The SELECT trial of semaglutide in patients with obesity and pre-existing heart disease marks a before and after moment in cardiology.
There should be trials directly comparing intermittent fasting vs. this drug for the same population. We know that decades long Type Two Diabetes patients have 50% reversal of their diabetes in one year simply staying on intermittent fasting of one to two meals a day without snacking when directly compared to those treated with traditional medical interventions! That’s monumental achievement!
Improving 1% seems minimums, in my opinion.
Semaglutide has been wonderful for our patients! It gives them hope and incentive to change their behaviors. They start losing weight immediately which is positive motivation to look at their diet and start an exercise (strength training) program. The con to this medication is patients who look at it as a quick fix and do not make any effort to change their diet or exercise. These patients will lose muscle mass which can lead to instability and falls in the elderly population. For patients taking this medication, it's so IMPORTANT to help them with diet and exercise and not just write a prescription and send them on their way. It's common sense that these drugs will improve outcomes. Get rid of the fat covering all of your organs and clogging your vessels, the better your outcomes will be long term. However, they can also effect other outcomes such as falls, instability, and frailty in elderly patients if they don't change the way that they eat and exercise.
The agriculture industry is not changing any time soon. Probably never. Too many people have too many financial incentives to keep our food unhealthy. I think this class of medications opens the door for more in depth discussion about diet and exercise along with the medication. This is what we do in the office where I work and we use an In-Body scan to assess muscle loss vs. fat loss. So far, our patients are very happy and are all working on diet and strength training.
It is odd. They smoke and live longer. Our toxic food and inactivity seems to be an offset.
I disagree John. We need to incentivize healthy behaviors and remove toxic junk food from the environment if we are really going to move the needle.
Ultra-processed foods make up most of the diet in the developed world. They contain three ingredients - processed added sugar, highly processed grains, and seed oils. These foods have no nutrition in them.
Denmark has a program where if you earn a lower income, you get a food card and you're incentivized to buy whole food. But in the US, if you’re on a lower income, you get a food stamp, and you can buy Coke. In fact, 10% of all that money goes towards Coke and sugary drinks, 70% goes towards ultra-processed food.
Instead, the US government subsidizes drugs like Ozempic to the tune of $10,000 per patient per year and it’s the reason why people are doing cartwheels on Wall Street right now - because obesity drugs are the largest target market. Much of that money should be invested in regenerative agriculture and better food, particularly for lower income kids.
Oh wonderful... let’s put half the country on this so that we can continue to see the stocks rise and profit off of this real pandemic.
The real problem lies with what people are eating. Until that is fixed, American will continue down the path of morbid living and addicted to drugs.
wait till gastroparesis really rears its ugly head?
what was All Cause Mortality?
I’m not impressed but check my math. At the beginning of the trial, I see 100 adults age ~62 in the room each hoping to get the drug v. placebo. 3 years later, we find out 93 had no CV event but 12 had an adverse reaction. Of the 7 who had CV event, 3 we’re taking drug and 4 were taking placebo. Presumption is that any benefit will continue after 3 years. Cost is too high for the possible long term benefit, especially if paid by third party. Nevertheless, John, keep these interesting articles coming . These are so good, they should be integrated and formalized into continuing education credits.
The final scientific word on obesity has not been written.
Some people erroneously dismiss that it has genetic precursors and that is to dismiss the fact that humans have stopped evolving, we are no longer evolutionarily "fit" because we no longer die of un-fitness, we now have medical interventions for nearly everything, and neonates who should be dead are forced to live and procreate, further spreading un-fitness.
We have sedentary lifestyles
We have junk-food lifestyles
We have high anxiety lifestyles (yes, the rat race is more anxiety causing than palaeolithic tribe survivalism)
I think Vinay has the final word on this.
Just like he says the purpose of cancer drugs should not be to defeat the cancer but to extend the life, the same must be said for anti-obesity drugs.
The criteria should NOT to "reduce obesity".
The criteria should be: did it delete the life shortening effects of obesity?
Honestly, for Big Pharma to be acceptable in its conclusions, the studies need to be run long enough to demonstrate life extension.
That's where the bar should be.
I had a friend a while back who'd been on Fenfen, she LOVED it and was incredibly disappointed when it stopped. I'd trust Fenfen before I'd trust these semaglutides. Because Fenfen acted by raising your baseline. Semaglutides reduce digestion, that just sounds like a catastrophe waiting to happen.
The girl who eats a saucer full of food and fells full is sensitive to leptin. Individuals who consume lots of fructose or are overweight are insensitive to leptin and they remain hungry.
All good points. The major problem facing the clinician is this. What will people do? How can I really help them deal with these challenges in realistic ways. The bottom line is: you can't outrun a spoon. You must walk a mile to work off the 100 calories in a piece of white bread. I have drastically reduced carbs and almost eliminated sugar. I go to the Y and do 30 min of progressive resistance exercise three times a week. Most people can do that and many of them will.
Obesity is not a disease. A disease is a physical and/or biochemical alteration that causes a body organ or organ system to malfunction. Nothing that can be eliminated through the exercise of will power is a disease and to call it such is a disservice to those who suffer from true diseases and causes people to have unrealistic expectations about what doctors and the practice of medicine are really all about.
You seem to have either missed or ignored that 2/3rds of the patients had an A1C > 5.7% and were thus prediabetic and that the drug worked better in those prediabetic than those that were not. It’s not surprising a GLP-1 helps obese hyperglycemic patients with preexisting atherosclerosis. Maybe this will awaken cardiologists to normalize blood sugars instead of trying to suppress LDL to < 1st percentile thru multiple drugs, some of which (evolocumab and bempedoic acid) are constantly associated with more cardiovascular and all-cause mortality.
Or we could jail the entire C-suite occupants of P&G, Conagra, etc, and every FDA and CDC jackoff who lies day in and day out to unassuming Americans and profits off the chronic diseases we’ve all been set up for with the soybean oil, HFCS, red-40 laden garbage that is virtually the only “food” that’s even legal to sell in this country anymore. Put those trials on PPV, and you could buy a lot of Ozempic and/or grass-fed beef from those ticket sales.
Well that's just peachy keen. These people were in their early 60's and so what will be the outcome if they live another 10, 15, 20, 25 or 30 years? And the cost to the patient and profit to pig pharma? Perhaps about $300-400 thousand over 15-20 years. Thanks for ramping up my insurance costs. Just how many retirees can afford to play an out-of-pocket $20K/year get out of obesity card?
This looks like lifestyles will go down the tubes as we now have more drugs to do the job and fix the problems. Eat, drink and smoke anything you want. Don't matter, no more. Coach potatoes are now saved from over-couching. And fast food junkies can "fast-food" all they want.
I will never give up the belief that most solutions for many medical problems do not involve endless drugs for life.
For the record - Ohio is just as fat as Kentucky.... maybe we start banning advertisement for anything containing sugar or fructose - similar to what was done with cigarettes. while we're at banning ads-- we could stop letting pharma run direct to consumer ads as well - if I see a pharma ad -- pretty sure the product doesn't work very well or you would not need the ad to sell it.