Doctor explains: Why obesity injections aren’t a ‘quick fix’ for weight loss

Weight problems is not only a matter of way of life however a posh interaction of hormones, genetics, drugs, stress, and sleep patterns. In India, rising charges of extreme weight problems (BMI ≥35) and metabolic weight problems, even amongst these with comparatively regular BMI have gotten a rising public well being concern. Polycystic Ovary Syndrome (PCOS), thyroid issues and sure drugs are key contributors to weight acquire in ladies, whereas stress, poor sleep and an “obesogenic” setting additional exacerbate the issue.

Newer weight problems drugs, together with semaglutide and tirzepatide, have proven outstanding effectiveness in scientific trials by focusing on urge for food regulation within the mind, delaying gastric emptying and enhancing metabolic parameters resembling blood glucose, liver fats and cardiovascular threat markers. But consultants emphasise that weight administration requires a holistic strategy, addressing hormonal, psychological and way of life components quite than relying solely on pharmacological interventions.

The press reporter talked to Dr. Subramanian Kannan, Director – Endocrinology and Diabetology at Narayana Well being Metropolis (Bengaluru) to grasp how clinicians decide candidates for weight problems injections, the physiological mechanisms of those medication and the broader methods wanted to deal with the weight problems epidemic in India.

How do you establish if a affected person is appropriate for prescription weight problems injections and the way quickly can they anticipate important weight reduction?

Dr Kannan: In ladies, it’s discovered that PCOS or Polycystic Ovary Syndrome is among the commonest causes of weight problems and weight acquire. And that is predominantly due to the hormonal modifications which can be occurring within the physique. So, if we see a younger woman who’s gaining weight and has irregular durations, we should always at all times display for PCOS as nicely.

The opposite quite common reason for weight problems is using sure drugs. For instance, steroids, some antidepressants, and even some drugs used for diabetes may cause weight acquire. So, it is vitally vital to take an in depth historical past of the affected person to grasp if any of those drugs are the reason for weight problems. Weight problems Injections could be prescribed in such circumstances and Weight reduction usually begins throughout the first 2 to 4 weeks.

What’s the mechanism by which these medication scale back urge for food and physique weight in sufferers?

Dr Kannan: These therapies work by correcting the damaged signalling between the intestine and the mind. To grasp how they work, we should take a look at the components they counteract: Poor sleep spikes ghrelin (the starvation hormone) and suppress leptin (the satiety hormone), resulting in intense cravings for high-calorie reward meals.
Additionally, Continual stress triggers cortisol launch, which is immediately linked to the buildup of visceral (stomach) fats and emotional consuming.

So, trendy injections concurrently lower the neurological drive to eat through mind signalling, enhance the bodily sensation of fullness by slowing gastric emptying, and improve general metabolic effectivity.

Are metabolic problems (kind 2 diabetes, NAFLD, hypertension) growing proportionately with weight problems prevalence in latest datasets?

Dr Kannan:  There’s a notable concern that sufferers whose BMI is probably not very excessive (under 25) can nonetheless carry a big burden of metabolic weight problems as a consequence of visceral adiposity (fats across the inner organs). Weight problems is not only about how a lot you weigh. It’s about the place the fats is distributed. Central weight problems, or fats across the stomach, is way more harmful than fats distributed in different components of the physique as a result of it’s carefully linked to metabolic ailments like diabetes and coronary heart illness. Whereas international knowledge suggests extreme weight problems numbers could also be coming down in some areas, in India, the inhabitants with a BMI over 35 or 40 is growing, which usually correlates with an increase in these metabolic problems.

How does thyroid operate affect the event, severity and administration of weight problems in sufferers?

Dr Kannan: Thyroid issues, particularly hypothyroidism the place the thyroid gland is underactive can even result in weight acquire. It’s because the thyroid hormone is answerable for the metabolism of the physique. When the degrees are low, the metabolism slows down, resulting in weight acquire even with a standard weight-reduction plan.”

