It is no longer new that pharmacotherapy can help people with obesity achieve and maintain their weight loss goal, thereby reducing the risk of obesity-related complications. And although there is already availability of approved anti-obesity drugs, this population may not have access to or receive treatment at consistent levels. Thus, learn more about the use of Saxenda in slimming.
Among the reasons for the low levels of initiation and prolonged use of anti-obesity drugs can be cited the reluctance of public health and medical organizations to recognize obesity as a disease, lack of reimbursement, inexperience of the provider and erroneous perceptions about the efficacy and safety of available treatments.
Anti-obesity drugs
There are several anti-obesity drugs currently available on the market as an aid in lifestyle modification, each with different mechanisms of action. These include liraglutide and semaglutide, which were initially developed for the treatment of type 2 diabetes, but have been shown to be effective not only in reducing blood glucose levels, but also in body weight.
In the case of liraglutide, marketed as saxenda, subcutaneous administration of 3.0 mg/day for the treatment of obesity is indicated. Being a glucagon-like peptide 1 receptor agonist (GLP 1RAs), it reduces body weight in several ways, i.e., by decreasing appetite and hunger, as well as increasing satiety, which results in a caloric deficit.
GLP-1 is released by L cells in the gut in response to energy intake and facilitates a multitude of physiological actions, including a delay in gastric emptying. While in the central nervous system, GLP-1 receptors are located in the hypothalamus, which is involved in regulating food intake and reducing the sensation of hunger is associated with an increase in functional connectivity of the solitary nuclei with the hypothalamus and thalamus.
In addition, compensatory changes in levels of weight-regulating hormones such as leptin, ghrelin, YY peptide and gastric inhibitor peptide can neutralize the diet-induced weight loss process, highlighting the difficulty in maintaining weight loss only with diet. Therefore, it is suggested that the treatment of obesity should be considered chronic (as in the case of hypertension), and not a short treatment associated with acute diseases.
Tolerability to Saxenda in Slimming
Because it is an antidiabetic drug being used to treat obesity, it is concerned about the possibility of increasing the risk of hypoglycemia in these patients. However, the action of GLP-1 is glucose-dependent and blood glucose is only reduced by GLP-1 if concentrations are above fasting levels.
In this context, the most frequently reported adverse events tend to involve the gastrointestinal system, with nausea, vomiting and diarrhea that in patients with obesity or obesity and diabetes only tend to be mild to moderate and transient.
In addition, there are several strategies that can be employed to help manage or minimize possible gastrointestinal discomfort when starting the use of GLP-1RA, such as a gradual dose increase is recommended for liraglutide 3.0 mg, starting with the initial dose of 0.6 mg per day for 1 week, increasing the dose in weekly increments until reaching the maximum therapeutic dose of 3.0 mg.
Why opt for Saxenda in slimming?
Currently, pharmacotherapy is recommended as an adjunct to lifestyle modification for individuals with BMI of at least 30 kg/m2 or at least 27 kg/m2 associated with comorbidities, as weight loss can improve cardiometabolic parameters, including prediabetes, dyslipidemia, and hypertension.
Thus, treatment decision-making can be guided by the different mechanisms of action of anti-obesity drugs to determine the adequacy of therapy for the patient individually. For example, if patients experience symptoms such as early hunger or lack of satiety, a GLP-1RA may be appropriate compared to other available treatments that work only by suppressing appetite or inhibiting fat absorption. In addition to taking into account the mechanism of action of each class of medication, there are certain contra indications and adverse effects to be considered as in the case of naltrexone-bupropion that is not suitable for patients with uncontrolled hypertension, phentermine which is contraindicated in patients with a history of cardiovascular disease or phentermine-topiramate that is contraindicated for those taking certain antidepressant medications.
Therefore, liraglutide is an alternative option when the patient has continuous mental health problems, although it should be avoided in patients with a history of suicide attempts or active suicidal ideation. It is important to note that orlistat is contraindicated in patients with chronic malabsorption syndrome and cholestasis, conditions that require avoiding fatty foods.
Clinical practice
Since GLP-1RA therapy has also been shown to reduce preference for fatty foods, GLP-1RA therapy may be preferred for patients who would find it difficult to avoid this type of food under normal circumstances. If other health problems such as prediabetes or polycystic ovary syndrome (PCOS) are present, GLP-1RA therapy is even more preferable compared to other treatment options, with the use of Saxenda in weight loss.
However, liraglutide has a black box warning for C-cell thyroid tumors, and is contraindicated for patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2.
Bibliographic references
Health Dictionary : Slimming
Ard J, Fitch A, Fruh S, Herman L. Weight Loss and Maintenance Related to the Mechanism of Action of Glucagon-Like Peptide 1 Receptor Agonists
. Adv Ther. 2021 Jun;38(6):2821-2839. Doi: 10.1007/s12325-021-01710-0. Epub 2021 May 11. PMID: 33977495; PMCID: PMC8189979.
