Anti-obesity drugs, scientific breakthrough of the year for ‘Science’ magazine
The magazine highlights the reduction of cardiovascular accidents and the possibilities they open in fields as diverse as addictions, Alzheimer’s and Parkinson’s.
From gossip magazines to the cover Science. GLP-1 analogs, drugs used to treat diabetes and weight loss, have shaped the conversation all year. They started with news from celebrities like Elon Musk or Oprah Winfrey, the last to speak openly about their consumption. They put the cultural debate around obesity on the table, not as a moral issue or lack of will, but as a disease. Since the times of Botox and Viagra, no drug has entered the collective imagination in this way. Then they jumped to the salmon pages. Its two most popular commercial formulations, Ozempic and Wegovy, made its manufacturing company, the Danish Novo Nordisk, the most valuable in Europe and have saved Denmark from the recession. During all this time, its presence has been constant in scientific journals, where it has been demonstrating its effectiveness in weight loss and the reduction of cardiovascular accidents. And that is where they end the year, because the magazine Science has chosen GLP-1 analogues as the scientific breakthrough of 2023.
These drugs mimic the hormones that naturally make us feel full after eating. And each time they do it better and for longer. Although they have been prescribed since 2017, in recent years their effects have significantly expanded. Semaglutide (a molecule marketed as Wegovy) can produce a 15% reduction in total weight, a historic percentage that has never been achieved with medications. “But perhaps the most important thing of all, beyond the weight loss itself, is that they are demonstrating a reduction in morbidity and mortality,” says Juan José Gorgojo, head of the nutrition service at the Fundación Alcorcón University Hospital. MORE INFORMATION
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A study published this year has shown that these drugs reduce the risk of heart attacks and strokes by up to 20% in overweight people. “In addition, this same drug [semaglutida 2,4mg] “It has shown clinical benefits in patients with heart failure,” adds Dr. Gorgojo. “These are more than enough reasons for it to be highlighted as one of the advances of the year.” The magazine highlights these “two historic clinical trials” underlining that they have demonstrated benefits “that go beyond weight loss.” What’s more, the unexpected side effects that GLP-1 analogues have had, modifying the addictive behaviors of many patients, have opened the doors to possible future uses. “Currently, there are several trials underway investigating its use in the treatment of drug addiction, Alzheimer’s and Parkinson’s,” the magazine notes.
The announcement of Science It comes a day after the magazine Nature, the other great reference in the scientific world, chose the biochemist Svetlana Mojsov, a key figure in the discovery of GLP-1, as one of the ten scientists of the year. Mojsov’s role is doubly relevant in this story. Firstly, for her scientific contribution to these drugs, since she identified and characterized the hormone and created the peptides on which all this technology is based. But her story is also relevant because she exemplifies the patriarchal mechanics of the scientific world. For years, industry magazines and awards praised the work of her male colleagues, doctors Daniel Drucker, Joel Habener and Jens Juul Holst, while systematically ignoring hers. After years of struggle, Serbian biochemistry has achieved the recognition that until now had been denied to it. Magazines like Cell y Nature, who initially silenced their contributions, have had to publish rectifications to put their name on par with that of their colleagues.
Expense and the rebound effect
Dr. Gorgojo understands that, in the Spanish context, where GLP-1 agonists are only financed for cases of type 2 diabetes, Social Security should take note and start financing treatment for patients with obesity and related problems. The difference means going from paying 130 euros a week to around four. This will entail an effort for the public coffers, acknowledges the specialist, but in the long run it can mean savings. Obesity is the gateway to more than 200 cardiovascular diseases and problems. The complications it causes take up 9.7% of the total health expenditure in Spain, according to the OECD.
The bad thing is that this expense would not be punctual, but constant. “Obesity is a chronic disease,” says Gorgojo. “There is no treatment for a chronic disease that is used for a few months. “The treatment should be continued for life.” A recent clinical experiment carried out with tirzepatide (an even more potent molecule marketed under the name Mounjaro) demonstrated this maxim. After 36 weeks of treatment, patients experienced an average weight reduction of 20.9%. From then on, they withdrew the medication from a portion of the patients, replacing it with a placebo. These experienced a 14% weight regain, while those who continued with the medication continued to lose up to 5.5% more in the following weeks. The rebound effect is pronounced and begins at the same time that the drug is stopped.
Cristóbal Morales, an endocrinologist at the Virgen de la Macarena hospital in Seville and a prolific researcher in this field, highlights how these drugs have changed the social perception of obesity. “The big change is that we have realized that this is a social disease,” he explains. “There is a lack of evolutionary adaptation. We have prehistoric genes, from the Pleistocene, and our context is not the same as we had then. “We live in an obesogenic environment,” he reflects. Old genes, coupled with our new environments, push us to overeat. Ultra-processed foods function as true designer drugs, capable of releasing huge amounts of dopamine in bodies designed to react in this way to sugars and fat, which are rarer in natural foods. “The good thing is that science has advanced to provide an answer to this lack of adaptation, to this metabolic deregulation,” says Morales.
Pharmacological treatment of this disease can be effective. But its visible effects cannot make us lose focus, says the expert. “This is not going to be fixed with drugs alone, we need the main revolution to be the change of society,” he points out. We do not have to look for an individual solution, but rather a social and environmental one. According to the 2020 European Health Survey in Spain, 24% of people with low socioeconomic status have obesity, while among people with more resources, the prevalence is 9%. Obesity is a class issue, and the emergence of these drugs, which in the future will be available to everyone after paying a few hundred euros a week, can only accentuate this fact. For this reason, specialists ask to understand these drugs as a tool that improves health, not aesthetics, and to accompany scientific advances with a social and multifactorial approach.
“He A wise man He always needs pieces in his story to tell his story,” reflects Morales. “And we were missing pieces to tell this story, pieces of epigenetics to understand why we are suffering from this pandemic.” Now that we have them, now that obesity is beginning to be understood as a disease of a social and environmental nature, and not the result of a weak character or lack of will, we can begin to take solutions, explains the endocrinologist. 2023, notes Science, has been the year of the GLP-1 agonists. “I think 2024 will be the year to confront the problem of obesity and lower the curve of its complications,” adds the expert.
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