My supervisor and I were working with a patient last week and he said "hey, have you heard about this new weight loss drug that just got approved?" The patient said no. I also said no, because I had no idea what he was talking about.
I went home to look it up - Liraglutide - and I realized that I did actually know about the drug. It's a diabetes medication that tries to squeeze as much insulin as possible out of the pancreas, keep the pancreatic cells alive and reduces hunger at lower doses.
At higher doses, and for the same reasons, it is helping people lose weight and it is being marketed as Saxenda for these purposes.
The drug was approved for use this year in Canada and trials to test the drug were conducted at some of our most well-known obesity clinics.
The study of most import is the one where they showed that liraglutide actually helped people keep the weight off. We have so many ways to help people lose a little bit of weight but we completely suck at helping people keep off the weight.
The phase III trial, called Weight maintenance and additional weight loss with liraglutide after low-calorie-diet-induced weight loss: The SCALE Maintenance randomized study, was published in 2013 by Wadden et al in the very fancy journal, Nature. Fancy means that the stuff that makes it in is the best of the best science out there and will probably change medical practice.
The study was paid for by the manufacturer of the drug. This is common. I feel a lot of ways towards pharmaceutical companies - their inadequacies and their triumphs - but I am a pragmatist in that I realize that no one else is going to fund the development of these medications.
The flip side is that if they didn't think it could make them some money, Novo Nordisk Inc also wouldn't have funded the study, and my preceptor wouldn't be talking about new options for our obese patients.
The study included 420 people. They were all morbidly obese or obese with some health problems. They started the study off together and were asked to participate in a "low calorie run in" period four to 12 weeks to lose about 5% of their body weight with diet and exercise alone. This run-in period allowed the researchers to make sure that the participants were able to tolerate the diet, were able to lose weight and were cooperative in terms of answering phone calls and showing up for weigh-ins. They also wanted to have some weight off each participant to see if liraglutide was better than diet and exercise alone in keeping the weight off.
Then the group was divided up into two smaller groups through random assignment. There were 212 people in the liraglutide group. This means that 212 people got the drug as well as continued the diet and exercise program, and 210 people didn't get the drug (but thought they did) and continued with the diet and exercise. The randomization was well done and the prevalence of demographic characteristics of both groups were about the same after randomization, including age, weight, ethnicity, etc.
The most common reason people in the liraglutide dropped out of the study was mild or moderate nausea and GI upset. But even so, more people dropped out of the placebo group (the group that thought they were getting the drug but weren't). Cardiac side effects were more common in the placebo group. Episodes of low blood sugar were reported by 11 people in the liraglutide group and 5 in the placebo group.
The results of the study were pretty remarkable.
Remember how all 420 people did the low-calorie diet? And they all started the study by losing over 5% of their weight?
Over 80% of the people who ended up spending the rest of the year in the liraglutide group kept the weight off.
Overall, the people in this group lost a little over 6% of their body weight and the vast majority kept it off. In the placebo group, just under 49% of the participants kept their weight off. The mean change in body weight was just -0.2% for the placebo group.
In the context of existing healthy change, the medication could be a valuable tool in the arsenal. Dr. Arya Sharma, who has been paid by liraglutide's manufacturer for speaking appearances, supports the medication as one of many tools, not as a panacea. It won't work for everyone, it needs to be carefully dosed up over a matter of many weeks and it has side effects.
But even if it works perfectly for many, we are absolutely still stuck in the place where too many calories into a body that is prone to obesity will result in weight gain, liraglutide or not. So we still need movement. We still need the efforts of nourishment and mindfulness. We still need to do good work around goal-setting with ourselves.
We still need to learn to love our varied, delightful and complicated bodies.
We still need to change the way our societies govern, regulate, sell and market food.
Don't believe the hype of one magical cure but believe that there's some decent science around a drug we know relatively well. The study I discussed in this post will need to be followed up and replicated for it to maintain its stature as a turning point in obesity pharmacology. But that takes time while, right now, the struggle is real.
Drug Monograph: Saxenda (Liraglutide)