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FDA-approved Zepbound is the brand name for tirzepatide when doctors prescribe the medication for weight loss. Zepbound and other weight loss drugs are extremely expensive, and most insurance companies dont cover them. Experts hope increased competition among drug makers will drive down costs and improve patient access to pricey weight loss medications. Photo: Getty Images

A newly approved weight loss drug called Zepbound may work even better than the popular drug Wegovy while also driving down the cost of multiple weight loss drugs.

The newest crop of weight loss drugs including Zepbound have sticker prices of more than $1,000 per month, and most insurance companies do not cover them. Doctors and patients, alike, are eager see if Zepbound will foster greater competition and price cuts among drug makers, thus improving access to pricey medications.

Medical experts at the U.S. Food and Drug Administration (FDA) gave a much-anticipated green light to Zepbound on Nov. 8.

The FDA previously approved a related drug called Mounjaro, which is made from the same active ingredient in Zepbound: tirzepatide. But Mounjaro was only available to people with Type 2 diabetes.

Approval of Zepbound is highly significant as the new drug and other similar medications change the way both patients and doctors view battles with extra pounds. About 70% of adults in the U.S. have a body mass index or BMI in the overweight or obese range.

This particular medication opens up a new era for obesity medications. It is the first combination peptide to get FDA approval for obesity, saidDr. Cecilia Low Wang, a UCHealth expert on endocrinology, diabetes and metabolism. Im super excited because this drug is so effective in helping people with obesity, which is a challenging medical condition.

While the drugs have produced dramatic results in people who have used them so far, Low Wang underscores the importance of physical activity and healthy eating.

Im glad we now have potent medications for obesity, but these drugs are not a replacement for healthy lifestyle changes. To be healthy, people need to make sure they exercise most days of the week and consistently choose healthy foods, Low Wang said.

So, what is Zepbound? How well does it work? Whats up with the weird name? How is Zepbound related to Mounjaro, Wegovy and Ozempic? How much will Zepbound cost, and will it cause negative side effects like the gastrointestinal problems that Wegovy and Ozempic can cause?

To answer all of your questions about Zepbound, we consulted with Low Wang, who is a professorat theUniversity of Colorado School of Medicineon theAnschutz Medical Campus.

She alsochairs the committeethat advises the FDA about drugs related to endocrinology and metabolism. (Low Wang does not receive funding from the drug companies. And her views do not represent those of the FDA orthe FDA Endocrinologic and Metabolic Drugs Advisory Committee.)

Zepbound is the brand name for the drug tirzepatide when doctors prescribe it for weight loss. Mounjaro is the name of the medication when its used to treat diabetes. (Learn all about Mounjaro.) Both Zepbound and Mounjaro are brand names for the generic drug, tirzepatide.

No. Zepbound is not a pill. Its an injectable medication that patients need to use once a week. It comes in three doses: 5, 10 and 15 milligrams. So far, Zepbound, Mounjaro, Ozempic, and Wegovy are all injections. The drug in Ozempic and Wegovy, semaglutide, is also available in a pill form for Type 2 diabetes called Rybelsus, and doesnt cause as much weight loss.

It suppresses appetite and makes you feel more full. It changes the rate at which your stomach empties, Low Wang said.

During clinical trials, study volunteers who used tirzepatide lost as much as 21% of their body weight.

The average weight loss for study subjects who did not have diabetes and used the largest dose of Zepbound (15 milligrams, once a week) was 18%, according to the FDA.

People who have diabetes tend to lose less weight with these new drugs than those who dont have diabetes. Another study found that people with diabetes who used Zepbound lost an average of 12% of their body weight, FDA officials said.

All of these drugs are part of a new class of weight loss medications that are shaking up treatment of obesity and diabetes. Theyre also sparking drug shortages and economic earthquakes around the world since demand for the drugs is so high. (Read how Wegovy and Ozempic are causing huge economic impacts in Denmark, home of the drugs maker.)

Many people including those who dont have obesity or medical conditions associated with being overweight have been clamoring to get the medications because they are powerful appetite suppressants and work so much better than previous generations of weight loss drugs.

Zepbound and Mounjaro are basically the same drug, but theyre approved for different medical conditions: Zepbound for weight loss and Mounjaro for diabetes.

Similarly, Wegovy and Ozempic are the same drug, but with different names and different doses for different conditions. Wegovy is the name of the drug as its prescribed for weight loss. Ozempic is the name of the drug as its used for diabetes. The generic name for Wegovy and Ozempic is semaglutide.

No. Zepbound and Mounjaro (also known as tirzepatide) work a little differently than Ozempic and Wegovy (also known as semaglutide).

Here are the differences.

First, the drugs are made by different drug companies. Competition between these pharmaceutical companies and others that are working on new weight loss drugs may drive down prices for the expensive medications.

Eli Lilly makes Zepbound and Mounjaro whileNovo Nordisk makes Wegovy and Ozempic.

Eli Lilly is based in the United States while Novo Nordisk is based in Denmark.

Zepbound, Mounjaro, Wegovy and Ozempic work in similar ways to reduce appetite. But Zepbound and Mounjaro are whats called dual-agonist drugs while Wegovy and Ozempic are whats known as single-agonist drugs. These drugs activate important hormone pathways in the body.

Tirzepatide is in a completely new drug class, Low Wang said. Its a combination peptide. This dual agonist approach seems to cause people who use Zepbound or Mounjaro injections to lose even more weight than those who use a medication that only activates one hormone pathway.

These drugs stimulate hormones that help control blood sugar levels and reduce appetite, triggering weight loss.

The hormones are glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP).

Wegovy and Ozempic activate the GLP-1 pathway, while Zepbound and Mounjaro activate two: both GLP-1 and GIP.

Drug makers spend considerable time and money creating brand names for drugs. Presumably, the zep in Zepbound comes from tirzepatide, the generic name for the drug from which Zepbound is made.

Low Wang says that drug makers come up with names that may sound strange to patients because the names need to sound OK in multiple languages, and the drug names cant conflict with or sound too much like existing brand names for pharmaceuticals. Low Wang concedes that the names often sound strange, and Zepbound may be hard for some people to pronounce. But judging by the popularity of the other weight loss drugs, Zepbound may soon become familiar to millions of people around the world.

Yes. Zepbound just like Mounjaro, Wegovy and Ozempic is a prescription medication. If you think you might benefit from using a weight loss drug, schedule an appointment with your doctor.

The FDA approved Zepbound for adults ages 18 and older who are dealing with obesity or are overweight and have additional weight-related health challenges.

Doctors use BMI to classify who is obese or overweight. Low Wang said BMI is far from a perfect measure of a persons health. Some people have a higher BMI and are perfectly healthy. These drugs may not be right for them.

