Oprah Weight Loss Muddled message

Reflecting on Oprah’s Journey and the New Weight-Loss Drugs

I’ve been an Oprah fan since her eponymous show debuted on national television in 1986. Like many viewers, I saw her as a friend. As someone who has spent much of my life struggling with self-acceptance due to being overweight, I especially resonated with her very public battles to overcome the genetics that make people like us softer and fleshier, rather than the more socially accepted buff and sleek.

Now, thanks to a new class of drugs that includes Ozempic, Wegovy, and Mounjaro, Oprah’s struggles with weight seem to be behind her. She’s not the only public figure whose figure has shrunk recently, but she’s one of the few who has admitted to using medication to slim down, though she hasn’t named the specific drug. And, being Oprah, she’s leveraging her platform to shape the latest public discourse about weight, diet culture, and body shaming.

Earlier this year, she stepped down from the board of WeightWatchers. In March, she hosted “An Oprah Special: Shame, Blame and the Weight Loss Revolution” on ABC. In May, she did a three-hour livestream on YouTube, “Making the Shift: A New Way to Think About Weight.” These shows and specials featured experts, including physicians and psychologists, and shared numerous stories about the challenges of being overweight in our fatphobic society.

I’m profoundly glad we’re having these conversations, and I don’t have a problem with people taking weight-loss drugs to live healthier lives. But I’m struggling with Oprah’s message nonetheless. While acknowledging her well-established past role in judgmental diet culture, Oprah now claims to have moved past that chapter in her life. The semaglutide implication is that medical weight loss is somehow better—more elevated or pure—than past strategies. Maybe this is not her intention, but her words draw an arbitrary line between different weight-loss strategies while ignoring the societal pressures that push so many people to try them. That’s not the end of diet culture; it’s merely an evolution.

Oprah opened her May YouTube special with an impassioned monologue in which she told the audience repeatedly and convincingly that she’s done with body shaming and wants them to be done with it, too. But her campaign for body acceptance coincides with her new, more socially acceptable body—one she achieved with the help of drugs that the Food and Drug Administration has approved to treat people with diabetes and the medical management of obesity.

Consequences of the Surge in Semaglutides

A significant consequence of the surge in semaglutides is that these drugs, while never approved for cosmetic purposes in the U.S., are being used off-label for weight loss. This off-label use has led to shortages for people who need the medications for their intended use.

Promoting drugs to make people thin, regardless of their metabolic profile, pathologizes obesity and reinforces the inaccurate belief that a fat body is always an unhealthy one that needs fixing. And that, Oprah, is one of the foundational pillars of diet culture.

When I broke down a few years ago and cried to my general physician, Dr. B., about how my parents sent me to WeightWatchers when I was 11—setting me on a course of disordered eating that was still plaguing me nearly half a century later—she sent me to a nutritionist who helped me develop a healthier attitude about food and my body. The self-loathing still crops up from time to time, but I’m getting better at quelling it. The reminders from Dr. B. help. “If you’re not ill, obesity isn’t an illness,” she told me.

I prefer not to think of myself as obese, though the National Institutes of Health says otherwise. But I am definitely not ill. I’m 63, and my cholesterol, blood sugar, and blood pressure are low to normal. My resting heart rate is lower than the average for a woman my age, my colon is clean, and my knees, hips, and back (all my original body parts) work fine. Maybe it’s tempting fate to admit this, but I’m not on medication because I don’t need any.

At some point, I’ll get sick and die—that’s how most of us go—but for now, I’m healthy. Healthier, I daresay, than the skinny dentist who told me last summer that I should get a new doctor after I mentioned Dr. B. didn’t think I needed to lose weight. I’ve never had high cholesterol. Meanwhile, the skinny dentist had gotten skinnier to avoid taking statins.

One reason I have a healthy metabolic profile is that I eat well and exercise regularly. But even eating well and exercising regularly do not guarantee good health. One of my closest friends weighed 60 pounds less than I, ate better, and exercised regularly, and she died at 62 from ovarian cancer. No amount of dieting protects against the mutated BRCA gene that, it turns out, runs in her family. I won a better ticket in the genetic lottery, unless you count the fact that along with my healthy genes, I inherited a slow metabolism and a sweet tooth.

