People with obesity have probably thought: if only there were a pill! Weight loss pills exist, and no, not just Ozempic, these doctors say. Moreover, they are reimbursed. “Combating obesity cannot be done with judgments and the tip to eat more carrots.”
But don’t immediately grab the first pill you find online. They are not only illegal, but can also be dangerous. And obesity requires a serious approach, because it is a chronic disease, explains internist-endocrinologist and professor of obesity Liesbeth van Rossum.
Fat is an active organ. With obesity, there is too much of it and it no longer functions properly. Fat produces hormones that communicate with the brain and organs, regulating appetite and energy consumption.
When fat cells become too full, fat cannot do its job properly and a chronic inflammatory reaction occurs in the body, adds internist-endocrinologist Arianne van Bon. This can lead to disease, such as thirteen types of cancer, depression, cardiovascular disease and fertility problems. Overweight people live shorter lives and are more often sick.
When we talk about obesity, prejudices and ignorance quickly come up, says Van Rossum. “Unfortunately, the road to obesity is often not the same as the road back. If you have severe obesity from eating too much unhealthy food, it will not disappear for many if you suddenly start eating healthy; the functioning of your hormones and brain are too disturbed. A healthy lifestyle contributes to better mental and physical health, so it is the basis.”
For example: if you have a lung tumor from smoking, quitting smoking is of course good. But everyone understands that the tumor will not go away. You need to be treated with medication or surgery. “That is why prevention, such as a much healthier living environment through better government measures, is so important to prevent more people from developing obesity. But don’t confuse prevention with treatment once obesity is present.”
‘Weight loss medication is not a quick fix’
We all talk about Ozempic, but not about the combination tablets naltrexone-bupropion and liraglutide pens, says Van Rossum. With this weight loss medication, people lose an average of about 5 to 10 percent extra weight, and it is reimbursed under certain conditions.
“A weight loss pill is not a miracle cure, but it clearly has an extra effect in combination with lifestyle. Those who lose weight in this way recover, suffer less from snack cravings and have less need for alcohol. And the heart does better. A depression clears up, a patient can move better. That is extremely motivating.”
But we have to get rid of that hype of Ozempic, says Van Rossum. “Weight loss medication is not a quick fix for people like Kim Kardashian who want to fit into a dress. Whoever has obesity is sick and medication can help, in combination with working on lifestyle. These agents can have side effects, such as gastrointestinal complaints in the build-up phase, so thorough medical supervision is very important.”
Depression, alcohol or medication use also causes
If we want to tackle obesity, the cause must be determined. Lifestyle is a common cause of overweight, but just as common are social causes such as poverty, medication use and hormonal disorders such as PCOS. “If the cause is depression, mental care is needed. And if the cause is too much alcohol, then referral to addiction care is necessary. If you are overweight, fill in this questionnaire and take the results to the doctor. This list is compiled on the basis of current guidelines, and in this way you gain insight into the causes.
Often one of the causes is lifestyle and a doctor will refer you to a reimbursed GLI trajectory. With a BMI between 25 and 35, this gives more chance to get rid of obesity than with much higher BMIs. With this Combined Lifestyle Intervention (GLI) you work together with a group on your lifestyle for about two years – from nutrition and exercise to relaxation.
Van Rossum: “Most people get better mental and physical health through GLI, so an important basis. But don’t expect to get rid of your obesity with a very high BMI. People lose an average of 3.5 to 5 percent. But if your BMI was 40, and after GLI 38.5, you still have severe obesity”
Lifestyle is the foundation
Addressing that lifestyle is the foundation, both doctors say. Van Bon: “GLI is not a one size fits all solution. Some people you want to give medication right away or have tried everything already. Or they can’t move. For them, a year is a very long time to be allowed to start with medication that is reimbursed.”
Medication that tackles the disease of obesity itself gives a very different view of what obesity is, says Van Bon. “The idea was always: first treat the obesity-related disease and then also lose weight and good luck with it. But if we tackle obesity, we automatically improve those other diseases. It is nice if that can be done in primary care thanks to medication.”
In the current guideline, Mysimba and Saxenda, both brand names, are reimbursed after at least one year of participation in a GLI program. Semaglutide and tirzepatide, the active substances in Wegovy and Mounjaro, have been approved by the EMA for the indication obesity. The Health Care Institute is assessing this year whether these stronger agents will also be reimbursed. Van Bon: “Hopefully we can start soon with the first very urgent patients. Thanks to tirzepatide, people can lose more than 20 percent, and every 5 kilos lighter immediately gives health benefits.”