It is a complex disease that affects millions of people and is one of the leading causes of death worldwide. The most severe form of obesity, morbid obesity, is a serious disease with an unprecedented spread in the last thirty years, which has now reached the proportions of a global epidemic.
According to the Organization for Economic Co-operation and Development (OECD), approximately 4.8 billion people worldwide are overweight and 2 billion of them are obese, while by 2035 the obese are estimated to have doubled to 4 billion, with half of them having a disease obesity.
“Our country, unfortunately, has one of the highest rates of obesity in Europe, with 22.5% of the population in Greece (18.2% of women and 26% of men) suffering from the disease according to the latest measurements. In addition, Greece is one of the European countries with the highest rates of childhood obesity. The above data may explain the frenzy observed in recent weeks in our country regarding the attempt to lose weight with the help of semaglutide, even though the drug on the market has no indication for obesity. A fact that highlights in a distorted way the constant battle of many people with their weight, a battle for their health and the improvement of their daily life”, explains Dr. Panagiotis Lainas MD MSc PhD, Associate Director of General Surgery at Metropolitan Hospital & head of the Obesity Department of the Diagnostic Centers Healthspot of the HHG group.

Surgical treatment of obesity

It is now scientifically proven that obesity is associated with a number of serious health problems, some of which can even lead to death. Since the conservative treatment of obesity has limited possibilities and high socio-economic costs, in recent years, many people resort to bariatric surgery, i.e. the specialization of surgery that deals with the fight against obesity.

The outstanding results of obesity surgery and the interest of the global scientific community have led to significant progress in understanding the pathophysiology of obesity. This, in turn, has led in recent years to the production of targeted drugs that assist in the treatment of the disease.

“Medications, however, alone cannot achieve what surgery can. On the other hand, surgery can be enhanced and assisted in many cases by medication in order to achieve ideal weight and remission or treatment of co-morbidities caused or aggravated by obesity. It is therefore very important to have sufficient and accurate information about the benefits and side effects of anti-obesity medication, as well as about which patients really benefit from it,” emphasizes the expert.

Pharmaceutical treatment of obesity

Today, the world’s most popular anti-obesity drug is semaglutide, which was developed for diabetes mellitus by Novo Nordisk under the name Ozempic. Although the European Medicines Agency has approved semaglutide against obesity, its marketing for this indication has not been possible in European countries, with very few exceptions. Instead, it is widely marketed in the United States of America under the trade name Wegovy.

Semaglutide is an analog of the glucagon peptide GLP-1. As an agonist of the GLP-1 receptor, it selectively binds to and activates it. Its main actions are the following:

  1. Lowers blood glucose levels by stimulating insulin secretion and decreasing glucagon secretion when blood glucose levels are high.
  2. It causes a slight delay in gastric emptying during the early postprandial phase.
  3. It reduces appetite and therefore energy intake resulting in weight loss.
  4. Reduces fasting and postprandial glucose concentrations in patients with type 2 diabetes.

“Due to the effectiveness of the drug in weight loss, it is natural that it attracts the interest of people who are overweight or obese. However, doctors should explain the following points to interested parties.

First, semaglutide is an antidiabetic drug and an injectable one at that. This is very important information, as in the Greek health system the prescription of antidiabetic drugs requires the patient to be registered in the diabetic registry. However, it can be administered without registration in the EOPYY with a simple doctor’s prescription, but its cost is not covered, which is quite significant per week.

Second, the benefits of the drug are seen while it is being taken and cease after the treatment is stopped, with regaining of the lost weight in most cases.

Third, according to scientific studies, this drug allows weight loss of only 5% to 20% (at best) of the patients’ total weight.

Fourth, semaglutide often causes unwanted symptoms, mainly nausea, while cases of significant hair loss have also been reported, side effects not negligible for patients’ daily life.

Finally, it is very important to emphasize that obesity is a chronic disease caused by a multitude of factors (psychology, diet, physical activity) and cannot be cured with any pharmaceutical preparation,” the doctor points out.

Conclusion

“It is clear from the latest scientific data that medication with new drugs such as semaglutide is another weapon in the experts’ quiver against morbid obesity. On the other hand, bariatric surgery has consistently produced long-term results with a safe loss of 70-100% of excess weight and minimal post-operative follow-up requirements, being today the only proven long-term effective treatment of morbid obesity.

The combination of bariatric-metabolic surgery and medication is sure to open new horizons, providing the ideal solution to the chronic and difficult problem of obesity and its accompanying diseases. A combination that should be recommended by specialized groups of experienced surgeons and endocrinologists to carefully selected patients, in order to achieve the best result in each case”, concludes Dr. Lainas.