Wegovy Drug Not Miracle Obesity Cure, Warns Weight-Loss Doctor

Natalie
Akoorie, Senior reporter

A weight-loss
doctor is warning patients not to rely on Wegovy as a cure
for obesity, saying the newly available medication could be
more harmful than helpful.

Waikato bariatric surgeon
Dr Rowan French said Wegovy was a welcome tool in the battle
against obesity, but it needed to be used in conjunction
with psychological, exercise and nutritional
support.

As with bariatric surgery, he recommended
patients address the reasons they overate and the types of
food they ate to avoid regaining any weight
lost.

“People need to know that it’s likely,
particularly for someone who’s living with severe obesity…
their problem is a lifelong one and, while it can be
controlled, there’s a good chance they will never fully be
cured of that.

“Without substantial change in their
lifestyle – this is not just the foods they eat, it’s the
reasons they eat as well – without external help to
understand their drivers to eat and nutritional help to
understand the sorts of foods that they should be eating,
particularly in the first 18-24 months, then the medications
could prove more harmful than good.

“Particularly by
causing some initial weight loss followed by substantial
weight regain.”

How does Wegovy work?

Wegovy
contains semaglutide, an obesity medication that’s a
synthetic form of a hormone called GLP-1, which is made in
the small intestine.

Ozempic is also semaglutide and
works in the same way, but is licenced for type 2 diabetes
rather than obesity.

GLP-1 plays several roles in the
body, including triggering insulin release from the
pancreas, and affecting areas of the brain that control
hunger and satiety (feeling full).

Gastric bypass
surgery causes amplified release of GLP-1 (and other
hormones) from the small bowel in response to meals, which
switches off appetite.

The release is cyclical, which
means the hormone levels go up and down through the course
of the day in response to eating, and goes directly into the
gut circulation.

By contrast, Wegovy is injected under
the skin in a large weekly dose into the systemic
circulation.

“Here’s the problem,” French said. “We
already know there is tachyphylaxis – the medical term for
tolerance – that occurs with bariatric surgery as early as
18-24 months after surgery – there is a slowly waning
effect.

“We can be almost certain that the injection
of synthetic GLP-1 given in large bolus will cause tolerance
earlier and more profoundly than bariatric
surgery.

“In other words, as time goes on, the patient
will get less and less benefit from the medication, so any
suggestion some people should stay on it for life is
unlikely to be sensible or beneficial.”

French said
that was where psychological and nutritional support, as
well as exercise to avoid muscle mass loss, was vital, but
“infrequently available”.

“We know that weight regain
is common several years after bariatric surgery,
particularly if patients are not engaged in
multidisciplinary follow-up.

“We know that, when
semaglutide is stopped, in most cases, weight is regained,
but we can also predict, if a patient stays on it, they will
develop tolerance, because this occurs with bariatric
surgery, albeit later in the piece.”

‘Obesity is a
lifelong disease’

French said people with a weight
problem almost certainly had a lifelong disease.

“We
are generally born with a likely predicted adult weight,
which – in large part – is decided by our genetics… things
that have happened to us in early life [trauma] and, to a
certain extent, the environment.

“We have far less
control over our long-term weight than most people think we
do.”

He said long-term weight control was subconscious
– it happened in the “primitive brain”.

“We can
temporarily go on diets. We can temporarily override our
primitive brain, but almost always this innate set-point…
that we are born with dictates what our adult weight is
going to be and it will drag us back up to that adult
weight, despite going on diets.”

The aim was to
control obesity, not cure it, French said.

“One of the
things we see that raises that set-point is what we call
‘cyclical dieting’.”

Also known as ‘yo-yo dieting’,
this is when a person loses weight on a diet, but regains it
after the diet ends.

“Our primitive brain interprets
that as starvation and it starts to fight back, and most
people will regain the weight quite quickly.

“They
will go back to a weight that was slightly higher and it’s
nature’s way of putting more in the bank in case it happens
again.”

French said, when yo-yo dieting elevated a
person’s set-point to a new, higher level, the brain in turn
defends that weight.

“So every time someone goes on a
yo-yo diet and gains more, their weight set-point rises, so
by the time we see people with severe problems who need
treatment such as bariatric surgery, they might have done
10-12 diets.

“Each time their set-point has risen and
it might have gone up 20, 25, 30, 35kg over a number of
years.”

The role of ultra-processed
food

French, who works in public and private, is
speaking out, because he’s concerned Wegovy has been
sensationalised by celebrities as a wonder-drug.

While
he said the new medications were the best New Zealand had
ever had for weight loss, he stressed the need to address
the causes of obesity.

One factor, he said, was the
type of food people ate.

French said ultra-processed
food (UPF) caused a spike in obesity rates in the mid-1980s
and what he refers to as “pandemic obesity” in the western
world.

“Essentially, you’ve got now a dominant food
that makes up about 50-60 percent of what we eat, which is
purely manufactured and designed to make us eat as much as
possible.

“We know from the very robust data that it
causes metabolic disease, it causes depression, it causes
dementia, it causes cancer.”

UPFs included most food
that wasn’t a whole food.

“Whole food being what your
grandma would recognise as food,” he said. “Very simply, if
it’s wrapped in plastic and it’s got one ingredient that you
wouldn’t find in a home kitchen, that’s an ultra-processed
food.”

The food was attractive because it was
convenient, quick to prepare and easy to cook, and often
less expensive.

French said it was often soft and easy
to chew, low in fibre and didn’t activate the hormone needed
to make a person feel full, so people ate more.

“It’s
the combination of salt, fat and sugar that’s always
engineered to make it the most moorish it can possibly
be.”

French, who’s private work is through Tailor
Clinics in Hamilton, said his patients learn about eating
whole foods at least 95 percent of the
time.

© Scoop Media