Semaglutide and “The Answer” to Obesity

“Medical care is nice, but it’s surely not the answer to obesity. Behaviors matter.” These words came to us from the audience of a webinar for a regional business group on health. Oddly enough, those words came on the same day that JAMA published yet another major study on semaglutide for treating obesity. Two weeks ago, NEJM created quite a buzz with one. Does all this buzz mean that semaglutide is “the answer” to obesity?

No. But then again, neither is behavior change. In fact, this new study tells us that semaglutide is roughly three times more effective than intensive behavioral therapy for helping people with obesity reduce their weight. Yes, behavioral therapy does help. So behavior matters. But the biology of obesity matters just as much or more.

Adding Semaglutide to Intensive Behavior Change

This was a placebo controlled study. Researchers randomly assigned patients to receive either the drug or a placebo injection – along with very intensive behavioral therapy. Lead author Thomas Wadden explained:

“We wanted to induce a large weight loss with rigorous behavioral therapy and see how much additional weight loss semaglutide could add.

“The results with semaglutide appear to be the breakthrough in weight management that health care providers and their patients with obesity have been waiting for. It’s clear that adding semaglutide to intensive behavioral therapy could substantially increase the proportions of patients who lose 10 percent or more of their starting weight, with accompanying improvements in health and mobility.”

Resistance to a Game Changer

These studies have sparked a lot of talk about semaglutide as a “game changer” for obesity. In some sense, this is well justified. Roughly a third of the patients in these rigorous studies lost weight that is comparable to the results that might come from a gastric sleeve operation. So definitely, semaglutide is a big deal. This increased level of efficacy will change the attitudes of many health professionals about anti-obesity meds.

But resistance is certain, too. Anti-fat bias and the false belief that people with obesity must own up to their fate is deeply rooted. As we see in many dimensions of life these days, bias resists mere facts. Making this point, King’s College Professor Tom Sanders wrote for BBC Science Focus that semaglutide is promising, but not a magic bullet:

“We still need to stick with public health measures and not become over-dependent on medicines.”

That’s a jolly good idea, but not too much help for 42 percent of population, which already has obesity. Wishful thinking and force of will does not make it disappear. Also, it would help if we had public health measures that actually work to reduce the prevalence of obesity.

The Answer or An Answer?

Of course, semaglutide will not be the answer to obesity. We are eager for Sanders and like-minded people to discover that we need many answers to solve this problem. Preferably they will be more helpful than the ineffective answers (like just eat less and move more) applied to this challenge up until now. Semaglutide will likely be an answer for some people.

Click here for the study in JAMA, here for the commentary from Sanders. For further reporting on this latest study, click here and here.

Spell Words, painting by Nicholas Roerich / WikiArt

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February 26, 2021