The Importance of a Holistic Perspective on Health

I wish Oprah had opened her YouTube show with a monologue about how losing weight helped her get healthier, and that fat people can also be healthy. Instead, she buried that critical information in the last half hour of a three-hour program. That’s when she invited a Yale endocrinologist onstage to confirm that our most important health numbers can’t be read on a scale; they’re the ones that reflect markers such as blood sugar levels, blood pressure, and cholesterol.

I’m not so naïve as to dismiss the reality that extra weight can be tough on your joints. In fact, it was a comment about joint health from my family doctor nearly 25 years ago that got me to lose 40 pounds on WeightWatchers (which I’ve since regained). I’m also aware that plenty of overweight people are at high risk of developing metabolic disorders.

Weight loss and body image will always be intertwined topics fraught with complexity. But when discussing weight loss and the drugs that make it easier to drop pounds, we need to emphasize the physiological benefits, not just the psychological ones. Continuing to focus on the connection between weight and self-image over the connection between weight and health doesn’t combat body shaming. Quite the opposite: It promotes and exacerbates it. That’s damaging for everybody, especially those of us who are overweight, healthy, and secure in the knowledge that our value comes from the good we do, not the way we look.

Semaglutide Helps Heart Failure Obesity Patients

Semaglutide Shows Promise for Heart Failure Patients with Obesity

LISBON — A new analysis from the STEP-HFpEF program reveals that the diabetes and weight-loss drug semaglutide significantly improves symptoms and physical limitations related to heart failure in patients with obesity, regardless of diuretic use. This research was presented at the Heart Failure Association of the European Society of Cardiology (HFA-ESC) 2024 Congress and simultaneously published in the European Heart Journal.

Consistent Benefits Across Diuretic Subgroups

Dr. Subodh Verma, a cardiovascular surgeon at the University of Toronto, highlighted that semaglutide “produced consistent beneficial effects on body weight, exercise function, and biomarkers of inflammation and congestion across the subgroups of diuretic use and dose.” The benefits were particularly pronounced in patients who were receiving loop diuretics at baseline. The study demonstrated that semaglutide reduced the daily loop diuretic dose by approximately 20% compared to placebo, decreased the initiation of new loop diuretics by 77%, and increased loop diuretic discontinuations by more than 2.5 times.

Disease-Modifying Potential

Dr. Verma stated, “These results suggest disease-modifying effects of semaglutide in obesity-related heart failure with preserved ejection fraction.” Dr. Dimitrios T. Farmakis, from the National and Kapodistrian University of Athens, who was not involved in the study, noted the STEP-HFpEF program as a significant advancement in heart failure treatment, adding that semaglutide offers more than just weight loss; it provides some improvement in the syndrome itself. However, Farmakis pointed out that there are still “missing pieces of the puzzle.”

Key Areas for Future Research

For patients with obesity, there is a need to establish semaglutide’s efficacy and safety beyond one year, including any potential renal or other side effects. For heart failure patients in general, it is crucial to determine if semaglutide is effective regardless of left ventricular ejection fraction and whether the effects are specific to semaglutide or common to all GLP-1 receptor agonist analogs. Additionally, the effects on different ethnic groups need further study due to the underrepresentation of non-White individuals in the trials.

Mechanism of Action and Diuretic Effects

Dr. Verma acknowledged that the changes in loop diuretic dose were analyzed in isolation, without considering other medications. The precise mechanism by which semaglutide affects plasma volume, natriuresis, and cardiac structure and function remains unclear. He noted that patients with heart failure with preserved ejection fraction are often given loop diuretics as a first-line treatment, but these can cause electrolyte imbalances, worsening kidney function, and hypotension, particularly in patients with obesity-related heart failure.

Improving Heart Failure Management

Loop diuretics have been found to be less effective in decongesting patients with obesity-related heart failure with preserved ejection fraction and can negatively impact kidney function. The STEP-HFpEF program has already shown that semaglutide, compared to placebo, improves heart failure-related symptoms, physical limitations, exercise function, reduces inflammation, and leads to significant weight loss.

Pooled Data Analysis

The current analysis combined data from the STEP-HFpEF and STEP HFpEF DM trials to evaluate the efficacy and safety of once-weekly semaglutide 2.4 mg across different diuretic doses and changes in diuretic use over 52 weeks. The trials included 1,145 patients aged 18 years or older with a body mass index over 30, who were randomized to receive standard-of-care treatment plus semaglutide or placebo, with dose escalation over the first 16 weeks.