An elevated BMI doesnt tell you everything about a persons health, Low Wang said. A person could be very fit and muscular, and have a higher BMI, but wouldnt need this medication.

Meanwhile, other people who have high BMIs are dealing with serious related health problems like high blood pressure, diabetes, and elevated risk of heart attack, stroke, heart failure or liver disease.

Low Wang encourages people to consult with their doctors.

To qualify for Zepbound, patients need to have a BMI of 30 and higher which means theyre dealing with obesity or a BMI of 27 or greater the marker for being overweight while they are also dealing with at least one other weight-related health condition. These conditions include high blood pressure, high cholesterol or Type 2 diabetes.

The common side effects are very similar to those that patients have experienced with Mounjaro, Wegovy and Ozempic. The most common side effects include nausea, vomiting, diarrhea, decreased appetite, constipation, upper abdominal discomfort and abdominal pain.

In addition, FDA officials have warned that tirzepatide can cause thyroid C-cell tumors in rats. Federal health experts dont know yet whether Zepbound and Mounjaro cause similar tumors including medullary thyroid cancer in humans.

Its not clear whether Zepbound or other weight loss drugs can case depression or suicidal ideation. But Zepbounds drug maker, Eli Lilly, has included a warning with the drug that doctors should monitor their patients for depression or suicidal ideation and should advise patients to immediately stop using Zepbound if they are experiencing any suicidal thoughts.

Weve had this problem with previous weight loss drugs, where they might increase risk of suicide in people with depression, Low Wang said.

Some patients report gastrointestinal problems with these drugs, but many do not have any problems, Low Wang said.

A portion of people who are taking these drugs will have side effects, but a majority tolerate these medications well, Low Wang said.

Her patients have had the best luck when they start with the lowest dose and let their bodies get used to it.

We start patients on a low dose for four weeks, then step up on the dose, Low Wang said.

Low Wang has found that patients do well if they pay close attention to when they start feeling full and stop eating at that point. People will end up dramatically reducing how much they eat. For those who love to eat and cook, taking the drugs can be a challenge.

In addition, foods that are rich in fat tend to increase negative gastrointestinal side effects.

The list price of Zepbound is more than $1,000 per month. And most health insurance companies are not yet covering these new weight loss medications. All of them are very expensive now. But Low Wang and other experts are hoping that increased competition among drug makers will drive down the costs of the medications.

In addition, recent studies of people using semaglutide, the active ingredient in Ozempic and Wegovy, suffered dramatically fewer adverse cardiovascular events like heart attacks and strokes. The studies have found benefits in both people with diabetes and those who were obese but did not have diabetes.

It will take time before researchers complete studies to determine if Zepbound produces similarly positive cardiovascular benefits.

If the drugs help people lose weight while also preventing heart attacks, strokes and other cardiovascular health problems, Low Wang expects more insurance companies to cover the drugs. Pressure also could increase for the federal government to cover the drugs through Medicare and Medicaid.

The pros are that Zepbound helps many people lose a dramatic amount of weight. It may also help reduce other health problems associated with excess weight.

There are multiple potential downsides to using Zepbound, Mounjaro, Ozempic and Wegovy. (Read more about eight reasons to be cautious about Ozempic and Wegovy.)

Low Wang emphasizes that its vital for individuals to speak with their doctors.

Patients have to use reliable sources for their medical information, and doctors need to think about an individuals risk-benefit balance. For each person, its going to be different, she said.

Low Wang encourages patients to review information from reliable experts including the Endocrine Society and the American Association of Clinical Endocrinology or AACE.

Yes. People who are pregnant should never take these medications. They need to be eating well and gaining weight to support their pregnancies.

FDA officials say people who have a personal or family history of medullary thyroid cancer should not use Zepbound along with patients with Multiple Endocrine Neoplasia syndrome type 2.

In addition, Zepbound has not been studied in patients with a history of pancreas inflammation (pancreatitis) or severe gastrointestinal disease (including severe gastroparesis, a condition that affects normal movement of the muscles in the stomach), according to the FDA.

Low Wang said many new drugs are being developed now.

There are going to be many more combination peptides dual agonists and triple agonists, she predicted.

In addition to double peptide medications, like Zepbound, there will also be triple peptide drugs.

We have to be aware of all of the side effects, and people should talk to their doctors. But the future for obesity treatment is really exciting.

Link:
How does the weight loss drug Zepbound compare to Mounjaro ... - UCHealth Today

There are several options when it comes to maintaining your weight. Dr. Ivanesa Pardo, a board-certified general and bariatric surgeon at MedStar Washington Hospital Center discusses which ones may be right for you.

This content is sponsored by MedStar Washington Hospital Center.

The U.S. obesity prevalence was about 42% in 2020, according to the Centers for Disease Control and Prevention (CDC). Conditions related to obesity include diabetes, heart disease, stroke and some cancers. The CDC also said these diseases are among the leading causes of preventable, premature death.

Fortunately, there are several options when it comes to maintaining your weight.

Dr. Ivanesa Pardo, a board-certified general and bariatric surgeon at MedStar Washington Hospital Center, said she encourages patients to use traditional methods like diet and exercise.

She recommends 60 minutes of exercise three times a week, avoiding trans fat, and moderating your intake of sugar and liquid calories. Dr. Pardo also stressed the importance of avoiding restrictive diets.

If youre starving yourself, when you finally start eating, your body starts accumulating all the calories, because it thinks when am I going to starve again. So you start taking extra into your reserve, Dr. Pardo explained.

Although diet and exercise can be effective, Dr. Pardo said results could be hard to maintain when only using the two methods alone.

We know that diet and exercise alone even though they could be successful in helping weight loss they fail in maintenance, she said.

Your lifestyle can also make it more challenging to incorporate diet and exercise into your daily routine.

And then you have people that have obesity they have limitations in their activity, Dr. Pardo said. They have arthritis or respiratory problems because theyre carrying that extra weight. That makes it much harder to be more active.

Other options include weight loss medication, but Dr. Pardo warns patients to be weary of gimmicks.

Obesity is not a one single-cause problem, and not one thing caused the obesity, so we cant expect that one ingredient is going to then make you lose all the weight, she said.

Prescription medications for weight loss have evolved over the years, and Dr. Pardo said weight loss clinics have produced some degree of success with medications like phentermine, and B-12 injections. However, she said newer medication GLP-1 agonists such as ozempic, Wegovy, and Mounjaro have been proven to be very effective.

These are now injectables instead of pills, and so far, the results are very promising. The problem is, of course, we dont have long term data, she said.

