Obesity has emerged as a major global health concern, affecting approximately 16% of the world’s population. In India, the situation is equally worrying, with nearly one in four women classified as overweight or obese. The prevalence stands at about 24% in women and 23% in men. In the United States, the numbers are even higher, reaching nearly 40% in women and 37% in men in certain studies. Closer to home, Goa shows a similar trend, with obesity affecting around 33% of females and 32% of males. Childhood obesity is also rising rapidly, with nearly one-third of children now affected.
Causes and Risk Factors
Obesity is a multifactorial condition caused by a combination of lifestyle, environmental, and genetic factors. Increased caloric intake, particularly diets rich in oils, processed foods, fast foods, sugars, and aerated drinks, plays a significant role. A sedentary lifestyle, poor sleep, stress, and certain medications further contribute to weight gain. Additionally, underlying diseases, environmental influences, and genetic predisposition can increase the risk of obesity.
The health consequences of obesity are extensive and serious. Obese individuals are at a higher risk of developing conditions such as heart disease, stroke, hypertension, type 2 diabetes, gallstones, sleep apnoea, joint arthritis, thrombosis, certain cancers, and non-alcoholic fatty liver disease. Beyond physical health, obesity also impacts daily life. Individuals often experience breathlessness, excessive sweating, snoring, reduced physical activity, joint and back pain, and decreased stamina. These physical challenges are frequently accompanied by psychological effects such as low self-esteem, lack of confidence, and social isolation.
Various treatment approaches have been used to manage obesity, including dietary modifications, regular exercise, lifestyle changes, and medical interventions. Surgical options such as liposuction, bariatric surgery, gastric banding, gastric bypass, sleeve gastrectomy, and gastrointestinal diversion have also been employed, though they come with their own risks and complications. In recent years, a new class of medications has been introduced, offering promising results in weight management.
Pharmaceutical Advances
Pharmaceutical companies such as Eli Lilly (USA) and Novo Nordisk (Denmark) have led research and development in this field. They have conducted extensive clinical trials and introduced medications that target both obesity and diabetes. Among these, tirzepatide and semaglutide have gained significant attention.
Tirzepatide, marketed under the trade names Mounjaro (for diabetes) and Zepbound (for obesity), is produced by Eli Lilly. Semaglutide, developed by Novo Nordisk, is marketed as Ozempic (for diabetes) and Wegovy (for obesity). These medications belong to a class of drugs known as GLP-1 (Glucagon-Like Peptide) receptor agonists, first approved by the US FDA in 2017.
These drugs are typically administered as subcutaneous injections once a week. Clinical studies have shown that they can reduce body weight by approximately 10% to 16% within a few months. However, their mechanism of action is complex. They mimic gut hormones that regulate glucose metabolism, digestion, and appetite. Specifically, they stimulate the pancreas to release insulin, slow the movement of food through the gastrointestinal tract, and act on the brain to reduce appetite.
Limitations and Risks
Despite their effectiveness, these medications come with certain limitations and risks. Common side effects include nausea, vomiting, abdominal pain, and constipation. More serious concerns include their contraindication in individuals with a history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia (MEN) syndrome. Additionally, once the medication is discontinued, weight regain is common, making long-term or even lifelong use necessary for sustained benefits.
There have also been rare but serious adverse events reported. For instance, a case involving a 58-year-old nurse from Scotland who died following her second dose raised concerns, although such incidents remain extremely uncommon. Millions of doses have been administered worldwide with relatively few severe complications, but continued monitoring is essential.
Another significant drawback is cost. These medications are expensive, although prices are gradually decreasing as availability increases. Accessibility remains a concern, particularly in developing regions.
It is important to emphasise that these medications should not be used in isolation. They are most effective when combined with lifestyle modifications such as a balanced diet, regular exercise, adequate sleep, and stress management. Sustainable weight loss depends on long-term behavioural changes rather than reliance on medication alone.
Future Outlook
While new-generation drugs offer a promising approach to obesity management, time is needed to fully understand their long-term safety and effectiveness. Ongoing research and clinical observation will be crucial in determining their role in future treatment strategies. In conclusion, obesity remains a complex and growing health issue with significant physical and psychological consequences. Although new medications like tirzepatide and semaglutide provide encouraging results, they are not a complete solution. Lifestyle changes, including healthy eating, physical activity, proper sleep, hydration, and avoidance of harmful habits such as smoking and excessive alcohol consumption, remain the foundation of effective weight management. These drugs should be viewed as supportive tools rather than standalone cures, and their use must be carefully monitored by medical professionals.
(The writer is a Professor of Pathology, former Head of Department at Goa Medical College, former Dean of Goa University, and the current President of the Asian Society of Cytopathology)