How have weight problems traits modified in youngsters and adolescents (5–19 years) primarily based on latest multinational surveillance knowledge?

Dr Kannan: Genetics additionally play a big position. If each dad and mom are overweight, there’s an 80% probability that the youngsters can even be overweight. Nevertheless, genetics solely present the predisposition; the setting and way of life selections act because the triggers. So, even with a genetic tendency, a wholesome way of life may also help stop weight problems.

What’s your perspective on public notion vs. scientific actuality relating to “fast fixes” in weight problems therapy?

Dr Kannan: Environmental components are additionally crucial. The provision of low-cost, high-calorie processed meals and the sedentary nature of our trendy jobs have created what we name an ‘obesogenic setting.’ It has change into very simple to devour energy and really tough to burn them off.”

Lastly, we should discuss in regards to the psychological influence. Weight problems is commonly related to despair, low shallowness, and social isolation. It’s a vicious cycle the place the psychological state results in weight acquire, and the burden acquire additional worsens the psychological state. Remedy ought to at all times be holistic, addressing each bodily and psychological well being.

Are we seeing a quicker rise in extreme weight problems (BMI ≥35 or ≥40) in comparison with reasonable weight problems globally?

Dr Kannan: Worldwide, does point out that there’s a lesser quantity of individuals with extreme weight problems. So the info signifies globally that the variety of individuals with extreme weight problems is coming down. Nevertheless, in India, it’s a concern that this group of the inhabitants, with a BMI of greater than 35 or greater than 40, is beginning to enhance. Additionally, what worries us is that there’s additionally an issue the place sufferers whose BMI is probably not very excessive, possibly under 25, however nonetheless carry the burden of metabolic weight problems due to visceral adiposity as nicely. So, whereas the worldwide extreme weight problems could also be coming down, in India, we’re seeing sufferers with larger BMIs, higher than 35 and higher than 40.

Are you able to clarify how the newer weight problems drugs work at a physiological degree?

Dr Kannan: Newer weight problems drugs, resembling semaglutide (a GLP-1 receptor agonist) and tirzepatide (a twin GIP/GLP-1 receptor agonist), handle weight by mimicking pure “incretin” hormones produced within the intestine. They act on three major physiological methods: the mind, the digestive tract, and the metabolic tissues.

How efficient are semaglutide and tirzepatide when it comes to imply share physique weight discount in scientific trials?

Dr Kannan: At a physiological degree, these drugs bind to and activate GLP-1 receptors positioned in a number of key organs:

Mind: They act immediately on the mind’s starvation and satiety facilities to extend emotions of fullness and considerably scale back “meals noise” (intrusive ideas about consuming). This suppresses urge for food and reduces general caloric consumption.

Digestive Tract: They delay gastric emptying, that means meals stays within the abdomen longer. This bodily delay creates a chronic sensation of fullness after meals.

Pancreas: They stimulate insulin secretion and suppress glucagon launch in a glucose-dependent method, which stabilizes blood sugar and prevents the metabolic crashes that always set off cravings.

Dr Kannan: These drugs are extremely efficient at decreasing liver fats and irritation. Medical markers present a big lower in liver enzymes (ALT and AST), and imaging confirms that hepatic fats content material can drop by 30% to 50%.

Customers usually expertise a discount in each systolic and diastolic blood stress. Whereas the medication have some direct vascular results, a lot of this enchancment happens as a result of weight reduction reduces the workload on the center.

What does present proof say about cardiovascular threat discount (if any) with weight problems injections?

Dr Kannan: Present proof reveals that weight problems injections—particularly GLP-1 and twin GIP/GLP-1 receptor agonists—present important cardiovascular safety. Essentially the most sturdy proof comes from large-scale cardiovascular consequence trials (CVOTs), which display that these drugs scale back the danger of main adversarial cardiovascular occasions (MACE) like coronary heart assault and stroke.