Covid-19 is bad, but diabesity is the major pandemic of the 21st century

A year ago this week (mid March), the World Health Organization (WHO) declared Covid-19 a pandemic. In the space of 12 months, the virus has killed 2.5 million people and infected at least 116 million globally, and there’s no doubt the world has been significantly changed by this contagious and pervasive pandemic. Fortunately, for those of us living in Australia and New Zealand, there has been nowhere near the devastation seen in the Northern Hemisphere, but still (especially in Victoria), lives have been lost and livelihoods destroyed.

But if we widen our focus to the 21st century thus far (20 years in), the major pandemic is quite clearly diabesity (the combination of diabetes and obesity). In some regions of the world, diabesity can affect anywhere between 10 to 30 per cent of the population, and in certain communities, such as the Pima Indians (a group of Native Americans) in the United States, 60 per cent of adults are Type 2 diabetics with obesity.

There are many complex factors involved in the generation of obesity, and there are a variety of dietary approaches that have been introduced over the years but, tragically, well over 95 per cent of people involved in any dietary program have either re-gained their original weight – or put on even more weight – three years after the commencement of the program.

Obesity surgery has become a very prominent method for dealing with this condition. But the reality is that although most programs, including obesity surgery, are highly successful initially, the vast majority of people still appear to regain weight over time.

About 15 years ago, I wrote a book titled Diets Don’t Work. Diets aren’t successful because you go on a diet like you go on a holiday, i.e. you come back. All dietary programs work in the vast majority of people until they stop the program.

In my own practice, many patients do not comply with the advice given. Lifestyle aside, compliance to drug or supplement therapy demonstrates that 50 per cent of people have stopped the prescribed therapy after 12 months, despite having an underlying chronic illness.

Therefore, any sort of innovation in this area is very welcome. Recently published, in February, in one of the most impactful medical journals in the world, The New England Journal of Medicine, was a study using a diabetic drug known as semaglutide. Administering this drug subcutaneously over a 68-week period, with a weekly injection of 2.4mg, demonstrated significant benefits. This study followed 1961 adults with a BMI greater than 30 (or greater than 27 if they had one or more weight-related conditions such as pre-diabetes, hypertension or sleep apnoea). Diabetics were excluded from this study.

The results were quite striking in that the average change in body weight was 15 per cent in the treated group and only 2.4 per cent in the placebo group. In the treated group versus the placebo group, 86 per cent versus 32 per cent lost 5 per cent or more of their body weight; 69 per cent versus 12 per cent lost 10 per cent or more of their body weight; 50 per cent versus 5 per cent lost 15 per cent or more of their body weight. While a striking one in three treated people lost more than 20 per cent of their body weight compared with no-one in the placebo group.

The average weight loss was about 15 kilograms in the semaglutide group and just under 3kg in the placebo group. Nausea and diarrhoea were common mild side-effects, with 4.5 per cent of the treated group stopping treatment, as opposed to 0.8 per cent of the placebo group.

As a side benefit, there were significant reductions in inflammatory and metabolic markers such as falls in glucose levels and blood lipids, such as cholesterol.

There are many questions that arise from a trial such as this, which most importantly include: what happens when the treatment is stopped? Are there any long-term side-effects that extend well beyond the intermediate treatment time? We do know that many drugs are released on the market where the long-term effects aren’t known until a significant proportion of people have used the drugs for a long period of time.

There are also oral versions of these types of drugs, too, so another question is whether they could be just as effective as having a weekly subcutaneous injection?

What we do know is that long-standing obesity and diabetes have dramatic and serious long-term consequences and we need to be managing these conditions much better than we are at present. There have been a number of breakthroughs in the field of diabesity in the past 10 years and hopefully this one will stand the test of time in the management of obesity.

IMPORTANT LEGAL INFO This article is of a general nature and FYI only, because it doesn’t take into account your personal health requirements or existing medical conditions. That means it’s not personalised health advice and shouldn’t be relied upon as if it is. Before making a health-related decision, you should work out if the info is appropriate for your situation and get professional medical advice.