New drug for obesity raises hope despite concerns over side effects
Amid overwhelming medical facts, many Nigerians tenaciously hold on to the belief that being overweight is a sign of good living. Experts, however, share the view that this could be a recipe for disaster.
An Abuja-based pharmacist who has been practising for 19 years, Hassan Ankuma, in an interview with Sunday PUNCH, raised the alarm over a growing trend of obesity, particularly among children.
“I see children that are already obese. We adopt western lifestyles, eating a lot of chocolates and so on. The rich feel that they don’t really need to get involved in a lot of everyday physical activity and that is why you see the number of people patronising the gym has become higher,” Ankuma said.
How well a person manages their weight is determined by their body mass index—the calculation of one’s weight in relation to one’s height which defines one’s health risk. Obesity is defined as a BMI over 30kg per metre-squared. A BMI of 25 to 30 is considered overweight, while a BMI of 18.5 to 24.9 is considered healthy.
The United States’ Food and Drug Administration says obesity or overweight is a serious health issue associated with some leading causes of death, including heart disease, stroke and diabetes, and is linked to an increased risk of certain types of cancer.
The number of obese and overweight people in Nigeria is already a cause for concern.
A group of 14 medical researchers led by Dr Davies Adeloye at the University of Edinburgh, in a paper based on 35 studies published in Annals of Medicine on March 30, 2021, noted that the rates of overweight and obesity in the country were 25 per cent and 14.3 per cent, respectively.
According to the research titled ‘Estimating the prevalence of overweight and obesity in Nigeria in 2020: A systematic review and metaanalysis,’ the prevalence in women was higher compared to men at 25.5 per cent versus 25.2 per cent for overweight, and 19.8 per cent versus 12.9 per cent for obesity, respectively.
In another study titled ‘Childhood obesity in Nigeria: causes and suggestions for control’ published in the Nigerian Journal of Parasitology in April 2018, Prof Evangeline Oparaocha of the Federal University of Technology, Owerri, Imo State, reported findings that showed 11 to 18 per cent prevalence of childhood obesity in Nigeria.
“Studies on the tracking of obesity indicate that 70 to 80 per cent of obese children and adolescents become obese adults. It is reported that from age six, about half of obese children turnout to become obese adults whereas just about a 10th of non-obese children eventually becomes obese adults.
“These thus buttress the need for timely intervention in childhood obesity to prevent obese children from becoming obese adults with its attendant health challenges,” the study noted.
Losing five to 10 per cent of body weight through diet and exercise has been associated with a reduced risk of cardiovascular disease in adult patients with obesity or overweight.
And perhaps one of the most significant breakthroughs in this regard came on June 4 with the approval of the first US drug since 2014 to tackle overweight and obesity.
The FDA, in a statement, said it had given its approval to Wegovy, a semaglutide injection for chronic weight management in adults with obesity or overweight “with at least one weight-related condition (such as high blood pressure, Type 2 diabetes, or high cholesterol), for use in addition to a reduced calorie diet and increased physical activity.”
The drug is indicated for chronic weight management in patients with a BMI of 27kg per metre-square or greater who have at least one weightrelated ailment or in patients with a BMI of 30kg per metre-square or greater.
The largest placebo-controlled trial, according to the FDA, enrolled adults without diabetes. The average age at the start of the trial was 46 years and 74 per cent of patients were female. The average body weight was 105kg and average BMI was 38kg per metre-square.
The statement read, “Individuals who received Wegovy lost an average of 12.4 per cent of their initial body weight compared to individuals who received placebo. Another trial enrolled adults with Type 2 diabetes. The average age was 55 years and 51 per cent were female. The average body weight was 100kg and average BMI was 36kg per metre-square. In this trial, individuals who received Wegovy lost 6.2 per cent of their initial body weight compared to those who received placebo.”
According to online sources, placebo is a substance or treatment which is designed to have no therapeutic value. Common placebos include inert tablets, inert injections, sham surgery, and other procedures and they are an important part of clinical studies as they provide researchers with a comparison point for new therapies, so they can prove they are safe and effective.
The Deputy Director, Division of Diabetes, Lipid Disorders, and Obesity in the FDA’S Centre for Drug Evaluation and Research, John Sharretts, was quoted as saying, “Today’s approval offers adults with obesity or overweight a beneficial new treatment option to incorporate into a weight management programme.
“FDA remains committed to facilitating the development and approval of additional safe and effective therapies for adults with obesity or overweight.”
After four 68-week trials with more than 2,600 patients receiving Wegovy and more than 1,500 patients receiving placebo, the most common side effects included nausea, diarrhoea, vomiting, constipation, abdominal (stomach) pain, headache, fatigue, and dyspepsia (indigestion).
Other side effects were dizziness, abdominal distension, eructation (belching), hypoglycemia (low blood sugar) in patients with type 2 diabetes, flatulence (gas buildup), gastroenteritis (an intestinal infection) and gastroesophageal reflux disease (a type of digestive disorder). However, the National Secretary of the Pharmaceutical Society Nigeria, Emeka Duru, expressed concern in an interview with Sunday PUNCH, saying, “You can be sure that the natural way of losing weight, such as exercise and diet, is more appropriate and can be recommended.
“Drugs are chemical substances and can have side effects and rebound effects. That means the person may eat more or the fat adipose tissue may get bigger. Side effects might be seen in the liver and heart. We might not say it (obesity) does not exist. But I don’t think that is one of our problems.”
Similarly, Ankuma stated that such drugs would likely appeal to Nigerians, though he warned that indiscriminate use could be costly. According to him, medication for chronic weight management should be on prescription.
“If it gets into Nigeria, I think Nigerians may patronise it. But my fear is that we may find people who are even underweight saying they want to ‘maintain this or that.’ If we are not careful, abuse of it can be involved and when we have abuse of it, the resulting effect will be that we may end up losing people.
“When somebody whose blood sugar level is normal takes it, the level could go very low and the person could go into shock easily. If not detected in time and the person is not resuscitated, they could (die),” he said.
The bottom line is, innovation always calls for celebration. But substitutes for more natural weight loss plans certainly call for discretion. ,,