Some people cant tolerate them due to the side effects, which include gastrointestinal issues. Some may not experience any weight loss.

So its like any tool. It may or may not work. But as of now, these are the medications that have proven to be the most efficacious, she said. They can cause somewhere between five and 10% weight loss within several months.

Dr. Pardo also said GLP-1 agonists are a good alternative to bariatric surgery, another effective weight loss option.

The American Society for Metabolic and Bariatric Surgery recently dropped the body mass index requirement from 40 to 35 without comorbidities and from 35 to 30 for people with comorbidities. Dr. Pardo praised the changes, saying surgery can reverse diabetes fully, so why wait?

Cost can be a deterring factor in receiving bariatric surgery, but Dr. Pardo said insurances are now covering the procedure more freely. She added that the data showed that it was more affordable to pay for surgery versus the prolonged, ongoing treatment of not only obesity or medications, but diabetes.

Only about one percent of people that qualify for surgery receive it. According to Dr. Pardo, this is because of the stigma associated with the procedure.

And the reality is that death from the surgery is less than half a percent. Bariatric surgery now is safer than a hip replacement, its safer than even taking your gallbladder out, she said.

Dr. Pardo also highlighted that bariatric surgery is not the end of a patients weight loss journey. Someone who just underwent the procedure must focus on nutrition and portion control since the stomach will be smaller. This includes learning to read labels, and consuming high protein and healthy fats.

Obesity is a chronic disease most people will fight their entire lives, and Dr. Pardo says the goal is to help people live healthier, longer lives.

Even if youre successful in weight loss, it doesnt mean that youre done, you still have to prevent weight regain.

Read more about weight management options on the MedStar Washington Hospital Center website.

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Network meta-analysis of three different forms of intermittent energy ... - Nature.com

A new experimental drug found to be more effective than Wegovy and Mounjaro for weight loss could also stop fatty liver disease in its tracks, according to new clinical trial data.

At this weeks Liver Meeting the annual conference of the American Association for the Study of Liver Diseases experts revealed that a retatrutide treatment regimen was capable of reducing liver fat by as much as 85%.

Retatrutide, which is under development by Eli Lilly for weight loss, is in the same family of drugs as Ozempic and Mounjaro, as they are all GLP-1 agonist drugs. However, retatrutide is also an agonist of the glucose-dependent insulinotropic polypeptide (GIP) and glucagon receptors.

In the phase 2 trial, patients who were given weekly injections of 8 mg and 12 mg retatrutide resulted in 24% weight loss and between 81% and 86% reduction of fat in the liver. Whats more, 89% and 93% of patients receiving retatrutide 8 mg and 12 mg had less than 5% liver fat after 48 weeks of treatment, meaning that there was no longer enough fat in their liver to meet fatty liver disease criteria.

Arun J. Sanyal, M.D., chair of the division of gastroenterology, hepatology and nutrition at Virginia Commonwealth Health, who presented the findings at the annual meeting, said that the results are quite dramatic.

Between 80-90% of patients and actually by week 48, at the high dose, 93% of patients lost so much fat in the liver that they were below the cutoff for having fatty liver disease, which is quite dramatic, because in the overweight-obese population, we first said that 70-75% of them will have excess fat in the liver, Dr. Sanyal said in an interview with HCPLive during the meeting. But now we have a treatment that can treat obesity, and you can wipe out the liver fat in 90% of these people.

People with fatty liver disease, also called steatotic liver disease, have excess fat build-up in their liver. Things like type 2 diabetes, obesity and chronic heavy alcohol consumption can cause the excess fat to accumulate. Often fatty liver disease will not cause issues, but if left untreated, long-term problems like hepatitis, fibrosis and cirrhosis can develop. Between 80 and 100 million adults in the United States are affected by the condition.

While clinical findings on retatrutide are positive thus far, Dr. Sanyal notes that there is a caveat the people involved in the phase 2 trial had early stage liver disease and were not considered at risk of advanced liver disease during the time of their enrollment. That makes it challenging to understand whether retatrutide would benefit patients who might be at risk of developing conditions like cirrhosis and hepatitis.

More clinical trials are needed to assess retatrutides utility in advanced liver disease, but in the meantime, Dr. Sanyal suggests that the drug could still help to delay the onset of severe liver scarring.

Here, the implication is that by treating the underlying obese state and by getting rid of all the fat in the liver, there's at least a reasonable assumption that you might in the future be able to say that this population that no longer has fat in the liver, they're not going to progress to significant scarring of the liver, or they will not develop fibrosis or fibrosis-related outcomes, Dr. Sanyal said.

Originally posted here:
New Weight Loss Drug Could 'Wipe Out' Liver Disease - The Messenger

Weight-loss medications, including the popular glucagon-like peptide-1 (GLP-1) receptor agonists semaglutide (Wegovy) and tirzepatide(Mounjaro), look like a promising option for people with HIV, although data are limited and more studies are needed.

Weight gain is a growing concern for people living with HIV and their health care providers. Not only do many people find weight gain and body shape changes distressing, they also raise the risk for cardiovascular disease and other health problems. HIV-positive people are often urged to take steps to manage their weight, but this is easier said than done.

Lifestyle changes, exercise and diet are incredibly important for your health, but to shift weight downwards in someone with established weight gain is next to impossible, Professor Francois Venter of the University of Witwatersrand in South Africa said at the International AIDS Society Conference on HIV Science (IAS 2023) in July. You really do need pharmaceutical or surgical help.

As aidsmap has reported, research has yielded conflicting data about weight changes after starting or switching antiretrovirals, especially integrase inhibitors. Numerous studies have found that people who start a new regimen can gain weight, sometimes as much as 5-10kg. This appears to be more likely when people switch away from tenofovir disoproxil or efavirenz, which have a weight-suppressing effect. But in general, changing antiretrovirals in an effort to lose weight does not seem to have much effect. Weight gain among people with HIV may also be attributable to a return to health after starting treatment or normal changes that occur with age.

A group of diseases characterized by high levels of blood sugar (glucose). Type 1 diabetes occurs when the body fails to produce insulin, which is a hormone that regulates blood sugar. Type 2 diabetes occurs when the body either does not produce enough insulin or does not use insulin normally (insulin resistance). Common symptoms of diabetes include frequent urination, unusual thirst and extreme hunger. Some antiretroviral drugs may increase the risk of type 2 diabetes.

Pertaining to the internal organs. Visceral fat is fat tissue that is located deep in the abdomen and around internal organs.

A pill or liquid which looks and tastes exactly like a real drug, but contains no active substance.

