Is the Natural Compound Berberine a Safer Alternative to Weight Loss Medications?

As we’ve been seeing over and over, a new class of medications, GLP-1 agonists — including Ozempic, Wegovy and Mounjaro — has gained immense popularity since their release. These medications work by mimicking hormones that influence the body’s control over appetite and food intake, as well as slowing digestion to promote a sense of fullness. Common side effects include gastrointestinal issues and injection site reactions.

These drugs have been a breakthrough for those dealing with weight-related conditions such as diabetes, high blood pressure, and heart disease. However, as with any new medication hailed as a “miracle” solution, some people use them to shed a few pounds for aesthetic reasons.

Susan B. Trachman, M.D., in her article in Psychology Today, writes that she is particularly concerned about how these “miracle” drugs might impact mental health. She reminds us that previously, weight-loss drugs like Zimulti were pulled from the European market due to increased reports of suicidal thoughts and behaviors. In the U.S., Qnexa (Vivus), containing phentermine and topiramate, was rejected by the FDA due to concerns over potential risks, including suicidal ideation, despite demonstrating significant weight loss.

Alarming side effects of GLP-1 drugs

While the research on the subject remains limited and conflicting, suicidal ideation has been linked to other weight-loss drugs in the past. For example, Sanofi’s Acomplia, which was never approved in the U.S., was withdrawn from the European market in 2008 due to similar concerns. Contrave, another weight-loss drug, carries a “black box warning” for suicidal thinking, and Qsymia includes a warning advising users to stop taking it if they experience such thoughts.

A recent study, published in the journal JAMA Network Open, examined reports of suicidal thoughts among individuals using semaglutide, whether for diabetes management or weight loss. The researchers analyzed data from a World Health Organization database that tracks adverse drug reactions in over 140 countries.

Out of more than 30,500 people taking semaglutide, 107 reported experiencing suicidal thoughts. Similarly, 162 cases of suicidal ideation were found among over 52,000 patients using liraglutide, another injectable diabetes medication from the same drug class as semaglutide. Since liraglutide has been on the market longer, it has been used by more people.

The study highlighted a disproportionate risk of suicidal thoughts in individuals taking semaglutide, which was not observed in those on liraglutide. Comparing the frequency of suicidal thoughts in semaglutide users with those on other medications in the database, the researchers noted an approximately 45% higher risk associated with semaglutide use.

Enter berberine, nature’s potentially safer alternative

Given that even a slight risk of suicidal ideation should be carefully monitored and mitigated, nature offers a potentially safer alternative for weight loss: berberine. This compound is found in various plants, including goldenseal, barberry, and Oregon grape, and has been used for centuries in Ayurvedic and Chinese medicine. Traditionally, berberine has been utilized to treat infections, skin diseases, and digestive issues. More recently, it has gained attention for its potential positive effects on diabetes and heart disease, as well as its growing popularity as a weight-loss aid.

When taken as a pill or powder, berberine enters the bloodstream and interacts with cells, influencing various biological processes. Instead of targeting a single pathway, berberine acts on multiple fronts, impacting several conditions simultaneously.

In a review published in Biomedicine and Pharmacotherapy, researchers highlighted berberine’s effectiveness in lowering fasting blood sugar levels in hundreds of patients. Additionally, the compound was found to reduce body mass index in a small group of subjects over three months. Other studies have shown that berberine supplements can reduce cardiovascular risk in postmenopausal women by lowering total cholesterol, and when combined with blood pressure medication, it has enhanced the effects of the treatment in hypertensive patients.

Berberine seems to decrease insulin resistance, which can lead to obesity and type 2 diabetes. It may also modulate gut hormones that regulate food intake and energy balance. However, scientific studies focused specifically on berberine’s weight-loss effects are limited due to small sample sizes. One such study involving individuals with fatty liver disease found that those who took berberine daily for three months experienced significant weight loss.

Berberine improves cellular responses to insulin and affects how blood sugar is utilized, helping reduce hunger signals. Additionally, it benefits gut health by promoting a balanced gut microbiome, suppressing harmful bacteria, and encouraging the growth of beneficial ones.

Thinking about trying berberine?

If you consider adding berberine to your regimen, Dr. Trachman advises:

The FDA does not regulate it. Try to source a higher-quality product to avoid side effects from additives in some less expensive forms.

