Защо лекарите трудно предписват лекарства за терапия на затлъстяването?

  • April 30, 2021
  • Recent studies published in JAMA and the New England Journal of Medicine highlighted the remarkable efficacy of once-weekly injections of semaglutide for long-term weight loss, with average losses of 16% and 14.9% over 68 weeks, respectively. Given the challenges of maintaining weight loss and the benefits of weight loss for many weight-responsive diseases, quality of life, mobility, and reduction of risk for chronic noncommunicable diseases, you might expect such a drug to be released to uniform cheer.

    overweight-fat-doctor-patient-visit-hospital

    You’d be wrong, though, because when it comes to obesity, many would seemingly prefer there to be no effective pharmaceutical treatments. The loudest voices opposing medications for obesity, though they often share talking points, usually fall into one or more of these four categories:

    1. The food-is-medicine proponents
    2. The lifestyle-is-medicine proponents
    3. The weight-biased
    4. The obesity denialists

    The first two groups’ arguments are the most obvious and generally involve some riff on, “Why would anyone take medication for obesity? They just need to go on the <insert diet here> diet,” or “Whatever happened to eat less, move more?”

    The weight-biased, of course, tend to perseverate around what they perceive to be the moral failings of people with obesity and frame medications as a reflection of their purported weaknesses, while the obesity denialists frame everything as a medico-pharma conspiracy for a disease that they believe doesn’t exist and therefore requires no treatment.

    Of the four groups, I’d venture that the most prevalent are the weight-biased. And here I’m not speaking of explicit bias but rather implicit bias — which, when it comes to healthcare professionals having negative feelings toward those with obesity, is well documented and has been shown to affect care.

    The Reactions

    In the discourse that followed the release of these two recent studies, there were disparaging remarks about the cost of medications, frequent suggestions that the drug’s primary mechanism of action is nausea (rather than what is for most — a transient or minor side effect), and complaints about the drug’s requirement for long-term use. Also apparently problematic was the fact that for many people, the 15% weight loss achievable from a single medication will still have them weighing more than some table says they ought to.

    Notable too was that the majority of these doctors weighing in on what they perceived as the drug’s shortcomings were physicians who don’t practice obesity medicine and who had probably never prescribed a glucagon-like peptide 1 analogue or followed and counseled a patient in the context of weight management. Perhaps I’m old-fashioned, but I would never presume expertise in a field where I didn’t practice. But of course, everybody eats, and consequently everybody is an expert, it would seem.

    Be a True Ally

    All this is to say, obesity is a chronic noncommunicable disease that medicine treats like no other. With all other chronic noncommunicable diseases, when indicated and when lifestyle means are insufficient or undesired, physicians rightly and readily recommend and prescribe long-term medication or combinations of medications.