A class of antiretroviraldrugs. Integrase strand transfer inhibitors (INSTIs) block integrase, which is an HIV enzyme that the virus uses to insert its genetic material into a cell that it has infected. Blocking integrase prevents HIV from replicating.

In cell biology, a structure on the surface of a cell (or inside a cell) that selectively receives and binds to a specific substance. There are many receptors. CD4 T cells are called that way because they have a protein called CD4 on their surface. Before entering (infecting) a CD4 T cell (that will become a host cell), HIV binds to the CD4 receptor and its coreceptor.

The use of weight-loss medications has skyrocketed in recent years. The European Medicines Agency (EMA) has authorised the use of Wegovy for people with obesity or overweight. (The same drug was previously approved for the treatment of type 2 diabetes under the brand name Ozempic.) On 9 November, theEMAs Committee for Medicinal Products for Human Use recommended expanding the indication for tirzepatide, previously approved for diabetes, to include weight management. (In the United States, tirzepatide was recently approved for weight management under the brand name Zepbound.)

Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that mimics a natural hormone that suppresses appetite, regulates insulin and blood sugar levels and slows emptying of the stomach. Tirzepatide mimics the action of both GLP-1 and glucose-dependent insulinotropic polypeptide (GIP). Other related drugs, including orforglipron and retatrutide (which mimics three hormones), are currently in the pipeline.

Semaglutide and tirzepatide are generally safe, but they can cause side effects including nausea, vomiting, diarrhoea, constipation, abdominal pain and bloating. More serious adverse events may include gastroparesis (stomach paralysis) and pancreatitis. They can lead to loss of lean muscle mass as well as fat, which may be a concern for older people. Whats more, the drugs are expensive and they may need to be used long term, as weight typically rebounds after they are discontinued.

In clinical trials of HIV-negative people, non-diabetic adults with obesity who used semaglutide reduced their weight by around 15% on average, while those who used higher doses of tirzepatide lost around 20%. Semaglutide may also improve fatty liver disease, and a recent study showed that it reduced the risk of heart attacks and strokes in non-diabetic people with obesity and cardiovascular disease.

To date, there has not been much specific research on weight loss medications for people with HIV, but data are starting to emerge.

As reported at the IAS conference, Marisa Brizzi of the University of Cincinnati and colleagues evaluated the effect of GLP-1 receptor agonists on metabolic outcomes in HIV-positive and HIV-negative people with type 2 diabetes. They hypothesised that GLP-1 might be depleted during HIV infection and that integrase inhibitors might disrupt fat cells, affect hormones that regulate glucose and lipid metabolism, stimulate appetite or reduce insulin sensitivity.

This retrospective cohort study included 15 adults with HIV matched with 30 HIV-negative people. Nearly 90% were men and the mean age was 57 years. Most of the HIV-positive people were on integrase inhibitors. Nearly three quarters used dulaglutide (Trulicity) and 13% used liraglutide (Victoza for diabetes or Saxenda for weight loss), two older and less effective drugs; only 13% used semaglutide and none used tirzepatide.

HIV-positive people with diabetes lost 10.4kg, on average, compared with 1.7kg for HIV-negative people, or 8.0% versus 1.5% of their baseline body weight. Whats more, 60% of people with HIV achieved at least 5% weight loss, compared with 33% of HIV-negative participants.

In this cohort, people with HIV and diabetes had significantly greater weight loss compared to people with diabetes alone, the researchers concluded. The greater weight loss observed in people with HIV may be related to differences in the mechanistic pathways leading to weight gain.

While these results appear to suggest that people with HIV might benefit more from weight-loss drugs, most participants used older medications and the amount of weight lost in the HIV-negative group was substantially lower than that seen in pivotal trials of semaglutide and tirzepatide for people without diabetes.

In a related study, presented at IDWeek in Boston in October, Quynh Nguyen of the University of California San Diego and colleagues looked at prescribing practices and clinical outcomes among people with HIV who used weight-loss drugs. This retrospective cohort study included 225 adults who were classified as overweight or obese and who were prescribed GLP-1 receptor agonists between February 2021 and February 2023. A majority were men and the average age was 54 years. Most were on integrase inhibitors, 90% had an undetectable viral load and CD4 counts were high.

In this study, 53% received injectable semaglutide, 31% used dulaglutide, 8% used an oral formulation of semaglutide, 6% used tirzepatide and 3% used liraglutide. Ninety-nine people (43%) received the drugs for weight management alone, while the rest also had type 2 diabetes.

People who received GLP-1 drugs lost 5.4kg, on average. Nearly a quarter achieved greater than 5% weight loss, body mass index (BMI) fell by 1.8 and 18% went from obesity to overweight classification; blood glucose (haemoglobin A1C) also decreased.Those without diabetes tended to lose more weight. People with a higher baseline BMI and longer duration of treatment were more likely to experience greater than 5% weight loss, while those who used dulaglutide were less likely to do so. Age, sex, race/ethnicity, HIV viral load, CD4 count and antiretroviral regimen were not predictive of weight change.

Use of GLP-1 receptor agonists led to improvements in weight, BMI and haemoglobin A1C among people with HIV and offers an additional strategy to address weight gain and related metabolic complications, the researchers concluded.

In another study presented at IDWeek, Professor Grace McComsey, of Case Western Reserve University in Ohio and colleagues assessed the effects of semaglutide on lipohypertrophy, or abnormal fat accumulation. McComsey noted that its not just weight that matters but also where fat is located. Visceral fat within the abdomen is more strongly associated with cardiovascular disease and other health problems than subcutaneous fat under the skin.

This trial enrolled 108 non-diabetic adults on stable antiretroviral therapy with viral suppression. A majority (60%) were men and the median age was 52 years. More than 80% were on integrase inhibitors and CD4 counts were high. They had a BMI of 25 or higher (indicating overweight or obesity), a large waist circumference or waist-to-hip ratio and reported that they developed increased abdominal girth after starting antiretrovirals. They were randomly assigned to receive semaglutide or a placebo once weekly for 32 weeks. CT and DEXA scans weredone to measure total, visceral, subcutaneous, trunk and limb fat, lean body mass and body composition.

Body weight fell by 8.3% in the semaglutide group while rising by 0.2% in the placebo group. A majority (65%) of people taking semaglutide, but only 4% of those taking the placebo, achieved at least 5% weight loss. BMI also decreased significantly in the semaglutide group.

" HIV-positive people are often urged to take steps to manage their weight, but this is easier said than done."

Total fat fell by 15% in the semaglutide group but rose by 0.2% in the placebo group. Visceral and trunk fat fell by 13% and 17% in the semaglutide group but increased by 5% and 0.4%, respectively, in the placebo group. Subcutaneous and limb fat both fell by 13% in the semaglutide group; in the placebo group, subcutaneous fat rose by 1.5% and limb fat was unchanged. Lean body mass fell by 5.4% in the semaglutide group compared with just 0.6% in the placebo group. However, fat accumulation in the liver and around the heart did not change much in either group.

