Weight loss medication is very useful for many individuals. However, expert believes things are moving too fast
General practitioners experience a significant increase in demand from patients week by week. But there is still a lot we don't know about the medicines, doctors warn.
Every year, Science – one of the world's leading scientific journals – selects the breakthrough of the year in research. This year, the honourable title goes to the work on GLP-1 drugs. These are new drugs to treat obesity.
Jorunn Sandvik is a senior physician and researcher at the Centre for Obesity Research at St. Olavs Hospital and the surgical department at Ålesund Hospital.
She agrees that the drugs are a major medical breakthrough.
The same goes for Marte Kvittum Tangen, head of the Norwegian Association for General Practitice.
Not something a quarter of the population should use
GLP-1 agonists are more commonly known under brand names such as Saxenda, Ozempic, and Wegovy, all of which are manufactured by the Danish pharmaceutical company Novo Nordisk.
These are medications that will be of great benefit to some patients, both Sandvik and Tangen believe.
At the same time, the doctors are concerned about the rapid increase in the use of these medicines.
“This is not a medication that a quarter of the Norwegian population should use. For most people who are overweight or mildly obese, there will be other measures that are better than being on lifelong medication treatment," Tangen says.
Tangen believes that further research is needed to assist physicians in becoming even more precise in identifying individuals who would benefit from using these medications for their health.
Now among the most sold medicines in Norway
At the end of 2023, weight loss drugs were among the most sold drugs in Norway, as reported by Farmastat, which compiles statistics for pharmaceutical sales.
Sales of Ozempic in Norway in 2023 will exceed well over NOK 1 billion (95 million USD).
Sigurd Hortemo, a senior physician at the Norwegian Medical Products Agency, told Norwegian newspaper VG that sales of Ozempic have become much larger than the Norwegian Medical Products Agency had anticipated.
Doctors find it problematic
Marte Kvittum Tangen tells sciencenorway.no that GPs perceive the high demand for these medications as problematic.
“This has happened very quickly. The demand is increasing week by week,” she says.
For Norwegian GPs, it is quite unusual for patients to come and request a specific medication. Doctors are accustomed to being the ones to suggest which medication a patient should use.
"We are focused on ensuring that patients have valid reasons for receiving such medication and that other measures have been tried first,” Tangen says.
She highlights the issue that many patients are requesting weight loss medicine, likely without experiencing any health benefits.
When there are quick and easy solutions like Wegovy available, it becomes challenging for GPs to discuss other possible ways to lose weight with the patient.
“People have simply made up their minds and come in with a demand,” Tangen says.
They may have learned about the medication in the media or through talking to others who have used it.
A discovery made in 1984
Although the development of weight loss drugs has progressed very quickly, the research behind this breakthrough has a long history.
As early as 1984, researchers discovered a new hormone called GLP-1 in the intestines, which effectively regulates blood sugar. This hormone is also called the satiety hormone.
20 years later, the first diabetes medication based on this hormone was introduced. It was then that researchers discovered a side effect of the medication: People who were treated with GLP-1 for their diabetes also lost weight.
Research has also shown that individuals who undergo weight loss surgery experience a rapid increase in this satiety hormone. They achieve normal levels of GLP-1 within the first few days after surgery.
Researchers then began to investigate the mechanisms behind this feeling of satiety, keeping individuals struggling with obesity in mind.
Completely logical that it works
Jorunn Sandvik explains that the new medications contain a copy of the satiety hormone GLP-1. This is the hormone your body produces after you have eaten a meal to signal that you are full.
"People with a healthy weight experience an increase in this hormone after eating. They feel satisfied and stop eating when their body has had enough food. However, in individuals who have developed obesity, this regulation of satiety is disrupter," she says.
For Sandvik, who has worked with bariatric surgery, it is therefore logical that these medications work similarly to how bariatric surgery affects patients.
Both approaches simulate the production of the satiety hormone GLP-1.
“The drugs are primarily very important for those with severe obesity that least to conditions like diabetes, fatty liver, high blood pressure, or strain injuries to joints and muscles as a result of excess weight. Or for those who experience a complete loss of appetite regulation," she says.
Decline in bariatric surgeries
Sandvik, like Tangen, believes that these medications should be reserved for those who would benefit from them the most.
“The medications should be used with the same respect as bariatric surgery. The patient should be part of a system where there is good follow-up and guidance. Medications should be part of a treatment, not a treatment itself,” she says.
Sandvik informs sciencenorway.no that she and her colleagues are already observing a decrease in the number of bariatric operations.
“You can stop taking a medicine if you experience side effects. But you live with the consequences of an operation for the rest of your life, whether it goes well or if you are one of those who encounter problems afterward,” she says.
Very strict regulations
Both Tangen and Sandvik believe there is reason to take a closer look at Norway’s reimbursement scheme for prescription drugs, and that better clarification is needed as to who benefits from the medication and thus should be given a prescription where the health system covers most of the cost.
Today’s regulations are very strict.
“Today, only a few patients with obesity receive these medicines on reimbursement. It is primarily patients with diabetes who receive them,” Tangen says.
“You must have a BMI of over 50 for the healthcare system to cover most of the cost of weight loss medication. Most applicants are therefore denied a refund from the National Insurance Scheme. They have to pay for the medicine themselves,” Sandvik explains.
Continuous research is emerging, showing that these are medications that can be medically justified for use in preventing obesity-related comorbidities such as heart diseases, she believes.
Wants more independent research
All medicines that have a positive effect also have side effects, Tangen reminds us.
“It is often the case that new drugs have more side effects than a doctor is familiar with. I am concerned that we are using them to such a large extent and for such a large proportion of the population,” she says.
As head of the Norwegian Association for General Practitice, she wants more research and an even stronger knowledge base.
“I hope there will be studies that are not funded by the manufacturers of the medications themselves. Studies that can better identify which patient groups benefit the most from the treatment,” she says.
Nausea, vomiting, and diarrhoea
Norwegian GPs are now starting to gain some experience with the side effects of the new weight loss drugs.
Nausea, vomiting, and diarrhoea are very common.
There have also been reports of more serious side effects, such as pancreatitis. There are also concerns about psychological side effects, such as suicidal thoughts.
“It's important that side effects that are not previously known are reported, both by patients and doctors,” Tangen says.
Jorunn Sandvik believes that these medications have relatively few side effects compared to what might be expected.
“Side effects are part of the mechanism. If you eat after you've become full, you may feel nauseous,” she says.
Muscle or fat?
Most people who try the new weight loss drugs lose weight.
But it is still unclear what the weight loss consists of, according to Sandvik.
“We don’t know if it's fat that disappears. Or if it's the muscles,” she says.
It's not necessarily healthy to be thin with little muscle mass.
“It might be better to carry a little extra weight and have good musculature. And those who experience rapid weight loss may accumulate more fat tissue when they gain weight again, especially if they are not attentive to their diet," she says
Translated by Nancy Bazilchuk