Explained | Ozempic, Wegovy and now Zepbound: The era of magic pills for treating obesity

Losing weight or beating obesity without much changes in lifestyle, exerciseor dieting is an attractive prospect. In the past few years, some 'magic pills' have appeared in the market for this. But how safe are they?

The newest entrant among medications that help with weight loss is Zepbound. The Food and Drug Administration (FDA) on Wednesday (Nov 8) granted its approval for Zepbound, fromAmerican pharmaceutical company Eli Lilly, after clinical trials demonstrated its potential to help peoplelose up to 23 kgs within a 16-month period.

Zepbound will join the league of existing medicines, such as Novo Nordisk's Ozempic and Wegovy, as well as Lilly's Mounjaro, that aid the process of weight loss.

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The FDA has authorised the use of this medication for adults suffering from obesity or those who are overweight and have at least one weight-related condition.

Eli Lilly has announced that Zepbound is expected to be available in the United States by the end of the year, with a monthly cost of approximately $1,060.

This high cost may make it inaccessible for many, as weight loss medications are often not fully covered by insurance, and Medicare does not cover them by law.

How does Zepbound work in the body?

Zepbound falls into the category of GLP-1 agonists, which imitate hormones that help reduce appetite and food intake. In addition to this, Zepbound also imitates another hormone, GIP, which may not only reduce appetite but also enhance the body's ability to break down sugar and fat.

In a phase 3 clinical trial, Zepbound led to an average weight loss of 22.5 per centof body weight, roughly equivalent to 23kgs, surpassing the efficacy of all currently available weight loss medications in the market.

The participants in the study had either obesity or were overweight with at least one weight-related condition.

Dr Christopher McGowan, a gastroenterologist who operates a weight loss clinic in Cary, North Carolina, told NBC news thatZepbound was the "the most effective form of pharmaceutical obesity treatment ever" and compared its effectiveness to that of bariatric surgery (a variety of surgical procedures to manage obesity and related conditions).

What about the side effects?

However, these medications do come with safety concerns. A recent incident that has garnered significant attention involves the passing of an Australian woman who was trying to shed weightbefore her daughter's wedding. Trish Webster, aged 56, was prescribed Ozempic, a medication (similar to Zepbound), primarily intended for managing Type 2 diabetes and aiding in weight loss.

Her weight loss journey took a distressing turn when she succumbed to a gastrointestinal illness. Consequently, her husband is now cautioning that the widely-used weight loss drug is "definitely not worth the risks."

Ozempic has gained worldwide popularity as a weight loss solution. According to information from the New York Post, this medication also works the way Zepbound does by mimicking a natural hormone called GLP-1, which slows down the passage of food through the stomach and intestines, resulting in prolonged feelings of fullness.

Furthermore, a recentexamination of the USFood and Drug Administration's adverse-event database by Reuters uncovered 265 reports of patients experiencing suicidal thoughts or behaviours while taking these or similar medicines since 2010. Among these reports, 36 instances describe suicides or suspected suicides.

For whom this medication works, is this a sustainable plan for weight management?

Some concerns are being raised by doctors, psychologists, and eating disorder experts about the potential long-term issues associated with these new medications, originally developed to treat diabetes.

The typical side effects of these medications, such as nausea, diarrhea, vomiting, and constipation, can be substantial. A real-world study demonstrated that nearly half of individuals with diabetes discontinued the earlier generation of these medications within a year, and 70 per cent within two years.

Moreover, individuals may not fully grasp the extent to which pharmaceutical companies, charging around $1,000 per month for these medications, are actively working to persuade them of the need for appetite-suppressing drugs, reported USA Today.

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There is concern that companies, society, and many doctors are reinforcing the inaccurate notion that a specific body mass index (BMI) signifies health while another equates to illness. Weight loss drugs are being viewed as a solution when, in reality, many individuals do not suffer from any underlying medical condition.

"There are people at a whole range of sizes and BMIs that are healthy when you look at actual diseases," DrKimberly Dennis, a psychiatrist who specialisesin treating addictions and eating disorders, told USA Today.

Weight loss drugs are"not a cure. For many of these folks, they have no actual illness," she added.

Studies indicate that the seesaweffect of weight loss and gain may inflict more harm on health than simply carrying excess weight. A compilation of studies in 2021 revealed that weight cycling was linked to an increased risk of diabetes. A previous study by Chinese researchers also identified an association between weight cycling and a 40 per centhigher risk of death, particularly from cardiovascular disease.

(With inputs from agencies)