Semaglutide was safe and well tolerated, McComsey reported. Side effects were common, but severe or serious adverse events were rare. Adherence was good despite the COVID-19 pandemic and the need for weekly injection visits. (Outside of clinical trials, most people use self-injection pens.)

Semaglutide significantly decreased central fat in people with HIV with lipohypertrophy, primarily driven by reductions in visceral adipose tissue, the researchers concluded. Semaglutide may offer an effective treatment to decrease visceral adiposity and reduce comorbidity risk.

McComsey noted that the loss of lean body mass could be a problem for a population prone to losing muscle mass over time, and there is concern that lipoatrophy, or fat wasting in the face and limbs, could potentially worsen.

A study presented at the recent European AIDS Conference (EACS 2023) in Warsaw raised another potential concern. Dr Sebastian Noe of MVZ Mnchen am Goetheplatz and colleagues assessed the effect of GLP-1 receptor agonists on circulating CD4 cells in people living with HIV with sustained viral suppression. Based on previous studies of related drugs, they hypothesised that these medications might lead to a decrease in CD4 counts.

This retrospective analysis included 76 people with HIV treated with semaglutide or dulaglutide for type 2 diabetes or obesity at two HIV clinics in Germany. Most were white men in their fifties and about half had diabetes. The median current CD4 count was high, above 800, but the median nadir (lowest-ever) count was just under 300. The data suggested that GLP-1 receptor agonist use might be associated with a non-time-dependent decrease in CD4 cells, with a median decrease of 64 cells, but not everyone was equally affected. Further research is needed to confirm our findings and to identify people living with HIV at risk of a relevant decrease in CD4 cells, the researchers concluded. The clinical relevance of these findings merits further investigation.

Finally, another study at IDWeek evaluated the effect of tesamorelin (Egrifta) on visceral fat in people taking integrase inhibitors. Tesamorelin, a synthetic growth hormone-releasing factor analogue, works differently from GLP-1 receptor agonists, acting on the pituitary gland in the brain to stimulate growth hormone production. It is approved in the United States, but its EMA application was withdrawn.

A previous study showed that tesamorelin reduced visceral adipose tissue by about 15% in HIV-positive people with lipohypertrophy, but the research was done before integrase inhibitors were the preferred treatment for HIV. Therefore, Dr Taryn McLaughlin of Theratechnologies and colleagues asked whether it would have a similar effect for people taking newer regimens. The researchers drew on data from a previous trial that enrolled 61 HIV-positive participants with fatty liver disease. Of these, 39 (64%) were on integrase inhibitors, most commonly dolutegravir. They were randomly assigned to take tesamorelin or a placebo for 52 weeks.

At baseline, demographics, HIV-related variables and body composition measurements were similar for integrase inhibitor recipients and those taking other antiretrovirals. Over a year of treatment, BMI did not change significantly in either the tesamorelin or placebo groups. Integrase inhibitor recipients assigned to receive tesamorelin saw an 8.3% reduction in visceral adipose tissue, while placebo recipients had a 10.8% increase. Furthermore, the tesamorelin group experienced a 5% decline in liver fat from baseline while the placebo group saw no change. People taking integrase inhibitors in the placebo group experienced a gain in visceral fat despite no change in BMI, while tesamorelin reduced both visceral and liver fat, the researchers concluded.

Taken together, these studies indicate that weight-loss medications hold promise for people with HIV who struggle to lose weight or reduce abdominal fat. But the medications are not without drawbacks, including side effects and cost.

GLP-1 agonists are revolutionizing the treatment of obesity in the general population, and I have no doubt they will do the same in people with HIV, Dr Rajesh Gandhi of Harvard Medical School, commented in a New England Journal of Medicine IDWeek conference update.

Because some people with HIV have fat maldistribution, with disproportionate central adipose tissue hypertrophy, the finding that semaglutide reduces visceral adipose tissue is particularly welcome, he continued. We have known for years that excessive visceral fat is associated with an increased risk for cardiac disease, so the impact of GLP-1 agonists on cardiometabolic health in people with HIV could be substantial.

Venter, however, took a more cautious tone, noting that advocacy will be needed to get the greatest benefits from weight-loss medications for people living with HIV.

In the last few weeks alone, theres been an explosion of new agents, but they are eye-wateringly expensive in rich countries and completely unavailable in low- and middle-income countries, he said at the IAS conference. The levels of cost of these agents and the levels of overweight that were seeing in these communities are going to require some focussed activism in terms of access to these drugs, because theres no way were going to be able to deal with thisWe need to start testing these agents in the HIV-positive population so that we can get access to these drugs for our patients as quickly as possible.

One such study, the SWIFT trial (NCT04174755), is currently underway in Ireland. It compares semaglutide plus a lifestyle intervention against lifestyle changes alone; results are expected in 2025.

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New weight-loss drugs appear safe and effective for people living ... - aidsmap

When you think of building a toned midsection and boosting your strength, complex workout routines and endless crunches often come to mind. Fortunately, that's not necessarily the case. We're here to offer a more holistic, sustainable approach to a slender waistline and increased strength. We consulted Michael Masi, CPT, a certified personal trainer at Garage Gym Reviews, who shares his expert wisdom and pro tips on how to get a slim waist and improve your strength without extreme measures.

Maintaining a healthy weight is more critical than ever. According to the Centers for Disease Control and Prevention (CDC), around one out of three U.S. adults are overweight and 42% are obese. The good news, however, is that fad diets and intense workouts aren't a prerequisite for a trim waistline. You can achieve long-term weight loss through healthy lifestyle habits, like regular exercise and a nutritious, well-balanced diet. And if you want to get stronger, strength training that includes weights or body weight is your answer. Moreover, studies show that strength training is an effective weight-loss strategy.

Your journey toward a slimmer waist doesn't mean compromising your strength or following restrictive diets. The following strategies will reveal the secrets of effective strength training exercises, balanced nutrition, and healthy lifestyle changes that can contribute to your fitness goals.

Read on to learn Masi's pro tips regarding how to get a slim waist and improve your strength. Gear up toembrace a more balanced, strength-focused approach to weight loss. And up next, check out the 7 Best Fast-Digesting Carbs That Will Boost Your Workout.

