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Novo Nordisk, the maker of weight-loss drug Wegovy has become Europe's most valuable firm, dethroning the French luxury conglomerate LVMH
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- Title
- Wegovy: Weight-loss drug firm becomes Europe's most valuable
- Published
- Sep 5 2023
I'm seeing a lot about this stuff, but weight loss drugs especially have historically been snake oil (or long term suuuper bad for you, remember speed?). This seems to actually work huh?
I don't quite get how it works but it seems to suppress appetite. So ultimately it's a forced diet rather than working on getting the right amounts of nutrients, calories, and exercise.
How can one maintain such a weight if they've never learned to cope with having to eat healthy, and more importantly, consistently less.
I'm going to oversimplify it, but imagine for a moment that some people's body/brain are just broken in such a way that they don't feel full until they've way over eaten. When a normal/healthy person eats, their body emits the GLP-1 hormone which leads to signaling satiety (fullness to the brain) so they feel full and stop eating. If that pathway is broken for some reason, then people will over eat
Wegovy/Ozempic and other semaglutides mimic this GLP-1 hormone, so you feel full with a normal amount of food. It isn't necessarily a "forced diet", but if you are overweight because of overeating and cut back to a normal amount of food, you will lose weight because it takes a lot of extra calories to maintain being overweight.
It also slows down how quickly your stomach your empties the food, so you feel full longer and don't need to eat so frequently.
I think people do frequently combine it with switching to a more healthy diet as well by cutting out carbs, drinking less, etc.
Maybe society will decide that some people should take this medication forever, because that's still better than being obese and all the complications that come along with that. There are many other medications that people take forever (blood pressure, anti-depressants, hormone replacement, etc) and I don't think there's anything wrong with it. If it makes your life better, and it creates better outcomes at a societal level too, society should pay for it. Having an increasingly worse obesity problem is a much worse state of affairs.
Thank you for taking the time.
I agree, and I think my initial post didn't reflect that well enough. If it works without too many adverse side effects I'm all in favour. It's just that I'm a bit distrustful of weight loss drugs, it's the quintessential snake oil salesmen tool.
Now I don't need to lose weight, but I'd be happy if it positively affects the general populace. Obesity is an expensive problem everywhere.
We don’t know what the side effects will be long term. Some people develop serious issues but also, being obese is a serious issue too so it’s always a risk/reward analysis.
It’s not snake oil (it works for sure). So does speed and meth (and adhd drugs to lesser extent) by suppressing appetite. Time will tell what the long term effects are.
Long term amphetamine treatments are pretty common for ADHD, and I wasn't aware of major ongoing health concerns around those, although the dosage and release formulation is well controlled in that scenario - was it stimulants in general you were meaning with those long term problems, or more the 1950s tendency to hand them out like candy?
Beyond that, I do kind of see what you mean about appetite suppression, and it looks like there's a pretty significant rebound effect on people who stop taking semaglutide, but equally I'm not sure what getting the right amount of calories would look like if not reduced appetite? Exercise and balanced nutrition are huge for general health, no question, but shedding the weight first and foremost comes down to eating less, and that's going to be a lot harder if you're really, really hungry the whole time you're doing so.
Worst case, reduced appetite rapidly reduces excess weight here and now - that alone is a significant public health win. Best case, the lifestyle change (and the ability to make it without feeling like crap for 6-18 months or more) is the catalyst to form more balanced exercise and nutritional habits that'll round out general health beyond just weight.
ADHD medication such as dexamphetamines (something I use) or methylphenidate is quite different from the straight up methamphetamines they gave you for losing weight a couple of decades ago. And while dexamphetamines do indeed suppress appetite, it usually only does so during the initial adjustment period or marginally at best.
What you often see with diets and dietary restrictions is that people tend to yoyo as soon as they stop following that diet, because they have no concept of eating healthily or what portions are appropriate for them. I expect people to do the same after the semaglutide.
You make a good point however, dieting is super difficult if you're hungry all the time.
If this is something that works for people without too many adverse side effects and is followed by a nutrionist it could help with the obesity epidemic that is plaguing the entire world.
Yeah, that's why I think appetite suppression is the right approach for weight loss drugs.
It's also important to note that people are being prescribed drugs that have side effects of increasing appetite and causing weight gain. A specific one I know if is Olanzapine (branded as Zyprexa in the US), though I know of that one only from personal experience and not like I went researching for them, so I suspect that there would be more if someone actually looked for them.
For what it's worth, methamphetamine is also still approved and prescribed for ADHD under the brand name Desoxyn, although you're right in saying it's a lot less commonly used than one or both isomers of amphetamine (Vyvanse metabolises to just the dextro- version, Adderall contains levoamphetamine salts as well). I'll readily admit that I don't know exactly how that extra methyl group affects things at prescription doses compared to the more common alternatives, though, which is why I wasn't sure which angle you were going for there.
Either way, I think you're right that pairing these newer drugs with proper support from a nutritionist is likely to be key - framing of "this gives you the space to re-learn the right habits and start from a healthier baseline" rather than "this makes weight go away" is how I'd be looking at them, but it's by no means a given that other people would think the same.
How common is it that both isomers are used to treat the same condition? My understanding is that chiral molecules usually have very different effects.
In psychiatric medicine, very common. Most antidepressants are distributed in racemic formations, for example. Regarding amphetamine, the broad difference between the L and D forms comes down to preference for peripheral vs central nervous system stimulation. L causes more anxiety, increases the subjective sense of wakefulness, suppresses appetite more, while D causes more euphoria in recreational doses, as well as better focus and executive function enhancement. Many theories persist regarding the reason for continuing to prescribe racemic mixtures when single-enantiomer formulations appear superior for their indication.
Ah, don't read too much into it. It was mainly to illustrate how there's plethora of prescription drugs that suppress appetite whether or not that was the intended effect, and how they've changed into something rather benign in comparison to the amphetamines of the past. None of these things are specifically prescribed for weight loss anymore.
I don't think Desoxyn is available where I am, that's actually really interesting. Though I assume this is not prescribed for weight loss anymore either!