Since the pharmaceutical company, Novo Nordisk has realized that GLP-1 medicines were useful for diabetes, doctors and researchers have struggled to answer a misleadingly simple question: Who should take them? Medicines are highly effective in inducing weight loss and most North -Americans are overweight or obese. But GPPs are also expensive, not covered by most insurance and are designed to be taken for life, not to mention that they often give rise to nausea and a loss of appetite. It is not appropriate to give them all the north -Americans with overweight.
Take President Donald Trump. During his first term, an exploration showed signs of plate accumulation in his coronary arteries, who put him at risk of a heart attack. By 2020, its body mass index was little more of the threshold for obesity. This combination would have made him a candidate for a GLP-1 drug and, in fact, throughout his 2024 campaign, people speculated that they took one. At that time, Trump’s last physicist showed that he had fallen £ 20, moving it from obese to overweight. (Trump has never said publicly that he is on a GLP-1, and when he received comments, the White House did not address questions on how the President had lost his weight. Trump is “in a maximum physical and mental condition,” said the secretary of the white house Karoline Leavitt. The Atlantic In an email statement.) The most revealing aspect of the President’s medical report was the list of drugs he is taking, which includes a combination that is equivalent to what doctors call “intensive lipid reduction therapy”: a generally reserved treatment for patients with a significant risk of heart disease. In terms of the president’s health, his weight is not more important than the fact that he is in this drug regime and which seems to work: his LDL (“bad” cholesterol) has dropped dramatically in recent years.
Trump’s example shows that the main purpose of doctors and patients should not be the changes in the weight alone, but the changes in health. GLP-1 drugs can help a wide range of people lose weight, but their risks are justified only for a smaller subset of Americans. To say if the health benefits that a person can get to take the drugs is worth spending and it is likely that the gastrointestinal discomfort, doctors cannot just trust the weight. The calculation can be life and death; Almost 1,000 deaths a day are related to diet -related diseases in the United States. In order to save lives and improve health, doctors, researchers and politicians need to take into account the true murderer: not weight or size, but a particular type of fat.
When humans eat too much calories, especially many of highly processed and absorbed carbohydrates that are so common in the modern diet: fat accumulates around the waist, surrounding and invading the liver, heart and pancreas. Doctors call it visceral, central or abdominal fat. It is more dangerous for health than fats that accumulate in places like arms and thighs because it filters free fatty acids and other molecules in the body, generating inflammation, increasing metabolism and causing havoc on our organs. Visceral fat is related to cardiovascular disease, stroke, diabetes, 13 types of cancer and probably some forms of dementia, among other important chronic diseases. Reduce visceral fat and these conditions can be prevented or even in certain cases, treat them.
Visceral fat is closely linked to two segments of metabolic disease: high levels of insulin and insulin resistance. Scientists have not yet determined what is the first visceral fat or high insulin, but they know that high levels of insulin are part of a vicious cycle that promotes fat storage, visceral fat and illness. As high insulin has become more common: in 2018, more than 40 percent of North -Americans had high insulin, there are also chronic diseases. Six out of ten north -Americans have at least one chronic illness and four out of 10 have more.
GLP-1 drugs are noticeably effective to reduce visceral fat. In fact, it can be a large part of why GLP-1 improves the metabolic health of the people who take them. The strongest case for the use of GLP-1s, then, is in people with excess visceral fat who have begun to suffer their consequences. The crucial problem of doctors is like identifying these people. The BMI is a poor measure, but the size of the waist is a good predictor of visceral fats, type 2 diabetes and atherosclerosis. Some abnormalities in lipid blood patterns may indicate the beginning of organs dysfunction.
However, the primary metric by which anti-obesity medicines are judged and distributed. Originally, the FDA approved these medicines for people with an BMI of 30 or more, or with a BMI of at least 27 and at least one disease related to weight. But the Agency has silently eliminated its references to the Drug Tags BMI, which now simply claim that medicines are for “obesity” patients or for those who have “overweight in the presence of at least a weighty condition related to weight.” Without saying explicitly, this change acknowledges that BMI is not a good measure of body fat or visceral fat that causes the most harm. However, the agency still requires that clinical obesity medicine trials use the BMI as a criterion for registering patients. When I go to obesity-medicine meetings, many of the doctors I speak with BMI still use as a guide.
During the last decade or so, awareness has grown between doctors and patients that the BMI has limited use as a health metric. Does not distinguish between muscle and fat. It does not take into account how fat tends to distribute -differently in male and female bodies. These shortcomings are important when considering what a patient has to obtain from a GLP-1 drug. People in the heritage of South Asia, for example, can develop insulin resistance to BMIS much lower than other populations. According to the American College of Cardiology, in terms of insulin resistance, a white person with a 30 BMI can be metabolically equivalent to a south -language person with a 23.9 BMI. Unfortunately, doctors do not have easy and reliable ways to directly measure insulin resistance. Developing a diagnostic test would be a long way to help determine who should be treated with obesity drugs.
The United States continues to decide how it approaches exactly on GLP-1s. The Trump administration searched a Biden administration proposal to cover medicines against obesity by virtue of the medication of Medicare’s D, but has not ruled out future coverage. During the last year, the FDA has expanded its eligibility guidelines for drugs and has stated that drugs are no longer scarce. This means that compound pharmacies can no longer produce Novo Nordisk and Eli Lilly’s Wegovy replicas, which will reduce the availability of cheaper options, but can also stop the risks associated with copycats. In addition, Novo Nordisk and Eli Lilly have recently introduced new discount programs. First data suggest that drugs can be useful for treating fat liver disease, heart failure and possibly neurodegenerative diseases, which, I suspect, will bring even more people to bring them.
If the GLP-1 really becomes more common in America, everyone who follows them must understand that they do it without a final game. GLP-1 medications were approved under the premise that patients will remain throughout their lives, but so far, most people take them less than a year, largely due to their side effects, usually a high cost and lack of insurance coverage. Scientists do not have good data on whether they can be downloaded from the drugs without recovering the weight, if they can be used safely and effectively or how to adjust the doses in the long term. The best way to find these answers is that the FDA requires pharmaceutical companies to collect data. Let companies outside the hook assuming people will be in these drugs would forever be a grave mistake.
All of these unanswered questions are only in addition to the urgency of determining who is most likely to benefit from GLP-1, and who would be safer or healthier to maintain lifestyle changes and other medicines. GLP-1 drugs are not a panacea. They are a powerful tool to help control the crisis of U.S. metabolic disease, one we need to get right.
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