Losing weight isn't about depriving yourself; it's about making smart choices that create a gap between what you consume and burn, paving the way for a slimmer midsection. "Consume a diet rich in lean meats, fruits, vegetables, whole grains, and healthy fats like nuts, nut butters, and olive oil," recommends Masi. "These foods are much harder to overeat, and if most of your calorie intake comes from these sources, it should help make dieting slightly easier. The ideal strategy for success is a small caloric deficit over one to two months, followed by a small caloric increase to maintain weight. This can be repeated over time to get to lower body weights and reduce more belly fat."

RELATED: People Swear by the '12-3-30' Workout for Weight Loss: 'I Lost 30 Pounds in 10 Weeks'

Say goodbye to crunches and hello to strength training. A 2018 study published in the International Journal of Sports Nutrition and Exercise Metabolism found that a regular strength training routine combined with a balanced diet significantly impacted weight management, regardless of resting metabolic rate.

"Engage in regular resistance training exercises. This will be a stimulus for building or maintaining muscle mass during a diet. Muscle is more metabolically active tissue than fat, so the presence of muscle helps increase metabolism. Muscle is also the tissue responsible for force production, which will be the main stimulus for strength gains," Masi explains.

RELATED: 9 Best Low-Calorie Breakfasts for Weight Loss

Protein isn't just for bodybuilders; it's your secret weapon for a slim waist. Several studies have demonstrated that increasing your protein intake above the recommended dietary allowance promotes weight loss and improves body composition, regardless of total calorie intake. Plus, ensuring you get enough protein helps support muscle growth and repair, enhancing your strength training efforts and promoting a lean physique.

Masi tells us, "Proteins are made up of amino acids, the building blocks of muscle. Asking your body to build or repair muscle without adequate protein is like asking someone to build a house without lumber or bricks. A good range to shoot for is 0.6 to 1.0 grams of protein per pound of body weight."

RELATED: People Are 'Souping' for Weight Loss & Say It Can Get You a Flat Belly Fast

Prioritizing quality sleep is non-negotiable if you want to achieve a slim waist and improve your strength. Research suggests that insufficient sleep can negatively impact weight loss efforts and impede your body's ability to recover following strength training, an essential component of enhancing strength. That's why it's critical to maintain a consistent sleep schedule to support your body's recovery, hormonal balance, and overall well-being. "Aim for seven to nine hours of quality sleep per night," Masi advises. "Poor sleep is linked to weight gain and decreased muscle mass. A consistent sleep schedule helps regulate metabolism and improves recovery, which will be important down the road for diet and exercise consistency."

RELATED: 10 Best Resistance Band Exercises for a Slimmer Stomach

Stress and a slim waist don't go hand in hand. Incorporate stress management techniques into your routine, whether it's meditation, yoga, or a hobby you enjoy. A calm mind contributes to a healthier body, helping you achieve that enviable waistline. According to a 2016 study, reducing stress helps regulate hunger hormones and prevent obesity. 6254a4d1642c605c54bf1cab17d50f1e

"High-stress situations increase cortisol, a chemical commonly referred to as the stress hormone. Chronically high levels of this can lead to difficulty building muscle and weight gain, especially in the abdominal area. Techniques such as meditation, yoga, or simply engaging in stress-relieving hobbies can help you in this department," says Masi.

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How To Get a Slim Waist & Improve Your Strength - Eat This, Not That

We hear so much about people wanting to lose weight, but there are plenty of folks out there looking to add pounds too! Too often, people who are underweight and want to put on weight end up getting left behind in conversation. That may sound easier said than done, but theres a great difference between gaining weight and gaining weightcorrectly.

Certainly, there are no shortage of less healthy ways to gain weight especially if you love junk food. Sure, indulging in soda, chips, and lots of fast-food can do the trick quite easily. Even though this is effective, it is not a long-term fix because doing this increases risk of gaining too much weight, along with higher odds of heart disease, diabetes, and hypertension.

Gaining weight intentionally is fine, but making sure its healthy is imperative.

Everyone has different goals. Simply maintaining weightcan be a great challenge for some. A lot of times, people who want to put on weight may want to do so for three big reasons, although there could be others:

Whether you are underweight in the setting of medical issues or want to put on some weight for the gym gains, the main ideas and ways to get there are the same. Of course, there may be some variation depending on individual circumstances. For this reason, always work with a dietitian on the best course of action for your lifestyle and unique needs.

You hear weight loss fanatics preach the importance of a calorie deficit, but you want to do the opposite if youre looking to gain weight. To do this, youll first need to find your total daily expenditure (TDEE), which measures the amount you need to eat to maintain your weight. There are several different sites, but TDEE Calculator is one of the most reliable tools.

Keep in mind that it is only able to provide an estimate, though. Try to take in 300500 calories more than the number generated for you on a daily basis.

We are not talking about fried foods, but healthy fats. Foods like avocado, olive oil, peanut and almond butters, are all great sources that contain virtually all of their calories from fat.

You dont need a lot to get this benefit, which makes high-fat foods a good choice for someone who wants to take in more calories without feeling super full.

If you usually drink skim milk and eat non-fat Greek yogurt, it may be time to make some changes. For the purposes of weight gain, try whole milk and whole milk yogurt instead. Cheese and full-fat cream are also good dairy choices to include in your diet.

If you are dairy-free, hemp milk typically contains the most calories per cup, coming in at 140 calories.

People struggle with a calorie surplus because they think they are eating more than they actually are, largely because they try to throw food back during three meals and end up feeling full. If you are trying to gain weight, you may find it more beneficial to eat snacks throughout the day to give you more calories and make being in a surplus less intimidating. Nuts, cheese, granola, and dried fruit are all snack ideas that can help.

Protein is the building block of the body. Its imperative for muscle growth, maintenance, and overall development. Protein-rich foods include meats, seafood, eggs, tofu, beans, and more. At the same time, its important to not overdo it as it is the most filling macronutrient.

If you end up being a little too full and satisfied from the protein overload, you may not take in as many calories to support your weight gain.

You may want to gain weight for several reasons, whether fitness, medical-related, both, or something else entirely. Sometimes it can feel difficult to gain weight when there isnt a clear plan on how to do it effectively. Having an idea of your TDEE and eating above that, along with making some dietary tweaks like eating more fat, protein, and eating more often, are some of the most effective nutrition tools. Individualized advice varies, so this is just general guidance. Work with a registered dietitian to establish a path with your unique needs in mind.

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Trying to gain weight? 5 tips from a dietitian for adding on pounds - Study Finds

Many of us already have our daily routines set in stone. In these routines, there are certain habits we religiously followsome of them good, others not-so-good. We here at Eat This, Not That! did some digging and spoke with an expert who calls out some of the most surprising habits that can seriously damage your body.

