In an unexpected shift from celebrity gossip to Science magazine cover stories, GLP-1 analogs, originally used to treat diabetes and aid in weight loss, have dominated conversations throughout the year. Initially thrust into the limelight by celebrities like Elon Musk and Oprah Winfrey openly discussing their use, these drugs have ignited cultural debates around obesity.
Unlike previous pharmaceutical phenomena like Botox and Viagra, these drugs have permeated collective consciousness. The two most popular commercial formulations, Ozempic and Wegovy, have propelled their manufacturer, Danish company Novo Nordisk, to become Europe’s most valuable, rescuing Denmark from recession. Their presence has remained constant in scientific journals, demonstrating their efficacy in weight loss and reducing cardiovascular incidents.
Concluding the year on a high note, Science magazine has declared GLP-1 analogs the scientific breakthrough of 2023.
Mechanism and Advancements
These drugs mimic hormones that naturally induce feelings of satiety after eating, doing so more effectively and for extended durations. Despite being prescribed since 2017, they have significantly expanded their effects in recent years. Semaglutide, marketed as Wegovy, can achieve a historic 15% total weight reduction, a percentage unprecedented in medication history.
Juan José Gorgojo, head of nutrition at the University Hospital Foundation Alcorcón, emphasizes, “Beyond weight loss, what might be more important is the demonstrated reduction in morbidity and mortality.”
Cardiovascular Benefits and Unexpected Side Effects
Studies this year have shown a 20% reduction in the risk of heart attacks and strokes in overweight individuals using these drugs. Dr. Gorgojo adds, “This same drug [semaglutide 2.4mg] has shown clinical benefits in patients with heart failure.”
Science magazine applauds these “two historic clinical trials,” underscoring benefits “beyond weight loss.” Moreover, the unexpected side effects altering addictive behaviors in many patients have opened doors to potential future uses. “Currently, several ongoing trials explore their use in treating addiction, Alzheimer’s, and Parkinson’s,” notes the magazine.
Recognition and Gender Dynamics
Science’s announcement comes a day after Nature, another major scientific journal, named biochemist Svetlana Mojsov, a key figure in GLP-1 discovery, one of the ten scientists of the year. Mojsov’s role is doubly relevant in this narrative. She contributed scientifically, identifying and characterizing the hormone and creating the peptides forming the foundation of this technology.
However, her story also underscores the patriarchal dynamics in the scientific world. For years, journals and awards lauded the work of her male colleagues, Drs. Daniel Drucker, Joel Habener, and Jens Juul Holst, systematically ignoring her contributions. After years of struggle, the Serbian biochemist has finally secured the recognition previously denied to her.
Journals like Cell and Nature, initially downplaying her contributions, have had to publish corrections to align her name with her colleagues.
Economic Considerations and Rebound Effects
Dr. Gorgojo suggests that, in the Spanish context where GLP-1 agonists are only funded for type 2 diabetes cases, the Social Security should reconsider and start financing treatment for obesity and related issues. While this might strain public finances, the specialist acknowledges that it could lead to long-term savings. Obesity is the gateway to over 200 diseases and cardiovascular problems, accounting for 9.7% of Spain’s total health expenditure, according to the OECD.
However, this expenditure would not be a one-time occurrence but a continuous one.
“Obesity is a chronic disease.”
Gorgojo
“There is no treatment for a chronic disease used for a few months; the treatment must be lifelong.” A recent clinical experiment with tirzepatide (a more potent molecule marketed as Mounjaro) demonstrated this. After 36 weeks of treatment, patients experienced an average weight reduction of 20.9%.
Some patients had the medication replaced with a placebo, resulting in a 14% weight rebound, while those continuing the medication lost an additional 5.5% in subsequent weeks. The rebound effect is pronounced and begins as soon as the drug is discontinued.
Changing Perceptions and Societal Considerations
Endocrinologist Cristóbal Morales from the Virgen de la Macarena Hospital in Seville, a prolific researcher in this field, highlights how these drugs have shifted societal perceptions of obesity. “The significant change is realizing that this is a social disease,” he explains.
“There’s a lack of evolutionary adaptation. We have prehistoric genes from the Pleistocene, and our context is not the same as we had back then. We live in an obesogenic environment,” he reflects. Old genes combined with new environments drive us to overeat. Ultra-processed foods act as potent designer drugs, releasing large amounts of dopamine in bodies designed to react this way to sugars and fats, more scarce in natural foods.
“The good thing is that science has advanced to provide an answer to this lack of adaptation, this metabolic dysregulation,” notes Morales.
While pharmacological treatment of this disease can be effective, the visible effects shouldn’t distract from the main focus, according to the expert. “This won’t be fixed with drugs alone; we need the main revolution to be a societal change,” he points out.
The solution shouldn’t be individual but social and environmental. According to the 2020 European Health Survey in Spain, 24% of people with low socioeconomic status have obesity, while among those with more resources, the prevalence is 9%. Obesity is a class issue, and the introduction of these drugs, which will likely be available to everyone for a few hundred euros per week, can only accentuate this fact.
Therefore, specialists urge understanding these drugs as a tool to improve health, not aesthetics, and accompanying scientific advances with a social and multifactorial approach.
“Homo sapiens always needs pieces in its narrative to tell its story.”
Morales
“And we lacked pieces to tell this story, epigenetic pieces to understand why we are experiencing this pandemic.” Now that we have them, now that obesity is beginning to be understood as a socially and environmentally related disease, not the result of weak character or lack of willpower, solutions can begin, explains the endocrinologist.
Science declares 2023 as the year of GLP-1 agonists. “2024, I believe, will be the year to confront the obesity problem and lower the curve of its complications,” adds the expert.
Original source: This information was Initially covered by elpais and has been translated for our readers.