Diuretic Use and Efficacy

Patients were assessed for diuretic use, type, and dose at weeks 20, 36, and 52, considering loop diuretics, thiazide diuretics, and mineralocorticoid receptor agonists as diuretics, but not sodium-glucose cotransporter 2 inhibitors. All diuretic doses were converted to furosemide equivalents.

Results and Improvements

Dr. Verma reported that adding semaglutide to standard-of-care therapy led to greater improvements in the Kansas City Cardiomyopathy Questionnaire–Clinical Summary Scores compared to placebo. Patients not on diuretics improved their score by 3.2 points, while those treated with more than 40 mg/day of loop diuretics improved by 11.6 points. Semaglutide was consistently effective in reducing body weight across diuretic doses, with patients losing 6.9%-9.4% of body weight over the study period. It also improved 6-minute walking distance, C-reactive protein levels, and N-terminal pro b-type natriuretic peptide levels.

Reduction in Diuretic Dose

Over the study period, patients on semaglutide were significantly more likely to reduce their loop diuretic dose and less likely to increase it compared to those on placebo. On average, semaglutide users reduced their loop diuretic dose by 17%, while the placebo group increased theirs by 2.4%, resulting in an estimated treatment difference of 11.8 mg/day. Semaglutide users were also significantly less likely to initiate new loop diuretics (6.1% vs. 20.1%) and more likely to discontinue them (5.9% vs. 2.3%).

These findings underscore the potential of semaglutide as a transformative treatment for patients with obesity-related heart failure with preserved ejection fraction, offering not only weight loss benefits but also improvements in heart failure symptoms and reductions in diuretic use.

Critters Give us Semaglutide?

Slippery and Slimy Semaglutide Origin

venom and semaglutide

Venomous bites and stings from spiders, scorpions, snakes, lizards, and jellyfish—even caterpillars, snails, and octopuses—affect millions and cause thousands of deaths annually worldwide.

However, these animal venoms are on the brink of revolutionizing medicine, offering new treatments for conditions ranging from cancer to heart disease, and even slowing down aging.

This is not just a distant possibility. Already, a potent animal venom is behind the popular weight-loss drug semaglutide, known as Wegovy and Ozempic.

Furthermore, viper venom is the basis for ACE inhibitors, medications used by thousands in the UK for high blood pressure.

Ozempic and Wegovy generated an impressive £15 billion last year, with endorsements from celebrities like Sharon Osbourne, Boy George, and Elon Musk.

The key to these weight-loss drugs’ success lies in the venom of the Gila monster, a 2-foot-long venomous lizard native to the US.

Human fatalities from Gila monster bites are rare, but in Colorado earlier this year, Christopher Ward, 34, died from complications after being bitten by one he was keeping illegally as a pet.

A bite from this reptile can cause swelling, intense burning pain, vomiting, dizziness, a rapid heart rate, and low blood pressure. Yet, Gila venom also stimulates the pancreas, which produces insulin to regulate hunger and blood sugar.

Nearly 35 years ago, Dr. John Eng, an endocrinologist at the Veterans Affairs Medical Center in New York, discovered that a chemical in the venom could serve a dual purpose—as both a poison and a hormone regulator.

Dr. Eng identified a small protein in the venom called exendin-4, similar to the human hormone GLP-1, which regulates insulin and appetite. While GLP-1 is active for about two minutes in the human body, exendin-4 remains active for hours, suggesting a long-lasting effect on blood sugar and appetite.

In 2005, Dr. Eng’s research led to the development of exenatide, the first GLP-1 mimicking drug, marketed as Byetta.

Competing pharmaceutical companies aimed to improve on exenatide, with semaglutide by Novo Nordisk emerging as a clear winner. Semaglutide, marketed as Ozempic and Wegovy, proved highly effective for treating type 2 diabetes and as a weight-loss drug.

This success has inspired scientists to explore venoms for new therapies, a field known as venomics.

With more than 220,000 venomous species, each with unique venoms, the potential for medical breakthroughs is vast.

