Every day, one can hear people around them clamoring to lose weight, but in fact, what many people think is' fat 'is not really' fat '. In medicine, for Chinese people, BMI≥24（ Weight (kg) ÷ height (m ²) is considered overweight, and for the sake of health, it is necessary to start losing weight.

 

For these truly obese people, weight loss is not as simple as saying "keep your mouth shut and take a step forward". Are there any "scientifically effective weight loss methods"? We have invited general practitioner He Haili to share with everyone.

 

Obesity is actually a chronic disease

"Overweight" and "obesity" are defined as abnormal or excessive accumulation of fat that poses a risk to health, which will lead to insulin resistance (and then develop into diabetes), hypertension, dyslipidemia, nonalcoholic fatty liver and other diseases, and shorten life expectancy.
 

 

In addition, being overweight or obese increases joint load and can easily lead to musculoskeletal disorders such as osteoarthritis. Obesity is also associated with cancer diagnosis, such as breast cancer, gallbladder cancer, colon cancer, etc.

 

2016 WHO The Director General's speech "Obesity and diabetes: a slowly approaching disaster" mentioned: "Since the 1980s, the prevalence of obesity diagnosis in the world has more than doubled. As the second largest economy in the world, China is now competing with the United States to see who has the largest number of overweight citizens... The most worrying news about diabetes is from China."

 

Obesity, as a chronic disease, is posing a huge challenge to public health in China and even globally.

 

Losing weight is as difficult as ever

When it comes to weight loss, there are always various folk remedies and treasures circulating among the people, and unscrupulous merchants take advantage of the situation to sell anxiety through various advertisements, making the already helpless obese population even worse.

 

At present, illegal addition of "sibutramine" can still be detected in commercially available weight loss products (due to increased cardiovascular risk, the harm outweighs the benefit, and it has already been withdrawn from the market).

 

Whether it's ascetic dieting or devilish hellish exercises, they are constantly tormenting the physical and mental health of overweight people, eroding their remaining confidence and dignity.

 

Life is so short and losing weight is so difficult, why not give yourself a way out? This should be the heartfelt cry of the "succulent boys and girls" who have worked hard and struggled.
 

Image source: Pixabay

 

Formal weight loss treatment methods

Based on existing medical guidelines and clinical data, there are several formal treatment methods for obesity, including:

 

1. Integrated lifestyle intervention

Mainly through a low-fat and low calorie diet, and exercising for at least 150 minutes per week (such as brisk walking, skipping rope, etc.).

 

Continuous guidance and monitoring of diet and exercise by nutritionists or qualified healthcare professionals are crucial for the success of weight loss.

 

2. Drug therapy

If the weight loss target cannot be achieved through the above interventions and your body mass index BMI≥30kg/m²， perhaps BMI For 27-29.9 kg/m² If there are coexisting weight related diseases (such as hypertension, dyslipidemia, obstructive sleep apnea, cardiovascular disease, etc.), drug treatment may be considered.

 

The US Food and Drug Administration (FDA) has approved 5 weight loss drugs for long-term management of chronic weight loss, in addition to pheniramine topiramate, the other 4 are also approved for use in Europe and Canada.

 

Liraglutide
Belonging to glucagon like peptide-1 (GLP-1) receptor agonists, abbreviated as GLP-1RA， It is currently the first-line drug for treating obesity and the first approved treatment for obesity GLP-1RA， It needs to be injected subcutaneously once a day.
 

semaglutide
Belonging to the same category GLP-1RA， Just need to inject subcutaneously once a week, and the weight loss effect is better than Liraglutide. So, although semaglutide has been on the market for a short time, it is more popular.
 

orlistat
A lipase inhibitor that can alter fat digestion and increase fat excretion in feces. However, due to gastrointestinal side effects such as bloating, fecal incontinence, and the discharge of oil stains, many patients are unable to regulate them. In other words, after eating it, the buttocks will involuntarily leak oil, and the scene is a bit awkward.
 

Fentamine Topiramate
The weight loss effect seems to be better than orlistat, but there may be more side effects such as increased heart rate, mental related problems (such as depression and anxiety), and cognitive adverse events (such as lack of concentration), and its effectiveness and safety are not yet clear.
 

Amphetamine naltrexone
Neurotransmitter agonists and reuptake inhibitors can reduce weight by 4% -5%, but may also lead to increased cardiovascular risk and mental health issues. However, if obese smokers want to lose weight and quit smoking with medication, this medication can be considered.
 

3 Medical Devices

Such as laparoscopic adjustable gastric banding (LAGB), electrical stimulation (vagus nerve block) system, intragastric balloon system, gastric emptying (aspiration) system, hydrogel, etc.

 

Suitable for patients who are unable or unwilling to undergo weight loss surgery due to ineffective or intolerable drug treatment, or as a transitional treatment before weight loss surgery, but may bring a heavy economic burden to patients.

 

4 weight loss surgeries

Weight loss surgery can achieve up to 40% weight loss within 12-18 months after surgery, and the effect of long-term weight loss maintenance is also good.

