GLP-1 agonists like Liraglutide and Semaglutide promote weight loss effectively with improved blood sugar control and cardiovascular risk reduction.
Terzepetide, combining GLP-1 and GIP agonists, shows potent weight loss effects and maintenance benefits, outweighing concerns about long-term medication use.
Misconceptions about weight loss medications are debunked, emphasizing the need for ongoing treatment to address biological factors and achieve sustainable weight loss.
Deep dives
GLP-1 Agonists: Liraglutide and Semaglutide
GLP-1 agonists like Liraglutide and Semaglutide promote weight loss by increasing feelings of fullness and reducing hunger. Liraglutide was found to result in 5% greater weight loss compared to placebo in a dose-dependent manner over 40 weeks, while Semaglutide showed an 11-12% weight loss advantage over placebo in long-term trials. Both medications also improved blood sugar control and reduced cardiovascular risk factors.
Terzepetide - A Dual Medication: GLP-1 and GIP Agonist
Terzepetide combines a GLP-1 agonist with a GIP agonist to enhance insulin release and aid in insulin activity at the cellular level. In a 40-week trial, Terzepetide resulted in greater weight loss compared to Semaglutide, with subjects using the highest dose losing an average of 11.2 kilograms versus 5.7 kilograms. This weekly injection medication demonstrated potent weight loss effects and improved weight loss maintenance.
Maintaining Treatment Consistency and Effectiveness
While concerns about long-term medication use exist, the benefits of sustained weight loss and improved health outcomes attributed to medications like Terzepetide often outweigh potential risks. Studies have shown promising durability in weight loss maintenance, highlighting the necessity of ongoing treatment to address underlying biological factors and achieve desired outcomes.
Addressing Misconceptions and Promoting Adherence
Some misconceptions around weight loss medications, such as severe side effects leading to high withdrawal rates, are debunked by studies showing minimal withdrawal rates due to intolerance. The necessity for consistent treatment to maintain health benefits aligns with the need for ongoing lifestyle changes to address underlying biological factors and achieve sustainable weight loss.
Overview of GLP-1 Agonist Therapy and Benefits of Exercise
GLP-1 agonist therapy shows promise in promoting muscular endurance, exercise tolerance, and adaptation to exercise. Studies indicate that GLP-1 levels increase with exercise, potentially enhancing its benefits, although more research is needed to understand its full impact. Additionally, myokines released during exercise may also bolster GLP-1 activity, suggesting a potential synergy between exercise and GLP-1 agonists.
Discussion on Medications for Obesity: Fentermine and Topiramate Combination
The Fentermine and Topiramate combination medication offers a weight loss advantage over placebo, with a dose-dependent relationship at higher doses. While not recommended for patients with cardiovascular disease, it is suitable for those without such conditions. Although cost considerations exist, prescribing the combination or individual components remains a viable option for patients seeking effective and affordable obesity treatment.
On this week's podcast, Drs.Feigenbaum and Baraki review the management of obesity.
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References:
Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity
https://publications.aap.org/pediatrics/article/doi/10.1542/peds.2022-060640/190443/Clinical-Practice-Guideline-for-the-Evaluation-and?autologincheck=redirected
Clinical Practice Guidelines For Healthy Eating For Prevention and Treatment of Metabolic and Endocrine Diseases in Adults by AACE
https://www.endocrinepractice.org/action/showPdf?pii=S1530-891X%2820%2943460-3
2022 American Society for Metabolic and Bariatric Surgery and International Federation for the Surgery of Obesity and Metabolic Disorders: Indications for Metabolic and Bariatric Surgery
https://www.soard.org/article/S1550-7289(22)00641-4/fulltext
The importance of gene–environment interactions in human obesity
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6381863/
Four-Year Weight Losses in the Look AHEAD Study: Factors Associated with Long-Term Success
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183129/
Orlistat Augments Postprandial Increases in Glucagon-like Peptide 1 in Obese Type 2 Diabetic Patients
https://pubmed.ncbi.nlm.nih.gov/15111524/
GLP-1 physiology informs the pharmacotherapy of obesity
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8859548/
The dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist tirzepatide: a novel cardiometabolic therapeutic prospect
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8613929/
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