For example, Australian octopus venom is being developed into a drug, Octpep-1, to stop melanoma tumors from growing. Dr. Maria Ikonomopoulou, head of the Translational Venomics Group at the IMDEA Food Institute in Madrid, is leading this research. Octpep-1 targets cancer cells specifically, minimizing effects on healthy cells—a significant advantage over current treatments.

The venom of the Australian funnel web spider, containing over 3,000 active chemicals, shows promise in treating heart attacks and strokes. Researchers at Queensland University found that a substance in the venom, Hi1a, could protect heart and brain cells from damage caused by a lack of oxygen, potentially reducing the impact of heart attacks and strokes.

Snake venoms have long been of interest, with the saw-scaled viper’s venom leading to the development of tirofiban, a drug that prevents blood clots. This viper, responsible for the most snakebite deaths globally, produces venom that causes internal hemorrhaging. Scientists at Temple University School of Medicine discovered that a chemical in the venom, echistatin, could prevent human blood platelets from clotting, leading to the creation of tirofiban.

Cone snail venom has led to ziconotide, a powerful painkiller used for severe chronic pain. The cone snail’s venom, capable of paralyzing fish, has been harnessed to create a drug that blocks pain signals to the brain. However, due to its potent effects, ziconotide is administered through a small pump directly into the spinal cord fluid, reserved for patients with extreme pain conditions like cancer.

Even caterpillar venom is being studied for its potential to deliver life-saving drugs directly into human cells. The venom of the asp caterpillar, known for its painful sting, contains a protein that can create openings in cells. This mechanism could allow targeted delivery of potent cancer drugs, sparing healthy cells and minimizing side effects.

Moreover, venoms from marine animals are being explored for anti-aging treatments. Dr. Ikonomopoulou’s research includes targeting “zombie cells” in the body—cells that are alive but function improperly. Venom-derived drugs could potentially rejuvenate these cells, offering new avenues for combating the effects of aging.

Venom-derived medicines represent a cutting-edge frontier in pharmaceuticals, with researchers continuously uncovering new therapeutic uses for these natural toxins. As scientists delve deeper into the complexities of venoms, the potential for groundbreaking treatments and life-saving drugs continues to expand, promising a future where nature’s deadliest substances become some of our most potent allies in medicine.

Maryland Biktarvy Affordability

Pharmaceutical drug pricing and reimbursement remain a prominent topic in national discussions. In recent news, Maryland’s Prescription Drug Affordability Board (PDAB) has finalized its selection of drugs for affordability review. The board will conduct a comprehensive “cost review,” gathering public comments, additional information, and data over a 60-day period to determine if the chosen drugs will be subject to state-prescribed upper payment limits.

Background:

Responding to the escalation of prescription costs and overall state healthcare spending, 11 states, including Maryland and Colorado, have established drug affordability review boards to assess certain high-cost prescription drugs, both brand and generic. Another 12 states are considering similar legislation. Currently, Colorado and Maryland are the only states with selected drugs for affordability review.

In 2019, Maryland’s General Assembly passed a groundbreaking law establishing the PDAB. Empowered by the Assembly, the PDAB is tasked with studying the pharmaceutical delivery and payment process, accessing data on drug pricing and usage, and developing regulations. The board also has the authority to set “upper payment limits.” In March 2024, the board identified eight drugs for “cost review,” ultimately proceeding with six after removing Biktarvy and Vyvanse from the list.

During its May 20 meeting, the board emphasized that selecting a drug for affordability review doesn’t imply it’s unaffordable. Instead, it allows the board to gather information on patient costs and financial metrics for an affordability determination. However, this offers no relief for drug manufacturers facing potential state-mandated upper payment limits.

The board plans to discuss the findings of its cost review at the next meeting scheduled for July 22. Based on this review, it will determine if the drugs have caused or will cause affordability challenges for the state healthcare system or high out-of-pocket costs for patients.

Before setting an upper payment limit for any drug, the PDAB must finalize its implementation plan and gain approval from the General Assembly’s Legislative Policy Committee (LPC). If the LPC doesn’t approve the plan within 45 days, it goes to the governor and Attorney General for approval.

Implementing upper payment limits may pose challenges, such as adjusting drug formularies and claims systems for insurance carriers. The Colorado Association of Health Plans (CAHP) raised concerns about the associated costs outweighing potential savings.

