in Nature, it was found that 29% of those who define themselves medically as obese according to their BMI do not have, on the other hand, other metabolic disorders).
For these voices, there is a risk that the practice of pharmacologically treating overweight people and pathologizing them will become generalized without necessarily attending to the real risk of complications of the specific patient , and without solving the root causes in those who do have this risk.
If we listen to this opinion, not only are certain people who do not necessarily need such consideration (with the implications that this may have for the mental health of these people) become pathologized, but other people can be trusted with drugs that do not necessarily eliminate risk factors for further complications.
Are the new drugs safe?
The truth is that new drugs based on hormonal regulation, such as Wegovy, have certain side effects. But it is just as true that this is a reality for any other drug. It is also true that they can be considered effective, as we have said, achieving weight losses of 15%.
If we look at the results of clinical trials, this drug (and similar approved ones, such as Saxenda) is no less safe than many other drugs already widely implanted, at least in the timeframes in which it has been tested (the longest studies deadline are still in process). That is, in principle its use under medical prescription should not be a cause for concern.
The debate, therefore, would be whether we should interpret obesity as a chronic disease defined based on the patient’s BMI or if, on the contrary, we should take other criteria into consideration (which could reduce the demand and prescription of pharmacological treatments to treat it ). And it is difficult to give an answer: although it is true that there are people who meet the ‘institutional’ definition of obesity based on BMI without having other metabolic problems, it is no less true that the definition based on BMI is a statistically quite indicator. good of commitments or risks to the life or the quality of life of the people.