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Monday, January 30, 2023

Has the Ultimate Weight-Loss Pill Arrived?

A new class of drugs holds remarkable promise for weight loss with few side effects. 

Initially targeted to treat diabetes, a new group of drugs called incretins is demonstrating stunning results when used for weight loss. One, called tirzepatide and marketed as Mounjaro, was approved by the FDA for treating diabetes in May of 2022. Doctors have leeway to prescribe approved drugs for other purposes. Knowing that trials had indicated its ability to help people lose weight, many doctors are now prescribing it for that purpose, and it is being fast-tracked for approval as a weight-loss drug.

Study of Mounjaro for Weight Loss

Just how effective is it? A recent trial involved 2,500 people without diabetes who had a body mass index over 30 or over 27 with at least one health condition related to weight. Participants got one of three weekly doses: 5, 10, or 15 milligrams, or a placebo, for 72 weeks. The results of the double-blind trial astonished researchers.

Taking Tirzepatide Requires Shot  

Here’s both the good news and the bad news. You only have to take Tirzepatide once a week, but it’s delivered as a shot, and you must keep taking it to keep the weight off. But don’t sweat it. According to Gabbay, we are not talking about a regular, full-size needle, but “a small, penlike device with a tiny, tiny needle” that is less painful than a finger prick for glucose. Phew!

Cheap, Effective Treatment for Hair Loss

Many older adults, both men and women, struggle with thinning hair. There are a thousand remedies hawked on TV and social media, but the best treatment appears to be one that costs only pennies a day. Dermatologists recommend using minoxidil, an old standby, in a new way. Instead of putting it on your scalp, it’s given as low-dose pills.

While not yet approved for the purpose by the FDA, many doctors are prescribing the drug off label. Minoxidil has been around since 1988 as the active ingredient in Rogaine, a foam or lotion that is rubbed on the scalp. However, many don’t like the sticky residue it leaves in their hair. It also doesn’t work well for many because the drug must be converted to an active form by sulfotransferase enzymes that may be insufficient at the hair roots. When taken orally, your body converts it to an active form. 

But many doctors are just learning about the treatment. “It is just starting to see a surge in popularity,” said Dr. Crystal Aguh, a dermatologist at Johns Hopkins School of Medicine. “More and more at conferences, we are sharing our success stories.”

“Almost 40% of individuals lost a quarter of their body weight,” said coauthor Dr. Ania Jastreboff, codirector of the Yale Center for Weight Management.

Study participants who took the lowest (5 milligrams) dose lost an average of 35 pounds. Those taking the middle dose (10 milligrams) lost 49 pounds on average, and those at the highest (15 milligrams) dose had an average loss of 52 pounds. 

“The weight loss that they got in this study was even greater than what had been seen in the previous studies of people with diabetes,” says Dr. Robert Gabbay, chief medical officer of the American Diabetes Association and not involved in the study. “The kind of weight loss that we see when people exercise and change their calorie intake is somewhere in the order of 5% to 7%. This study showed a profoundly greater weight loss, far above what we would imagine with lifestyle changes.”

Obesity Is a Disease 

It’s a falsehood that everyone can control their weight through diet and exercise. Your brain regulates your appetite and your metabolism. For the severely overweight, those settings are primed to retain weight.

Tirzepatide works by retaining food in the stomach longer, slowing its journey to the small intestine, and by making the brain feel satisfied quickly. Forrest Smith, an overweight petroleum engineer, used to wonder how his slimmer friends could resist eating an entire plate of cookies when it was sitting in front of them. He started the medication, and it was like “a switch flipped overnight,” he says. “One cookie? Totally doable.”

“Obesity should be treated like any other chronic disease – with effective and safe approaches that target underlying (causes of) disease … and these results underscore that tirzepatide may be doing just that,” says study coauthor Dr. Anna Jastreboff of the Yale Center for Weight Management. “These results are an important step forward in potentially expanding effective therapeutic options for people with obesity.”

Cost of Tirzepatide an Issue

Some insurance plans cover the drug for weight loss, and patients pay a reasonable $25 or so a month. But without coverage, the cost rises to a prohibitive $2,000 or so a month. Another factor is that diabetes medications are meant to be taken indefinitely. Quit the drug, and the weight is likely to return. 

Seniors on Medicare get disappointing news, too. Medicare does not cover anti-obesity medications. The Treat and Reduce Obesity Act would change that, but it’s currently tied up in Congress. However, if enough patients demand the drug, Medicare could change its position and authorize coverage.

Will Patients Demand Its Use?

Doctors must also know about the drug to begin to prescribe it widely. The only known side effects are constipation, diarrhea, and nausea, which occur in about 5% to 7% of users. But the potential for easing issues related to weight, such as high blood pressure, high cholesterol, and cardiovascular disease, is profound. 

And there’s another benefit that may be just as, or even more, life changing. Suzy McLaughlin has been losing weight on the drug, and she recently planned a trip to Europe with her husband. This would have been unthinkable just months ago, when the thought of walking more than a block or two wasn’t doable. Now, she says, “I cannot wait to get on a plane and take a seat comfortably.”

Anyone who has ever been mocked for being overweight may demand to get the drug. The mental health benefits could be as important as the physical ones. 

For now, many questions about tirzepatide remain. What we do seem to know is that, finally, there is a drug for safe and substantial weight loss available now. Time will tell how many people will get to use it, and how much it will change their lives.