Blockbuster weight loss drugs are revealing what we still don't understand about obesity

Over the past year, there has been widespread curiosity about whether Ozempic or other similar blockbuster weight loss and diabetes drugs are suitable for individuals. This interest was sparked significantly due to the potential benefits of improved blood sugar regulation, enhanced heart health, and weight loss. Although obesity is a prevalent issue in the developed world, there is ongoing debate regarding its diagnosis and causes, with some experts questioning if it is even a disease.

A noteworthy discussion held in Copenhagen with a Danish scientist involved in the discovery of the molecules underscoring diabetes and weight loss medications revealed that the original research focus was on treating peptic ulcer disease. However, they found, through serendipitous discoveries, that targeting GLP-1 could significantly reduce blood sugar and body weight. These findings have proven transformative for those struggling with obesity.

The early approval of GLP-1 medications drew little attention, partly due to uncertainties about the willingness of individuals to use injections for weight loss and concerns about the exact nature of the problem being treated. Obesity is associated with various diseases, but not everyone with obesity develops related health issues. There are individuals known as the "happy obese," who experience no current health complications but are seen as at risk of developing diseases.

There is wider debate on whether obesity should be classified as a disease, especially using Body Mass Index (BMI) as a measure. BMI, an antiquated measurement from nearly 200 years ago, doesn't distinguish between fat and muscle mass. Alternatives like waist-to-hip ratios are suggested for more accurate assessments. Despite differing opinions, there is an increasing consensus that obesity, much like depression and addiction, may have roots beyond personal choice or willpower. GLP-1 drugs exemplify this by functioning as post-nutrient hormones that promote satiety, aiding those who struggle to feel full by quieting persistent hunger signals in the brain.

Concerns arise over potential downsides of GLP-1 drugs, such as reducing food enjoyment and potential negative physical effects like sagging skin due to rapid weight loss, loss of muscle mass, and side effects such as constipation. These factors contribute to the early discontinuation of the drugs by over half of the users within a short period. Despite these drawbacks, those who incorporate substantial lifestyle changes alongside the medication often have better long-term success in maintaining weight loss.

Deciding who should use these drugs remains complex, yet adopting a healthy diet and regular exercise continues to be the most effective strategy for maintaining overall health. Although challenges in defining and diagnosing obesity persist, these medications may offer crucial support for individuals needing additional help in managing their weight.