Berberine does interact with some drugs because it can inhibit the clearance of these drugs from the liver, causing an elevated blood level. Check with your healthcare provider before starting this if you take prescription medication.

Berberine’s half-life is only a few hours. That means your blood level will decrease to about 50 percent within a few hours. To maintain a more constant level, many providers recommend multiple daily dosing — two or three times per day at a total of 1500mg.

On a final note, side effects, primarily gastrointestinal, include constipation, nausea, and diarrhea — similar to the side effects reported with newer weight-loss drugs. However, unlike those drugs, berberine has not been associated with mental health issues.

Your responses and feedback are welcome!

Source: “Is Berberine Nature’s Weight Loss Drug?, Psychology Today, 8/23/24
Source: “A study linking popular weight loss drug to suicide risk again raises long-standing safety questions,” CNN.com, 8/20/24
Image by Chris Abney on Unsplash

Freed From The Burden — Louis Anderson

In the context of “obesity plus happiness,” a recent post brought up the subject of professional comedians. There is a lot more to say about that particular demographic, and since one of the traits of an accomplished comedian is to speak with extreme honesty, most of them are worth listening to. This is especially true of Louie Anderson, who performed stand-up comedy for around 40 years, and acted in films and on TV; and who died (of cancer) two years ago at the age of 68.

Matt Zoller Seitz described Anderson as being conscious that if he ignored his size, audiences would ignore him. Consequently, at any given time, his standup act might be 50% fat jokes. Seitz writes,

The jokes were preemptive: He knew if he didn’t make them, someone else would. [He] felt he had to do them, otherwise viewers would be looking at the TV saying, “D’ya think he knows he’s fat?”

Childhood Obesity News has also mentioned, more than once, a fear that is believed to be universal among fat funny folks: If they no longer inhabit such an identifying trademark of a body, perhaps they will lose their comedic edge and be hounded out of the profession. This apparently was not the case for Anderson, who was asked by Conan O’Brien whether an extreme weight loss would cause him to drop the fat jokes from his repertoire. In that eventuality, Anderson replied that he would retire his fat jokes because “I think I’ll always be funny.”

Dark days transformed

His comedic mood varied, especially when the narrative concerned his alcoholic, abusive father, but in general what he wanted, and achieved, was to offer a gentle sort of comedy that could help people forget their troubles. He was described as a generous, beautiful, loving soul, whose pre-comedy activities included working as a counselor for troubled children.

At the beginning of the COVID-19 pandemic, Anderson already had a head start on becoming the behemoth that inactivity caused millions of other people to dread turning into. (Government agencies and medical institutions all over the world have quoted childhood obesity statistics that vary, but are universally dismaying.) Entering the COVID-19 era at close to 400 pounds he joked, “I’m on the intermittent fast. One minute I’m eating, the next minute I’m not. Then I’m eating again.”

Anderson wrote five books, including Goodbye Jumbo, Hello Cruel World, which…

[…] dealt with his lifelong efforts to come to terms with being overweight. In it, he recalled how his mom would overcompensate for the trauma her children were experiencing by overfeeding them.

He told journalists Christie D’Zurilla and Nardine Saad that the process of writing that particular autobiographical volume completely changed his life:

I was able to be freed up from that burden, and that low self-esteem and self-hatred that you get into… I decided that I was gonna change all that, and I was not gonna hate myself anymore. That I had gone through enough guilt, and enough shame, and I wanted to move on. And that I had something to offer.

Your responses and feedback are welcome!

Source: “Honoring His Mother Was Louie Anderson’s Life’s Work,” Vulture.com, 01/22/22
Source: “Comedian Louie Anderson Says He’s Lost About 40 Lbs. Through Intermittent Fasting,” People.com, 03/17/21
Source: “Stand-up comic and actor Louie Anderson, Emmy-winning ‘Baskets’ star, dies at 68,”
LATimes.com, 01/21/22
Image by Walt Disney Television/Attribution-NoDerivs 2.0 Generic

Food Is Life Is Love Is Food

Imagine being the restaurant critic of The New York Times, which is tantamount to being a professional eater. There you are in one of the world’s largest and most opulent cities, famous for (among other things) its abundance of fine dining establishments, with not only the opportunity but the obligation to eat, eat, eat. Actually, we don’t need to imagine the experience, because Frank Bruni, author of Born Round: The Secret History of a Full-Time Eater, has described the dilemma in 354-page detail.