Notably, one PDAB member anticipates legal challenges from drugmakers regarding setting upper payment limits on drugs covered by state and local government health plans.

Key Takeaways:

The fate of state-prescribed upper payment limits remains uncertain. While some states move forward with drug selection and review, manufacturers have challenged such laws in court. The outcome of these legal battles is unpredictable, prompting pharmaceutical companies to carefully evaluate their product portfolios and prepare for potential future developments.

How We Can Help:

Morgan Lewis will continue to monitor state drug affordability review developments. We provide strategic guidance to pharmaceutical manufacturers navigating federal and state government pricing complexities, assisting them in addressing these intricate issues.

Weight Loss Meds and Repeat Spinal Surgery

CHICAGO – Semaglutide, a drug used for diabetes and weight loss, has been linked to a significantly higher risk of repeat operations in diabetes patients undergoing lumbar surgery, according to a new study.

The risk for additional surgeries increases with prolonged use of the popular weight loss and diabetes medication.

Investigators say this study is the first to provide evidence on the impact of semaglutide on spine surgery outcomes.

“We expected better postoperative outcomes, including fewer wound complications, but instead, we found increased odds of needing additional surgeries in our diabetic patients,” said Dr. Syed I. Khalid, a neurosurgery resident at the University of Illinois Chicago, in an interview with Medscape Medical News.

The findings were presented on May 3 at the American Association of Neurological Surgeons (AANS) 2024 Annual Meeting.

Additional Surgery at Year 1

The study utilized the all-payer Mariner database to identify patients aged 18-74 with type 2 diabetes who underwent elective one- to three-level transforaminal lumbar interbody fusions (TLIFs) between January 2018 and October 2022. Patients were matched 3:1 for age, sex, hypertension, obesity, smoking history, chronic kidney disease, osteoporosis, insulin use, and spinal fusion level, resulting in 447 patients using semaglutide and 1334 not using it. Over half (56%) were female, 62% used insulin, and 81% underwent single-level TLIF.

Total medical complications were higher in the semaglutide group at 13.4% compared to 7.7% in the non-semaglutide group (odds ratio [OR], 1.85). This increase was due to higher rates of urinary tract infections (6.7% vs. 2.5%) and acute kidney injuries (6.3% vs. 3.9%), complications previously observed with semaglutide, Khalid said. However, total surgical complications were lower in the semaglutide group at 3.8% versus 5.2% in the non-semaglutide group (OR, 0.73).

Patients on semaglutide experienced fewer wound healing complications (5 vs. 31), hematomas (1 vs. 9), surgical-site infections (12 vs. 44), and cerebrospinal fluid leaks (2 vs. 3).

Nonetheless, semaglutide users were nearly 12 times more likely to require an additional lumbar surgery within a year compared to non-users (27.3% vs. 3.1%; OR, 11.79; 95% CI, 8.17-17.33).

Kaplan-Meier plots showed a significant divergence in outcomes based on semaglutide exposure of more than or less than nine months (log-rank P < .0001).

Currently under review for publication, this study provides the first evidence on semaglutide’s impact on spine surgery, Khalid said. A follow-up study, also under review, examines morbidly obese patients without diabetes who took semaglutide for weight loss and showed a similar trend.

Sarcopenia the Cause?

The additional surgeries were primarily extensions of constructs, with more levels requiring fusion, Khalid noted.

“One hypothesis is that muscle loss, or sarcopenia, in conjunction with fat loss might be causing these issues,” Khalid explained.

The mechanism remains speculative, but other studies have shown that patients with frailty, weaker bones, and sarcopenia have worse outcomes with spine surgery.

The researchers plan to use artificial intelligence to evaluate changes in body composition after semaglutide use in patients who underwent imaging prior to spine surgery or even before back pain occurred. Since these medications are uptitrated over time, follow-up studies will investigate whether these changes occur at specific doses, Khalid added.

Based on this analysis of generic semaglutide, it is not yet clear whether other glucagon-like peptide 1 (GLP-1) receptor agonists will yield similar findings, but “the odds of a class effect are high,” Khalid said.

Commenting on the findings, Dr. Walavan Sivakumar, director of neurosurgery at Pacific Neuroscience Institute, noted that recent guidance from the American Society of Anesthesiologists recommends stopping GLP-1 receptor agonists before elective surgery to reduce anesthesia-related complications.

