A miracle injection for the "good" obese

A miracle injection for the “good” obese

On paper, it’s a miracle drug. Baptized Wegovy and self-administered in the form of a subcutaneous injection, once a week, it makes it possible to achieve weight loss never before observed in clinical trials: 15.3 kg on average in sixty-eight weeks. The active substance, a compound mimicking a natural appetite-regulating hormone, has been tested on thousands of overweight and obese people worldwide, always with the same results. “On average, the weight loss approaches 15%,” notes Prof. Alain Golay, head physician of the Therapeutic Education Service for Chronic Diseases of the Geneva University Hospitals (HUG).

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The specialist journal Minerva, whose aim is to promote the dissemination of independent scientific information, confirms that the efficacy of the drug is based on studies “of good methodological quality”. However, a careful reading of the studies reveals that this substance was tested only on people who agreed to observe a dietary restriction of 500 calories per day, the equivalent of a bar of chocolate. A diet that can be considered “drastic”, according to psychologist and psychotherapist FSP Magali Volery, a qualified dietician and founder of the Nutrition and Psychotherapy Consultation Center (CCNP), in Geneva. In addition, patients were actively encouraged to engage in regular physical activity. In countries where the drug is already available, it is also registered as an “additive to diet and physical exercise”.

Selection of ideal patients

“These studies were carried out under conditions that do not correspond to reality, says Magali Volery. In real life, people find it difficult to tolerate a reduction of 500 calories a day in the long term. We selected ideal patients. According to the researchers themselves, the protocol applied is likely to lead to a bias “with an overestimation of weight loss”. Contacted, the manufacturing laboratory, Novo Nordisk, recognizes that all the subjects who did not support the drug during the preliminary phase were excluded, but this is justified: “In practice, we would not stop the treatment, we would reduce the dose. We cannot do this in a study where the aim is precisely to measure the effectiveness of this dose. Moreover, several doctors specializing in the treatment of obesity point out that a restriction of 500 calories a day is not problematic for a very obese person who absorbs an excessive amount of calories anyway.

Did the patients lose weight due to the substance or due to their efforts to change their lifestyle? The studies cannot answer this question because they did not aim to compare the effectiveness of the two methods. Novo Nordisk openly defends a global therapeutic approach including drug treatment, diet and physical activity. There remains the question of side effects. Mild to moderate in intensity, they are essentially gastrointestinal problems such as nausea, diarrhea or vomiting. They would affect, according to studies, between 71 and 89% of subjects. On condition of anonymity, a Vaud doctor certified in endocrinology and diabetes says that the effectiveness of Wegovy is due at least in part to the fact that it “makes you want to vomit”. “With so much gastric distress, no wonder patients are losing weight!” affirmed in July 2021 Suzanne B. Robotti, consumer representative to the FDA, the American pharmacovigilance authority.

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For all these reasons, strict criteria will certainly be applied for the prescription of Wegovy in Switzerland, as is already the case for its predecessor, Saxenda, which contains the same active substance and has been found in Switzerland since 2016. Patients must commit to following a diet involving a food restriction of 500 calories a day, to practicing “enhanced” physical activity and to demonstrating “motivation”. Compliance with these conditions is checked by the doctor (for example, using a pedometer) and confirmed to the insurer for reimbursement. In addition, treatment should be stopped if the patient does not lose enough weight; regular check-ins are carried out. Finally, the limitation period is limited to three years.

A huge market

It must be said that the long-term effectiveness of this new class of drugs is not yet well known, and for good reason: almost all of the studies do not exceed sixty-eight weeks. However, it is well known that people who lose weight a lot and quickly tend to regain weight after a while. Dissecting the studies devoted to Wegovy, the American medical blogger Ken Berry, a general practitioner engaged in the fight against obesity and diabetes, explains on his YouTube channel that subjects tend to regain a little weight after sixty weeks. The question of the sustainability of the results will be “one of the points that will have to be answered”, concludes the review Minerva.

For the pharmaceutical industry, the market is enormous. More than 1.9 billion people are overweight worldwide, of which 650 million can be considered obese. In Switzerland, this represents respectively 42% and 11% of the population. Already authorized elsewhere in Europe and the United States, Wegovy generated sales of $198 million during the first quarter of 2022.

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