EnvisioningHealth - Changing Lives One Idea at a Time | Health Dispatch
Beneath the starry allure of a touted weight-loss drug lies a promising stride in the battle against both obesity and diabetes.
Issue 2 | September 2023
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During the 2023 Academy Awards, host Jimmy Kimmel humorously hinted at Hollywood's latest infatuation when he quipped, "When I look around this room, I can't help but wonder, 'Is Ozempic right for me?'"
From Tesla's Elon Musk to actress Amy Schumer, the allure of the weight-loss drug has rippled through the star-studded community. But beyond the glitz and glamour, this medication represents a renewed emphasis on weight loss - and it offers more than just a slender physique for many.
Ozempic, once exclusive to type 2 diabetes patients, has quickly become the sought-after solution to shed excess weight. Hashtags, headlines, and TikTok trends aside, the underlying science of the drug is compelling, especially in light of the mounting correlation between diabetes, obesity, and cardiovascular health.
The new generation of weight-loss drugs came into the spotlight quite serendipitously. Developed to fine-tune glucose regulation in people with diabetes plagued by elevated blood sugar levels, these drugs deploy amino-acid chains to mimic hormones—those that the body typically produces after a meal but are often scant in people with diabetes.
At its core, semaglutide, the active ingredient in the drug, mirrors the workings of the glucagon-like peptide-1 (GLP-1) hormone. It amplifies the production of insulin, which facilitates the shuttling of blood sugar into cells. It curtails glucagon release, limiting the sugar released from the liver into the bloodstream. Moreover, by moderating the rate at which the stomach empties, the drug creates a feeling of fullness, thereby curbing appetite. While primarily tailored for lowering of blood sugar, its weight loss implications are pronounced.
Considering the inherent challenges of combating obesity, Dr Khoo Chin Meng, head and senior consultant at the Division of Endocrinology, Department of Medicine at the National University Hospital (NUH), commends semaglutide as highly "game-changing" when it comes to the management of metabolic disorders.
Wegovy, a higher-dose version of semaglutide, has been shown to help those with obesity or a high-risk body mass index (BMI) lose about 15% of their weight.
However, weight-loss drugs such as Ozempic should be used with caution. It's vital that their use aligns with the patient's best interests, and that the potential benefits significantly outweigh the risks. A solid medical rationale should back their prescription, and patients must be thoroughly informed and consenting.
In addition, Ozempic isn't without side effects, stemming from its effects from delayed gastric emptying. Common issues include nausea, vomiting, abdominal discomfort, and constipation. Less frequent but more severe side effects range from pancreatitis and kidney failure to allergic reactions and gallbladder problems. A particularly notable side effect, called "Ozempic face", results in a gaunt appearance due to the reduction of facial fat pads and a subsequent loosening of skin coupled with more prominent wrinkles.
Addressing obesity, especially with a startling 20.7% of Singaporeans falling into the high-risk BMI category, is crucial. Beyond mere appearance, obesity is a precursor to multiple health complications, ranging from type 2 diabetes, high blood pressure, fatty liver, sleep apnoea, and heightened cancer risk. The intertwined nature of diabetes, obesity, and cardiovascular diseases underscores the urgency to manage these conditions, with overall heart health at the epicentre.
"Taking weight-loss drugs such as Ozempic to manage obesity should ideally be part of a holistic management strategy, encompassing healthy eating, physical activity, and cognitive behavioural therapy," advises Dr Khoo. Failing so, there is a high risk of weight rebound upon cessation of the weight-loss drug.
One dietary strategy is the Healthy Ketogenic diet developed by NUH. By limiting carbohydrates intake to 50 grams per day to induce ketosis and focusing on healthy fats, high fibre and lean proteins while restricting calories, this diet can promote weight loss, regulate cholesterol, and even manage blood sugar levels.
For those severely impacted by obesity - having a BMI of 32.5kg/m2 with related health issues or above 37.5kg/m2 without complications - bariatric and metabolic surgery is an option. This procedure reduces the functioning capacity of the stomach which then leads to a reduction in calorie intake. It tackles obesity and diabetes by recalibrating energy balance, promoting gut health, and modulating hunger.
The surgery offers numerous benefits - it not only improves the quality of life for patients but also adds precious years to their lives. Moreover, it mitigates various health concerns such as osteoarthritis, sleep apnoea, hypertension, fertility challenges and many other metabolic diseases. However, it's important to note that potential risks do exist, which can be effectively managed with regular post-operative check-ups.
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