“It’s an incredibly topical point and appears to be a daily concern for clinicians in neurosurgery,” Sivakumar said. “This study is thought-provoking and a great first step.”

Sivakumar also observed that frailty is a critical issue in neurosurgery. “It significantly impacts all surgical outcomes and is currently a major focus of study in neurosurgical research.”

FDA Recall Due To Weight Loss Drug Labels Mix Up

It’s remarkable how willing some doctors have been to prescribe diabetes drugs like Ozempic and Wegovy off-label for weight loss. However, some patients have found alternative ways to obtain these medications. This year, there have been several reports of counterfeit versions of these weight loss injectables, with multiple patients hospitalized due to adverse reactions.

The risks don’t end there. This week, the FDA announced the recall of 751 units of tirzepatide on April 20, 2024. Tirzepatide is the active ingredient in diabetes and weight-loss drugs Mounjaro and Zepbound, popular brands in this medication class. A 2021 study in the New England Journal of Medicine suggested that Mounjaro might be superior to semaglutide—used in Ozempic and Wegovy—for controlling blood sugar and potentially appetite and weight loss.

Revive Rx Pharmacy, a Texas-based company, appears to be the manufacturer of the recalled 10-milligram multi-dose tirzepatide vials, along with two-milliliter doses of compounding sterile solution. According to the FDA report, the recall was due to a “label mix-up,” revealing a serious issue: vials labeled as tirzepatide actually contained testosterone cypionate.

Yes, vials labeled as tirzepatide contained testosterone. The FDA reported that the mislabeled drug was distributed nationwide in the USA but did not specify particular regions or organizations. The recalled tirzepatide has the following identifiable details:

  • Lot #: 748127
  • Expiration: 9/24/2024

The FDA has classified this as a Class I recall.

FDA Recall Classifications:

  • Class I Recall: The most severe, issued for products that could cause serious health issues or death.
  • Class II Recall: Involves products that may cause temporary or medically reversible adverse health effects.
  • Class III Recall: For products unlikely to cause health problems but that fail to comply with FDA labeling or manufacturing regulations.

Dr. Tricia Varacallo, DO, a contributor to The Healthy by Reader’s Digest, lists potential health consequences for individuals unknowingly administering testosterone:

  1. Diabetes management: Patients missing out on tirzepatide for diabetes could experience uncontrolled blood sugar levels, leading to serious conditions like diabetic ketoacidosis, cardiovascular disease, nerve damage, and other severe complications.
  2. Unintended hormone exposure: Patients receiving testosterone cypionate instead of tirzepatide might face elevated testosterone effects. Testosterone influences muscle mass, fat distribution, and bone density. Inappropriate use can cause hormonal imbalances, mood swings, increased aggression, skin issues, and changes in sexual function. For those not prescribed testosterone, exposure could lead to severe side effects like cardiovascular issues or liver problems. It is particularly serious for pregnant women or individuals with hormone-sensitive cancers (e.g., breast or prostate cancer). Affected individuals should consult their healthcare provider immediately.
  3. Lack of expected weight loss: This could be frustrating and harmful for patients relying on the medication as part of a weight management plan, potentially causing emotional distress or setbacks in their health goals.

Revive Rx did not immediately respond to The Healthy’s request for comment.

Weight-Loss Injections Show Promise in Reducing Cancer Risk

semaglutide reduces cancer rate

A major study suggests that popular weight-loss medications Wegovy and Ozempic, originally developed for diabetes, may also offer significant protection against several common cancers.

The research, presented at the American Society for Clinical Oncology conference, found that obese patients taking these weekly injections were nearly 20% less likely to develop cancers like breast, bowel, pancreatic, and ovarian varieties.

Interestingly, the study also showed a 50% reduction in the death rate among obese patients taking the semaglutide injections over a 15-year period, compared to those not receiving them. Experts believe this benefit stems from the drugs’ ability to target obesity-related cancers, such as those of the thyroid, kidney, and liver.

This is significant because obesity is considered the second leading cause of cancer in the UK, after smoking, and is responsible for roughly 5% of new cases annually.

The study adds to the growing body of evidence highlighting the wider health benefits of GLP-1 receptor agonists (GLP-1a), the class of drugs to which Wegovy and Ozempic belong. These medications go beyond just promoting weight loss.

