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Letter: Obesity

Wednesday 9 August 2023 | Written by Supplied | Published in Letters to the Editor, Opinion


Letter: Obesity

I was very surprised and pleased to receive a briefing from Nature magazine that anti-obesity drugs are available.

I clicked on the link and read that more than four years ago, the American FDA approved the use of semaglutide, marketed as "Wegovy" as an anti-obesity drug.

Semaglutide had originally been used in treatment of people suffering from Type 2 Diabetes, one of the NCDs (non-communicable diseases). 

The drug is injected once a week, and works on the body’s receptors for appetite regulation and reward, to bring on a feeling of fullness and reward associated with eating, and slows the emptying of the stomach.  The Danish manufacturers of semaglutide had to cease advertising, because demand became hard to keep up with. 

Read: TMO responds to anti-obesity drug proposal

I began to wonder how, as an ordinary person with no medical training, I got this information before health administrators in small island developing States everywhere (not just on our little island) got it?

This is not mis-information, Naturemagazine is regarded as a trusted source.   A lucky few were able to have bariatric surgery which made them lose a lot of weight.  

TV1 News recently reported on a NZ woman who spent $20,000 to have bariatric surgery,  because she was certain she would not reach retirement age otherwise.   Even if it is expensive, this drug must surely cost less than that, so that more people could benefit.   

The Nature article went on to say that there are many factors which lead to obesity and could affect someone’s response to treatment, for example, genetics, lack of sleep, chronic stress, poor nutrition and a sedentary lifestyle.  

I think this may be a long way of saying there is no guarantee that everyone who uses semaglutide will lose weight.   But following normal statistical patterns, many would.

I found it interesting that the scientists agreed that these medications show that obesity is not due to “a lack of willpower. "Exercising more and eating less usually aren’t enough, because the brain instructs us when and how much to eat.   That’s where the biological imbalance — and therefore treatment potential — lies" wrote the research scientist.  It was also thought that teens with obesity especially would benefit “if we can actually improve their quality of life and improve their physical health.     Participants at the June 2023 Conference in Bridgetown, Barbados put a statement afterwards that says they  "Remain deeply concerned that SIDS ("Small Island Developing States" show the highest rates of childhood and adult obesity worldwide and that the challenge in ensuring healthy diets and effectively responding to NCDs in SIDS is significantly constrained by high dependence on imported food, medicine and diagnostic devices, commercial influence and trade-related challenges."    

In closing, I call on our Ministry of Health professionals to consider seriously working with the appropriate visiting NZ specialists and WHO to quickly develop a protocol and research program, and then offer voluntary trials for patients here in Rarotonga.   Maybe if they were asked, NCD specialists from another country could provide their program so it can be modified for use in SIDS, which would act like an extension of their own program.  Cook Islands health staff could ensure prior, informed consent before patients join the trial.   The patients could continue to attend their weekly NDC clinics, where their weight, blood pressure and pulse and other vital signs are monitored.    Semaglutide could be administered at that weekly NDC clinic to reduce appetite (and therefore food intake).   This could be a pilot study for a Pacific regional trial to fix a problem that is widely thought to be very serious.  Eventually improvements in patient health will be reflected in lower referrals and lower demand for NCD medication, which has historically been a significant an increasing expense.  So let's stop wringing our hands helplessly, and try this drug that has helped others who already have access to it.

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