In order to lead a healthy lifestyle and avoid injury or long-term damage, it's important to kick these bad habits to the curb. Keep reading to learn all about them, and when you're finished, be sure to check out People Swear by the 30/30/30 Plan for Weight Loss: 'Completely Changed My Body'.

Some of the more surprising habits that can damage your body and hinder long-term fitness or weight loss progress happen at the gym. Tyler Read, BSc, CPT, the founder of PTPioneer.com and a personal trainer who has been involved in the health and fitness world for the past 15 years, explains, "Focusing too much on isolation exercises (like bicep curls or leg extensions) and neglecting compound movements (like squats or deadlifts) can lead to muscle imbalances and a lack of functional strength. Over time, these imbalances can cause postural issues and increase the risk of injury during everyday activities."

RELATED: The #1 Protein to Eat for Weight Loss, According to a Dietitian

Let's be honest: Remembering to take a break from a busy workday to fill up your water glass can be challenging. However, drinking sufficient water during the day is so important. 6254a4d1642c605c54bf1cab17d50f1e

"It's well known that you should stay hydrated, but chronic slight dehydration, which may not be immediately noticeable, can affect your muscles' ability to repair themselves and lead to a gradual decrease in strength and endurance," Read explains. "Over time, this can contribute to kidney stones and even kidney damage due to the increased concentration of urine."

RELATED: 7 Best Ways To Burn 500 Calories, According To Personal Trainers

While many fitness pros advocate for static stretching to increase your flexibility, too much of anything is never a good thing. Over-stretching before strength training can temporarily reduce your muscle strength, along with stability in your joints, potentially resulting in injury, Read says. "Dynamic stretching is generally recommended to prepare for activity," he adds.

RELATED: People Swear by the '12-3-30' Workout for Weight Loss: 'I Lost 30 Pounds in 10 Weeks'

Just as much as you can over-train a muscle group, you can also under-train it. "Everyone knows about the risks of over-training, but under-training can be just as harmful," explains Read. "Neglecting to train the back and core adequately, for instance, while focusing on more visible muscle groups like the chest and arms, can lead to a weak foundation, poor posture, and chronic back pain."

When it comes to workout goals, grip strength likely isn't at the top of your mindbut ignoring it altogether can result in a few pitfalls. "Grip strength is often an afterthought in workouts, but over time, a weak grip can limit your ability to perform key exercises, leading to diminished results and an increased risk of accidents or dropping weights," Read tells us.

RELATED: 10 Things You Should Do Every Morning for All-Day Energy

If you typically utilize a weight belt in your workouts, beware of misuse. "Weight belts are commonly used to support the lower back during heavy lifts, but relying on them too much can lead to weakened core muscles," says Read. "This can paradoxically increase the risk of lower back injuries over time, as the body becomes accustomed to the artificial support."

Many of us are guilty of letting our bed sheets extend a bit beyond a week before tossing them in the wash. However, not washing them for an entire weekand beyondcan seriously harm your body and overall health.

According to research performed by Amerisleep, one-week-old pillowcases contained 3M colony-forming units (CFUs) per square inch17,442 times the amount of bacteria you would find on a toilet seat! Pillowcases that went two weeks without a wash jumped up to harboring 5.98M CFUs. When it came to bed sheets, those that weren't washed for a week contained 5M CFUs24,631 times the amount of bacteria you would find on a bathroom door knob.

Not washing your sheets for a full week, week after week, can lead to a vicious cycle of hurting your health and wellness. The research also pointed out that one of the types of bacteria you could find on your bed is called "gram-negative rods," which can result in antibiotic resistance.

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Alexa Mellardo

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7 Surprising Habits That Seriously Damage Your Body - Eat This, Not That

People with type 2 diabetes (T2D) lost more weight by eating whatever they wanted, but only during an eight-hour window, than people who were instructed to cut their calories by 25 percent, according to a new study published today in JAMA Network Open.

Both groups had similar reductions in long-term blood sugar levels, as measured by a test of hemoglobin A1C, which shows blood sugar levels over the past three months.

Our findings show that time-restricted eating [also called intermittent fasting] is a good alternative to calorie counting for people who cant do the traditional diet or are burned out on it, says the study's senior author,Krista Varady, PhD, a professor of nutrition at the University of Illinois in Chicago. For many people trying to lose weight, counting time is easier than counting calories, she says.

This study demonstrates that time-restricted eating can lead to modest weight loss in individuals with type 2 diabetes, says Sun Kim, MD, an associate professor of medicine and an endocrinologist who specializes in the treatment of T2D at Stanford University Medical Center in California. Given that the instructions for time-restricted eating are fairly simple to give and follow, this is a nice option to discuss with patients, says Dr. Kim, who was not involved with the research.

It's estimated that about 1 in 10 U.S. adults has T2D, according to the Centers for Disease Control and Prevention (CDC). If current trends continue, by 2050, 1 in 3 people will have the disease.

Weight loss achieving a healthy weight through dietary changes, physical activity, weight loss medications or procedures like bariatric surgery can reduce blood glucose levels and in some cases even lead to T2D remission. Thats why innovative strategies to help people achieve and maintain a healthy weight are critically needed, according to the authors.

To explore whether time-restricted eating is a more effective way to lose weight and improve blood sugar than calorie restriction, investigators enrolled 75 participants with an average age of 55 years old, an average BMI of 39, and an HbA1C level of 8.1 percent.

As the name suggests, time-restricted eating is when food and liquids containing calories are consumed only during certain hours of the day. Most time-restricted eating studies to date have looked at eating windows between 4 and 12 hours long.

A total of 53 subjects were women, 40 percent were Hispanic, 53 percent were Black, 5 percent were white, and 1 participant was Asian. The higher-than-normal percentage of Hispanic and Black participants in the study is notable because diabetes is prevalent among those groups, so having studies that document the success of time-restricted eating for them is particularly useful, the researchers said.

According to the American Diabetes Association, the rates of diagnosed diabetes are:

Participants were split into three groups: those who followed the time-restricted eating rules, those who restricted calories, and a control group who didnt change how they ate.

The time-restricted eating group ate whatever they wanted between 12 p.m. and 8 p.m. each day they werent asked to count calories or eat certain types of food. During the 16-hour window of fasting, they were encouraged to drink lots of water and were allowed to drink calorie-free beverages. They kept a log and recorded the times when they started and stopped eating each day.

The people in the calorie restriction group were instructed to reduce their calorie intake by 25 percent according to their baseline energy need, which was calculated at the start of the trial. That means if a person needed 2,000 calories to perform basic life-sustaining function, their goal was to cut that by 500 calories and consume only 1,500 calories per day. People in this group met with a dietitian at the start of the study who helped them develop individualized weight loss meal plans and log their food intake into an app every day.

