Treating obesity: why medication alone is not the answer

According to data collected by the World Health Organisation, in 2022 more than one billion people around the world were living with obesity. Although the condition is often seen as an aesthetic issue, it can also constitute a health risk, as obesity can lead to cardiovascular issues. 

To better understand the risks and possible treatment of this condition, Fabio Broglio, associate professor of endocrinology at the University of Turin and metabolic disease, shares his expertise. 

The history of obesity medication

For many years, experts believed that the best obesity treatment was diet and exercise. However, in recent years, new medication has been introduced that specifically target the incretin system, which contains hormones that regulate our appetite and metabolism.

Professor Broglio explained that «These new drugs have actually been approved in recent years for use in obesity. They differ from a more nutritional approach in terms of their potency. The two molecules currently approved, in studies, have been shown to allow a weight reduction of about 15% for the former and up to 23–25% for the latter. The studies have also documented that this effect is long-lasting, so if one continues the therapy, the effect persists. The only significant adverse effect is gastrointestinal adverse events, so potentially nausea and vomiting, which in most cases tend to resolve».

In response to fears that the medication may be harmful, Professor Broglio is adamant in stating that «although the most common fake news is that these drugs cause cancers or pancreatitis. In reality, this is not the case. These fears originate from early studies that were conducted before human trials, in which the use of very high doses could indeed induce these kinds of problems in animals that are much smaller than humans, essentially due to overdosing».

On the contrary, the use of these medications has proved to reduce the risk of cardiovascular issues, which cause heart attacks or strokes. Nevertheless, obesity tends to be a multifaceted issue, which can be linked to the central nervous system, brain circuits of hunger, satiety, and also of food-related pleasure.

«We very often eat for pleasure, out of desire rather than true hunger – Professor Broglio explains – and then there is a whole other range of hormones produced by our intestine that, when we eat, communicate to the brain that we have eaten, and moreover they modulate how what we eat is managed in our body, for example whether it is stored as adipose tissue».

Although there is currently much research on various medications that can supplement the aforementioned hormones, another challenge in pharmacological research in recent years is to have molecules that can be administered orally, that is, in the form of pills. According to Professor Broglio: «The drugs currently available for excess weight are injectable; they are subcutaneous and administered weekly. They are certainly convenient and possible, but they are also very expensive due to their chemical formulation. What researchers are therefore looking for are molecules that do more or less the same thing but require less complex technology for their synthesis, allowing them to be administered orally».

Combining medications with behavioural therapy

For many people, obesity can be linked to an emotional approach to food. As Professor Broglio illustrates: «very often we realise that in some people, food intake is not perfectly controlled just for nutrition; rather, they eat out of boredom, anger, or frustration, and this set of behaviours is what really undermines a diet».

Therefore, treating obesity must be done through a personalised and strategic approach. «It’s paramount to identify what their needs are, as well as their resources; that is, in which aspect, what is the likely reason they have gained weight or tend not to lose it, considering nutrition, psychological factors, and physical activity».

Obesity is considered a chronic, relapsing disease; that is, it takes time and can potentially return if the driving factors that caused it are not addressed. Therefore, every person should be assessed in these three areas, nutrition, physical activity, and psyche, and build a long-term care plan. Medication can certainly help and can be included as part of this process to accelerate weight loss.

The importance of preventing childhood obesity

Adolescent and paediatric obesity is a very important issue because it is extremely common. Moreover, obesity during childhood often continues into adulthood, increasing the amount of time a person may accumulate additional risk factors and develop other diseases. 

Professor Broglio emphasises how «it’s an important problem because it is often unrecognised. Significant statistics are showing that a child with clear obesity is not recognised as such even by their own parents, and therefore a whole pathway toward weight loss and health is not initiated».

Furthermore, bullying someone because of their weight tends to be common among adolescents, some children may forgo physical activity out of fear of being ridiculed. Therefore, the use of developing medication to aid children and adolescents in losing weight has been discussed. Professor Broglio explains that «trials and studies have also been designed in adolescents to verify that these drugs are safe. By ‘safe,’ I mean not only that they do not have the same complications ruled out in adults, but also, for example, that they do not interfere with growth».

«It is essential that treatment be guided by healthcare professionals who integrate medication within a broader care pathway that also includes non-pharmacological approaches – the Professor concludes – This helps avoid the risk of excessive medicalisation as the easiest and quickest solution, while instead encouraging meaningful and lasting behavioural change».