Previous research has shown that semaglutide, the active ingredient in both drugs, can also reduce the risk of heart and kidney failure.

Weight Loss and Reduced Cancer Risk

The study involved tracking the health of over 270 obese patients who received GLP-1a medications for 15 years. Their outcomes were compared with two other groups: around 400 patients who underwent weight-loss surgery and 20,000 obese individuals who received no treatment.

While the medication group didn’t achieve the same level of weight loss as the surgery group, both sets of patients showed a similar decrease (around 19%) in the development of obesity-related cancers compared to the control group.

This suggests that weight reduction appears to be a key factor in the observed cancer risk reduction. Dr. Cindy Lin, a sports medicine expert, commented that weight loss seems to be a major driver in the lowered cancer cases observed in the study.

Beyond Weight Loss

The popularity of these medications has soared in recent years, not just for their weight-loss benefits but also due to celebrity endorsements from figures like Elon Musk and Boris Johnson. Research indicates that patients taking semaglutide can lose an average of 20% of their body weight.

The study also acknowledges the emergence of tirzepatide, an even more potent GLP-1a medication that recently became available.

Overall Significance

This research highlights the potential of GLP-1a medications in lowering the risk of cancer development, particularly among obese individuals. While further investigation is needed, these findings suggest a promising new avenue in the fight against cancer.

Weight-Loss Drug May Alter Taste Perception, Reducing Sweet Cravings

semaglutide changes sweet cravings

A new study suggests that popular weight-loss medications Ozempic and Wegovy (both containing semaglutide) might work by enhancing taste sensitivity, leading people to crave sweets less.

Researchers presented their findings at the Endocrine Society’s annual meeting, indicating that semaglutide appears to influence how the tongue and brain process sweet flavors.

“People with obesity often have a dulled sense of taste and a stronger desire for sugary, high-calorie foods,” explained lead researcher Mojca Jensterle Sever, an endocrinologist from Slovenia.

The study involved obese women who were randomly assigned either semaglutide injections or a placebo for four months. Researchers monitored their taste sensitivity using taste strips with varying intensity levels. Brain activity in response to a sweet solution was also tracked using MRI scans before and after meals. Additionally, tongue tissue samples were analyzed to assess genetic activity.

Women taking semaglutide exhibited changes in taste perception, gene expression in taste buds, and brain response to sweetness. These alterations mirrored observations in animal studies.

“These findings may correlate with patient reports about changes in food preferences, beyond just the general appetite and satiety effects that aid weight loss,” Jensterle Sever commented.

However, the researcher emphasized the need for further studies due to the lab setting and individual variations in taste perception. Future research will determine if semaglutide’s effectiveness hinges on taste modifications.

It’s important to note that findings presented at medical meetings are considered preliminary until published in peer-reviewed journals.

Biktarvy as PEP: Boston Study

HIV Post-Exposure Prophylaxis (PEP) and the Efficacy of Biktarvy

HIV post-exposure prophylaxis (PEP) is a crucial HIV prevention strategy. Studies on simian immunodeficiency virus (SIV), which is closely related to HIV, have shown that a combination of antiviral drugs can reduce infection risk if administered within 72 hours of exposure. Current guidelines recommend initiating PEP as soon as possible after potential HIV exposure, with a maximum window of 72 hours.

Research on Biktarvy for PEP

Researchers at Fenway Health in Boston, a clinic and research center serving the LGBT community, conducted a study on the use of Biktarvy as PEP. Biktarvy is a single-pill regimen containing:

Biktarvy is widely used in high-income countries for HIV treatment due to its efficacy and tolerability.

Study Methodology and Findings

The study involved 52 adults who had recent potential exposure to HIV and sought PEP. Participants underwent brief interviews and HIV rapid testing. Those who tested negative for HIV were provided with a 28-day supply of Biktarvy. Follow-up testing up to two months later confirmed that all participants remained HIV negative, and the medication was well-tolerated with mild and uncommon side effects.

Recruitment and Participant Profile

Participants, who may have been exposed to HIV through unprotected sex, were referred through:

  • Primary care providers
  • An HIV treatment and prevention clinic hotline
  • Self-referrals after community education campaigns

The study’s participants were predominantly men (49 out of 52), mostly gay or bisexual, with an average age of 37 years (ranging from 21 to 71). The ethnic distribution was 77% White, 12% multiracial, and 12% Hispanic. Notably, 56% reported more than one recent potential HIV exposure.