Participants weight, waist circumference, blood sugar levels, and other health indicators were measured throughout the trial.

In six months, the time-restricted eating group lost 3.6 percent of their body weight, and the calorie-counting group lost 1.8 percent of the body weight compared with the control group. Both groups reduced their HbA1C by 0.9 percent.

We were surprised that the calorie restriction group did not lose more weight. In most studies looking at people with obesity, the time-restricted eating and calorie restriction groups lose the same amount of weight, says Dr. Varady.

Varady suspects it boils down to three reasons. Looking at the adherence data, the time-restricted eating group was more adherent to their diet than the calorie restriction group, she says. At least part of that may be because patients with diabetes are generally told to cut back on calories by their doctors as a first line of defense, so many of these participants likely had already tried and struggled with that form of dieting, according to the authors.

Also, most participants in the time-restricted eating group reported that the diet was easy to follow, and at least half the participants in the calorie-restriction group reported the diet was difficult to follow, says Varady.

And finally, it could come down to numbers: The calorie-restriction group reduced their intake by an average of only 197 calories per day, while the time-restricted eating group reduced their intake by 313 calories per day.

Intermittent fasting is trendy, and people are eager to try it, says Dr. Kim. I think there is better data for earlier time-restricted eating (eating between 8 a.m. to 4 p.m.). However, this time period is harder to adapt, as dinner is a very social meal in our society, she says.

In Kims experience, the success of intermittent fasting (as with many other weight loss interventions) is variable. Many patients do find it difficult to maintain long term. In the study, people were adherent about six days per week, she says.

The findings also highlight that losing weight isnt easy, says Kim. The weight loss for the time-restricted eating group was modest (less than 4 percent) compared with effects from currently available GLP-1 receptor agonist medications like Ozempic, Wegovy, and Mounjaro, approved for diabetes and weight loss, she says.

Varady and her team were also surprised that even though weight loss was different, the HbA1C reduction and mean glucose reduction was the same. This might be because though the two groups lost different amounts of weight, they had similar reductions in their visceral fat and their waist circumference. We speculate that this might be why their blood sugar improved similarly, even though the weight loss was different on the scale, she says.

Many experts believe that belly fat is just as important as BMI. Too much belly fat not only increases T2D risk, its also associated with a higher risk of heart disease and stroke, per theCDC.

Kim points out that there are many variables that impact blood sugar, including the tweaks made to diabetes medications, which seemed to be greater in the time-restricted eating group. Perhaps the greater surprise is that patients in calorie restriction had a meaningful decline in A1C. This may be a tribute to working with dietitians to reduce carbohydrate intake, she says.

There were no serious adverse events reported during the six-month study. Occurrences of low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia) did not differ between the diet groups and control groups.

The study was small and should be followed up with larger ones, says Varady. While this acts as a proof of concept to show that time-restricted eating is safe for people with T2D, they should consult their doctors before starting this sort of diet, she adds.

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Intermittent Fasting Leads to More Weight Loss in Type 2 Diabetes ... - Everyday Health

Phentermine-topiramate is the most cost-effective weight-loss treatment approved for adolescents, according to the results of a recent study published in JAMA Open Network. Although semaglutide resulted in more weight loss, the clinical benefits do not outweigh the higher cost, according to the study authors.

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Our findings suggest that, as a weight-loss treatment for adolescents, the relatively low-cost phentermine-topiramate will both place smaller demands on health care budgets and offer better value for money, the study authors wrote.

Childhood obesity increases the risk of adult obesity and serious comorbidities. Currently, more than 50% of children will have obesity by 35 years of age. As of January 2023, American Academy of Pediatrics (AAP) guidelines recommend children aged 12 years and older take antiobesity agents to prevent obesity in adulthood.

Unfortunately, many US insurance plans still do not provide coverage for weight loss drugs. There are still a lot of unknowns associated with this medication class, given the limited hard data supporting long-term efficacy, or studies evaluating post-treatment weight rebound.

Investigators conducted a modeling study of 10,000 pediatric patients aged 12 to 17 years with severe obesity to evaluate the cost-effectiveness of 4 antiobesity drugs (orlistat, liraglutide, semaglutide, and phentermine-topiramate) approved for pediatric use, relative to the cost efficacy of no treatment. Currently, orlistat and phentermine-topiramate cost between $1500 to $8500 annually, with semaglutide and liraglutide costing upward of $12,000.

The team measured cost effectiveness by quality-adjusted life-years (QALYs). Relative to no treatment, the cost effectiveness of phentermine-topiramate was $93,620 per QALY, which was within the average willingness-to-pay threshold ($100,000 to $150,000/QALY) of patients.

Semaglutide, which is the most effective anti-obesity drug with the highest QALYs, had an incremental cost-effectiveness ratio of $1,079,480 per QALY, costing significantly more than the willingness-to-pay threshold. And after further evaluation, the benefits for weight loss did not justify the cost of the product.

In addition, neither orlistat, which cost more than phentermine-topiramate and semaglutide, or liraglutide, which was not as effective as the 2 treatments, can ultimately be considered cost-effective weight loss agents.

AAP guidelines also recommend bariatric surgery for children aged 13 years and older with obesity, therefore, investigators conducted a sensitivity analysis to evaluate the cost-effectiveness of sleeve gastrectomy and gastric bypass surgeries. They also analyzed metformin hydrochloride in this assessment.

Neither type of bariatric surgery was as cost-effective as antiobesity medication, according to the study. In addition, metformin became the least costly agent when compared to the other 4 drugs, but it was also less effective than phentermine-topiramate, making the incremental cost-effectiveness ratio $64,000 per QALY. In addition, it is not FDA-approved for this indication or population and is not currently a plausible weight loss option for adolescents.

The sensitivity analysis also worked to highlight the potential cost effectiveness of medication that lasts into adulthoodin hindsight, investigators suggest that the current cost effectiveness ratios may not be high enough.

Study limitations include the absence of long-term efficacy data and having a majority female and White cohort. In addition, drug efficacy information came from different trials. Previous studies link semaglutide and liraglutide to the risk of thyroid cancer and phentermine-topiramate to birth defects; and the model did not capture all associated benefits of semaglutide.

Further research is needed to determine long-term drug efficacy and how long adolescents continue treatment, the authors concluded.

Reference

Mital S, Nguyen H. Cost-Effectiveness of Antiobesity Drugs for Adolescents With Severe Obesity. JAMA Netw Open.2023;6(10):e2336400. doi:10.1001/jamanetworkopen.2023.36400

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New Study Heralds Phentermine-Topiramate as Most Cost-Effective ... - Pharmacy Times

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