 

Mainly suitable for patients with severe obesity.

 

A new dawn for weight loss has arrived

Looking at the above 5 effective weight loss drugs, we will find that 2 of them belong to the same group of glucagon like peptide-1 receptor agonists (GLP-1 RAs).

 

GLP-1RA Originally designed to lower blood sugar, it regulates blood sugar through mechanisms such as increasing glucose dependent insulin secretion, reducing postprandial glucagon, and slowing down gastric emptying. By affecting the appetite center of the brain to increase satiety, leading to a decrease in food intake, this may be GLP-1 RA The reasons for weight loss are not fully understood, but the mechanism behind it is not yet fully understood.

 

In the past two years, clinical trials of the Simeglutide weight loss series have been called STEP（Semaglutide Treatment Effect in People with Obesity）， Its research results have repeatedly won the top tier medical journals in the world, indirectly indicating its extraordinary strength.

 

Research data:

[1] 68 weeks STEP 1 The experiment (once a week for overweight or obese adults) showed that the average weight loss of the semaglutide group was 14.9%, far exceeding that of the placebo group.

[2] 68 weeks STEP 2 Test (Smeglutide once a week for overweight or obese adults with type 2 diabetes): divided into Smeglutide 1 mg Group (weight loss of 7%), Smeaglutide 2.4 mg The group (9.6% weight loss) and placebo group (3.4% weight loss) indicate that semaglutide is effective in weight loss and may be dose-dependent.

[3] 68 weeks STEP 3 Experiment (Simeglutide) VS The effect of placebo as an adjunct to intensified behavioral therapy on weight loss in overweight or obese adults showed that the average weight loss in the semaglutide group was 16%, far exceeding that of the placebo group (-5.7%).

[4] STEP 4 Experiment (continuous weekly injection of semaglutide) VS Comparison of placebo in weight loss maintenance: Participants who received the same treatment with semaglutide for the first 20 weeks experienced a 10.6% weight loss, and then half of them were randomly assigned to switch to placebo. Within the following 48 weeks, patients who continued to use semaglutide experienced a further weight loss of 7.9%, while those who switched to placebo experienced a weight rebound of approximately 6% Kg）。

[5] STEP 5 Experiment (Simeglutide 2.4) mg VS Comparison of the two-year efficacy of placebo on overweight or obese adults) showed that among overweight or obese adults without diabetes, Smeglutide was injected subcutaneously once a week, and combined with lifestyle intervention, the average weight loss after two years was 15.2%.

[6] STEP 6 The trial (Smeglutide once a week for overweight or obese East Asian people with or without diabetes) was completed in Japan and South Korea in March this year, which is of reference value to us. After 68 weeks of clinical observation, the average weight of the semaglutide group decreased by 13.2% compared to baseline.

 

All the above data show that Smeglutide's performance in weight loss is excellent regardless of whether the patient has diabetes or not.

 

Since June 2021 in the United States FDA Approved Simeglutide Injection (2.4mg, once a week) for chronic weight management, it quickly became a new favorite in the industry, giving obese people a new dawn of weight loss.

In the same year, Health Canada, UK regulatory agencies, and the European Medicines Agency in 2022 also approved semaglutide for the treatment of obesity.

On June 18th of this year, the National Medical Products Administration (NMPA) of China approved Novo Nordisk ® The market application for Simeglutide, a widely concerned "phenomenal" drug, has finally obtained the Chinese "ID card" and become a weight loss drug approved for sale in China, in addition to Orlistat and Liraglutide. This means that individuals with long-term weight management and adjustment consultations will be able to benefit from breakthrough health weight loss management plans with their assistance.

 

reference material:

[1] https://www.who.int/health-topics/obesity   

[2] https://www.who.int/zh/director-general/speeches/detail/obesity-and-diabetes-the-slow-motion-disaster-keynote-address-at-the-47th-meeting-of-the-national-academy-of-medicine   

[3]UpToDate： The prevalence, screening, and evaluation of adult obesity;   

[4]UpToDate： Adult obesity: treatment overview;   

[5.]Kadowaki T, Isendahl J, Khalid U, et al. Semaglutide once a week in adults with overweight or obesity, with or without type 2 diabetes in an east Asian population (STEP 6): a randomised, double-blind, double-dummy, placebo-controlled, phase 3a trial[J]. The Lancet Diabetes & Endocrinology, 2022, 10(3): 193-206.  

[6]Rubino D, Abrahamsson N, Davies M, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021; 325（14）：1414-1425.  

[7]Knudsen LB, Lau J. The Discovery and Development of Liraglutide and Semaglutide. Front Endocrinol (Lausanne). 2019; 10:155.  

[8]Lau DCW, Batterham RL, le Roux CW. Pharmacological profile of once-weekly injectable semaglutide for chronic weight management. Expert Rev Clin Pharmacol. 2022; 15（3）：251-267.  

[9]Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021; 384（11）：989-1002.  

[10]Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension [published online ahead of print, 2022 Apr 19]. Diabetes Obes Metab. 2022; 10.1111.