Pills vs. Food: Study Spotlight Take-Away with Chef Dr. Mike

by Michael S. Fenster, MD

Study Spotlight Take-Away with Chef Dr. Mike

A Pill for Every Ill?

One pill makes you larger, and one pill makes you small.” ~ White Rabbit, Jefferson Airplane

There has been a search among people for easy fixes since there have been human conditions in need of fixing, which is why snake oil is as old as the original sin. Our modern original sin, obesity, is no exception to the rule.

There is no doubt that at some point, increasing weight correlates with an increased risk of a host of modern disabilities and diseases, such as type 2 diabetes, certain types of cancer, and cardiovascular disease, which remains the number one cause of mortality in the United States and many other Westernized nations.

Obesity is defined as abnormal or excessive fat accumulation that presents a risk to health; it is a pro-inflammatory disease state unto itself and thus, from a physiological perspective, involves more than just weight gain, although, unfortunately, that is how it is often diagnosed. Decades ago, the United States adopted the worldwide convention of obesity, which is defined by a body mass index (BMI; weight (usually in kilograms) divided by height (usually in meters) squared) greater than 30. Morbid, severe, or extreme obesity (class III) is classified as a BMI greater than 40 kg/m2.

With the exception of certain medical conditions and their treatments, the solution is fairly straightforward and low-tech: increased activity and better food choices. But that does take work and effort. The prospect of simply being able to pop a pill without the rigors of changing behavior is a drive-through siren song few can resist. But does it really work in the long run?

This week’s study sought to help answer that question.

The Study:

  • A database review (Single Center; 2 locations in Ohio and Florida) providing insight into long-term compliance with prescription anti-obesity medications (AOMs).
  • The study involved 1911 patients from January 2015 to July 2023 with a median baseline BMI of 38 kg/m2 and a median follow-up time of 2.4 years.

The Take-Away:

  • Once discontinued, AOMs are associated with a regaining of lost weight and a reversal of cardiometabolic improvements.
  • The AOMs included FDA-approved medications for weight management: phentermine-topiramate, naltrexone-bupropion, orlistat, and glucagon-like peptide-one receptor agonists, GLP-1 RAs (semaglutide (e.g., Ozempic) and liraglutide (e.g., Victoza)).
  • At one year, only 19% of patients continued taking the AOMs.
  • Factors that influenced continued use included the type of medication, insurance carrier, and amount of weight loss at six months.
  • AOMs can be expensive; e.g., popular medications like Ozempic can cost over $15,000 per person per year.

The Caveats:

  • In general, as a short-term solution, AOM use represents low-value healthcare.
  • This study examined the use of GLP-1 RAs (e.g., Ozempic) strictly in the context of an AOM, not in terms of efficacy in treating type II diabetes.
  • A prior US-based study found that the average time someone remained on AOMs was 81 days.
  • AOMs come with side effects, e.g., GLP-1 RAs carry an increased risk of thyroid cancer and significant gastrointestinal toxicities, including pancreatitis.

Dietary changes, particularly developing more healthful food choices, require behavioral change for long-term success. It’s hard. However, the allure of simply being able to take pills to cure all our ills is a Faustian promise. Medications have their place and purpose, but they also come with added expense and unwanted side effects.

Utilizing a food-as-medicine approach allows us to build a framework for understanding the health implications of food choices in decision-making and daily routines. It also allows us to incorporate deliciousness into our daily experience. It does so economically, without side effects, and with rewards lasting a lifetime. But it does take thought and work. If the history of snake oil has taught us anything, it is that the things that matter most in life, usually do.

The Study:

Gasoyan H, Pfoh ER, Schulte R, Le P, Rothberg MB. Early-and later-stage persistence with antiobesity medications: A retrospective cohort study. Obesity (Silver Spring). 2023; 1-8. doi:10.1002/oby.23952

5/5 - (3 votes)

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