The results of research work that led to the development of new drugs such as Ozempic have just been recognized as scientific progress in 2023 by the journal Science (1). Indeed, these molecules may be useful in the treatment of type 2 diabetes, but also in the management of high-risk obesity. Given their high cost, significant side effects, and the need to take them for decades, it would be wise, in most cases, to consider lifestyle approaches since they also produce interesting results.
The role of the gut in type 2 diabetes and obesity
The relatively recent discovery that the gut produces hormones (incretins) that affect not only blood sugar control, but also appetite, led the pharmaceutical industry to develop molecules – semaglutide, known under the trade name Ozempic – with properties similar to these hormones, but which degrade much less quickly
The first research results were very encouraging as they showed their effectiveness in glycemic control in patients with type 2 diabetes, in addition to inducing quite significant weight loss. Subsequent studies found that this new class of drugs also reduced the risk of cardiovascular disease in patients with type 2 diabetes.
Ozempic does it reduce cardiovascular risk?
These drugs were subsequently tested on patients with obesity but without diabetes. Significant weight losses were again noted. Is this weight loss also associated with a reduced risk of cardiovascular disease?
The SELECT study, published on November 11, 2023 in the journal New England Journal of Medicine, tried to answer this question (2). More than 17,000 patients randomly assigned to receive semaglutide or placebo were followed for an average of 40 months. Patients were overweight or obese and had existing cardiovascular disease but no diabetes. However, two-thirds had a condition called prediabetes and their waist circumference was very high (over 110 cm), indicating the presence of visceral obesity and elements cardiorenal metabolic syndrome.
A significant 20% reduction in the rate of cardiovascular events (heart attack, stroke, cardiovascular death) was observed, despite the fact that these patients were already receiving medication to treat risk factors such as hypertension or high cholesterol.
Is this a real solution?
Latest data from 2020-2021. show that 23% of the population of Quebec meets the criteria for obesity (3). Should this drug be prescribed to everyone who wants to lose weight? Ozempic undoubtedly helps with weight loss and has the potential to help at-risk patients who need it, but it comes with a cost associated with this treatment, which must be taken over a long period of time, which is not without side effects, and long-term risks that remain unknown.
Targeted lifestyle
In our studies conducted at the IUCPQ – Université Laval, we supported men with visceral obesity by targeting their diet and physical activity levels. At one year, we observed reductions in waist circumference at baseline similar (4) to those seen with semaglutide in the SELECT study. However, the participants were regularly monitored by kinesiologists and nutritionists, which certainly involves costs, but significantly less than those associated with taking Ozempic. So we could give ourselves the resources to invest in the care of hundreds of thousands of at-risk patients by targeting, initially, their lifestyles.
The development of these new molecules undoubtedly represents a remarkable advance. Also, by investing in preventive approaches and the development of socioeconomic conditions that will limit the progression of obesity in our society, everyone will benefit and at a lower price!
(1) Couzin-Frankel J. Obesity meets its match. Science 2023;382(6676):1226-1227.
(2) Lincoff AM et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med 2023; 389(24):2221-2232.
(3) Camirand H et al. (2023). Quebec Population Health Survey 2020-2021 (Online), Quebec, Quebec Statistics Institute, 328 p. (statistique.quebec.ca/fr/fichier/enquete-quebecoise-sante-population-2020-2021.pdf).
(4) Borel AL et al. Reducing visceral, not subcutaneous, abdominal fat brings the benefits of a one-year lifestyle change program. Obesity (Silver Spring) 2012;20(6):1223-1233.