The results of the research work leading to the development of new drugs like Ozempic have just been recognized as the scientific breakthrough of the year 2023 by the journal Science (1). Indeed, these molecules can be useful in the treatment of type 2 diabetes, but also in the management of at-risk obesity. Given their high costs, their significant side effects and the need to take them for decades, it would be wise, in most cases, to consider lifestyle approaches since they provide results that are just as effective. also interesting.
The role of the intestine in type 2 diabetes and obesity
The relatively recent discovery that the intestine produces hormones (incretins) affecting not only blood sugar control, but also appetite has led the pharmaceutical industry to develop molecules – semaglutide, known by the trade name Ozempic – in properties similar to these hormones, but which degrade much less quickly
The first research results were very encouraging since they demonstrated their effectiveness in glycemic control in patients with type 2 diabetes in addition to inducing fairly significant weight loss. Subsequent studies revealed that this new class of drugs also reduced the risk of cardiovascular disease in patients with type 2 diabetes.
The Ozempic does it reduce cardiovascular risk?
These drugs were subsequently tested in patients with obesity but without diabetes. Again, significant weight losses have been reported. Is this weight loss also associated with a reduced risk of cardiovascular disease?
The SELECT study, published on November 11, 2023 in the New England Journal of Medicine, aimed to answer this question (2). More than 17,000 patients randomly assigned to receive semaglutide or a placebo were followed for an average duration of 40 months. Patients had overweight or obesity and existing cardiovascular disease, but not diabetes. However, two thirds had a condition called prediabetes and their waist circumference was very high (more than 110 cm), suggesting the presence of visceral obesity and elements of 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 medications to treat their risk factors such as hypertension. or their high cholesterol.
Is this really the solution?
The latest data from 2020-2021 indicates that 23% of the Quebec population meets the criteria for obesity (3). Should this medication be prescribed to anyone who wants to lose weight? Ozempic undoubtedly helps lose weight 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 the long-term risks of which remain unknown.
Target lifestyle
In our studies carried out at IUCPQ – Université Laval, we supported men with visceral obesity by targeting their diet and their level of physical activity. After one year, we observed reductions in waist circumference essentially similar (4) to those reported with semaglutide in the SELECT study. The participants were, however, accompanied on a regular basis by kinesiologists and nutritionists, which certainly involves costs, but much lower than those associated with taking Ozempic. Thus, we could give ourselves the means to invest in the care of hundreds of thousands of at-risk patients by targeting, initially, their lifestyle.
The development of these new molecules undeniably represents remarkable progress. By also investing in preventive approaches and in the development of socio-economic conditions that will limit the progression of obesity in our society, everyone will benefit and at a lower cost!
(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 [En ligne]Quebec, Institute of Statistics of Quebec, 328 p. [statistique.quebec.ca/fr/fichier/enquete-quebecoise-sante-population-2020-2021.pdf].
(4) Borel AL et al. Visceral and not subcutaneous abdominal adiposity reduction drives the benefits of a 1-year lifestyle modification program. Obesity (Silver Spring) 2012;20(6):1223-1233.