Side Effects and Completion Rates

Common side effects included:

  • Nausea or vomiting (15%)
  • Fatigue (10%)
  • Diarrhea or loose stools (8%)

Most symptoms were mild and temporary. However, one participant discontinued due to excessive fatigue. Overall, 90% of participants completed the 28-day PEP regimen, while 10% lost contact with the clinic.

Comparative Analysis and Recommendations

Researchers compared their findings with historical PEP regimens, concluding that Biktarvy was better tolerated. They also noted that other PEP regimens, such as those involving dolutegravir, TDF, and FTC, require multiple pills daily.

Conclusion: Biktarvy PEP

The results are promising, suggesting that Biktarvy is an effective and well-tolerated PEP option. Larger studies with diverse populations are needed to confirm these findings. For individuals with ongoing HIV exposure risks, discussing HIV pre-exposure prophylaxis (PrEP) with a healthcare provider is recommended.

Better Contraception for Ozempic Users

Better contraceptive for ozempic babies

Ozempic Users Need Better Contraception

Claims that “skinny jabs” are causing an unexpected baby boom have prompted experts to advise women to use effective contraception alongside these medications.

Drugs like Wegovy and Ozempic, which contain semaglutide, have gained immense popularity due to their ability to help users lose more than 10% of their body weight. These medications work by mimicking a hormone called GLP-1, increasing insulin production, slowing stomach digestion, and reducing appetite.

However, the rise in the use of these drugs has coincided with numerous reports of women becoming pregnant while using them—these drugs are known as GLP-1 receptor agonists. The Facebook group “I got pregnant on Ozempic” has over 750 members, and Reddit threads are filled with similar anecdotes.

Although studies confirming a direct link are lacking, experts believe the association is plausible. Dr. Karin Hammarberg of Monash University in Australia explains that women with obesity often have irregular or no periods due to anovulation. Weight loss can lead to more regular ovulation, thereby improving fertility.

Research is ongoing to investigate whether semaglutide can enhance ovulation in women with obesity and polycystic ovary syndrome (PCOS), a condition associated with irregular periods, weight gain, and infertility.

Despite potential benefits, concerns exist about the safety of using GLP-1 receptor agonists during pregnancy. A Novo Nordisk spokesperson, the manufacturer of Ozempic and Wegovy, noted that pregnancy or intention to become pregnant were exclusion criteria in their trials. Consequently, there is limited clinical trial data on semaglutide use in pregnant women.

Animal studies have indicated that semaglutide may cause fetal abnormalities. Novo Nordisk reported that pregnant rats exposed to the drug showed structural abnormalities and growth alterations in their offspring. Similar outcomes were observed in studies with rabbits and cynomolgus monkeys, with increased pregnancy loss and slight increases in fetal abnormalities at clinically relevant doses.

Novo Nordisk is conducting trials to determine the safety of these drugs for pregnant women. Meanwhile, the company advises against using semaglutide during pregnancy due to unknown effects on an unborn child. The patient information leaflet for Wegovy recommends using contraception while taking the medication and stopping its use at least two months before trying to conceive.

Despite these precautions, some women have reported pregnancies while using GLP-1 receptor agonists and hormonal contraception, sparking speculation that the drugs might interfere with birth control effectiveness.

Professor Sir Stephen O’Rahilly of the Wellcome-MRC Institute of Metabolic Science highlighted that the question of whether GLP-1 receptor agonists affect oral contraceptives remains largely unanswered. Gastrointestinal side effects like diarrhea from these drugs could potentially impair the absorption of oral contraceptives.

To mitigate the risk of unintended pregnancy, O’Rahilly suggests that women on the pill who wish to avoid pregnancy should consider using additional contraception, such as barrier methods, during active weight loss on GLP-1 receptor agonists. Once weight stabilizes, contraceptive efficacy is likely to return to normal.

Hammarberg supports this advice, noting that while anecdotal reports exist of women on semaglutide getting pregnant while on the pill, this can also happen without the medication. She advises that women on Ozempic and similar drugs use condoms or consider an IUD to ensure effective contraception.