In the realm of weight management, diet and exercise have long been the foundational approach. However, with obesity affecting 30% of Canadians, the emergence of specialized weight-loss medications offers a promising adjunct for those requiring additional support to achieve a healthier lifestyle.
A Brief History and New Developments
Weight-loss medications are not new to Canada. The first drug approved was Xenical in 1999. Over two decades later, drugs like Ozempic, which contains the active ingredient Semaglutide, have gained significant attention for their weight-loss potential. This ingredient is also central to Wegovy, a weight-loss-specific medication introduced to the Canadian market in May 2024.
We consulted with Zubin Punthakee and Katherine Morrison, researchers specializing in obesity and diabetes at McMaster University, to delve into the mechanics of these medications and their implications for both adults and children.
Understanding Semaglutide
Semaglutide is a Glucagon-Like Peptide-1 (GLP-1) receptor agonist. This class of medication mimics the hormone GLP-1, which is produced naturally in the body post-eating. GLP-1 communicates with the brain to signal satiety and slows gastric emptying, prolonging the feeling of fullness.
“By making us feel fuller for longer after meals, Semaglutide helps reduce the signals that typically trigger more eating,” explains Punthakee, an associate professor in the Department of Medicine and a member of the Centre for Metabolism, Obesity, and Diabetes Research (MODR).
This medication is recommended for adults with a body mass index (BMI) of 27 or higher, particularly if they have related conditions such as hypertension, Type 2 diabetes, dyslipidemia, or obstructive sleep apnea. It is also approved for use in children aged 12 and above.
Side Effects and Patient Experiences
Common side effects of Semaglutide include nausea, vomiting, constipation, and diarrhea. Some patients may also experience a diminished appetite, which, while beneficial for weight loss, can lead to reduced enjoyment of food. “Some individuals may discontinue the medication because it works too effectively in suppressing appetite,” Punthakee notes.
Integrating Medication with Lifestyle Changes
The notion that weight loss is simply a matter of eating less and exercising more is a misconception. According to Morrison, a professor in the Department of Pediatrics and co-director of MODR, the brain’s biochemistry plays a significant role in regulating hunger and weight.
“Biological differences mean that some people have stronger appetite drives than others,” Morrison explains. “Obesity, like diabetes or hypertension, is a chronic health condition. While non-drug interventions are preferred, they are not always effective for everyone.”
Medications like Wegovy can be instrumental by altering the brain’s hunger signals, thereby assisting in weight management.
Application in Pediatric Cases
Although Semaglutide is approved for children aged 12 and older, the long-term effects remain under-researched. Morrison emphasizes that its use should be focused on improving health rather than merely reducing body size.
“When considering this medication for adolescents, the primary concern should be health improvements,” Morrison advises. She is involved in developing new clinical practice guidelines to aid clinicians and families in making informed decisions. These guidelines are expected to be released later in 2024 and will emphasize healthy nutrition, regular physical activity, reduced screen time, adequate sleep, and mental health.
Long-Term Sustainability and Research Needs
Both Morrison and Punthakee stress the need for more research to understand the long-term implications of these drugs, particularly upon discontinuation.
“We have limited long-term data, especially in pediatric cases, and it’s crucial for families to be aware of this before deciding on such treatments,” Morrison says.
Punthakee highlights that most adult research has focused on Semaglutide for diabetes management rather than weight loss. However, existing evidence suggests that the medication does not pose known long-term harms. “Studies have indicated benefits such as reduced heart attacks, strokes, and kidney complications from diabetes,” he adds.
Patients ceasing the use of weight-loss drugs should expect a return of appetite and reduced feelings of fullness.
Conclusion
As weight-loss medications gain traction in Canada, understanding their benefits and limitations is crucial. While these drugs offer significant support for those struggling with obesity, comprehensive research and individualized care remain essential to their effective and safe use.
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