During his five years as “one of the most loved and hated tastemakers in the New York restaurant world,” it was Bruni’s profession to dine not only in his newspaper’s native city but all over the USA. This duty coincided with his lifelong struggle against obesity.

Several Childhood Obesity News posts have mentioned the particular difficulty that many people experience in getting through holidays, when family gatherings are fraught with the emotional obligation to eat everything that isn’t nailed down. For chubby and perpetually hungry little Frank, whose mother and grandmother both existed with one purpose — to cook massive, calorie-laden meals — this was every day of his young life.

Even when his mom had misgivings and tried to impose some limits, it was impossible to avoid constant clashes with the overwhelming emotional equation: If you don’t love Grandma’s food, you don’t love Grandma. Eventually, his mom gave up and, just like Grandma, “cooked with a ferocity.”

Growing up — and out

To complicate matters further, little Frank was a naturally inactive child. If reading books could burn calories, he would have been fine. Sadly, that was not the way of things. Heading into his teens, Bruni got into swimming, but basically remained a fat kid. Then there was the considerable matter of realizing that he was gay. All the while, and rivaling his massive love for his family, the abiding passion of his young life was food.

As a college freshman, he was already into diet pills, laxatives, and bulimia. Embarking on his journalistic career, the young man weighed well over 250 pounds. Eventually, a friend hooked him up with her personal trainer, and change began to occur. By the time he became a restaurant critic, he had mastered the technique of portion control.

Reviewer Dominique Browning notes that this life story is not only told with humor, but is “embarrassingly, inspiringly honest” and adds,

I could feel the profound pleasure he took in his work — both the dining and the writing. No matter whether he was covering slow food or fast, fancy or fraught or both, he seemed to want to invite everyone to the table with him…

Another reviewer, George Ilsley, seems to have approached this autobiography from a strictly psychological angle, saying,

Even when others like him and admire the way he looks, Bruni still seems to feel fundamentally unattractive. In my opinion, he never reached the core of that false core belief, and the societal programming that drove it, like poison, into the depth of his soul.

Yet another description characterizes Born Round as a “heartbreaking and hilarious account of how he learned to love food just enough,” and opines that the book “will speak to every hungry hedonist who has ever had to rein in an appetite to avoid letting out a waistband.”

Your responses and feedback are welcome!

Source: “Weight Watcher,” NYTimes.com, 08/19/09
Source: “Born Round: The Secret History of a Full-Time Eater,” Goodreads.com, undated
Source: “Born Round: A Story of Family, Food and a Ferocious Appetite,” Goodreads.com, 09/18/17
Image: Book cover/Public Domain

New Obesity Treatments Show Promise

A research team led by Dr. Ki-young Shin at the Human Care Electro-Medical Device Research Center, part of the Electro-Medical Equipment Research Division at KERI, is making significant progress in developing neuromodulation technology to treat and manage metabolic syndrome.

Metabolic syndrome is a cluster of conditions, including obesity, high blood pressure, and elevated triglycerides, often linked to poor diet and lack of exercise. While various treatments for obesity exist, such as drug injections and pharmaceuticals, these chemical approaches often carry the risk of side effects with long-term use. In response, Dr. Shin’s team at KERI has introduced a new method that involves suppressing appetite by electrically stimulating the cerebral cortex through the scalp.

This technique, known as transcranial random noise stimulation (tRNS), has shown promise in non-invasively targeting the dorsolateral prefrontal cortex to reduce appetite. The research team has identified three key technologies essential for this approach: accurately delivering electrical stimulation to the desired brain area, developing electrodes that can effectively contact the scalp through hair, and creating monitoring systems to ensure the stimulation reaches the target and alters brain activity. Dr. Shin’s team is actively developing these advanced technologies.

To validate the effectiveness of tRNS in suppressing appetite, KERI collaborated with Professor Hyung-jin Choi’s team at Seoul National University Hospital in a clinical trial. This trial involved 60 female participants, divided into two groups — one receiving tRNS and the other an active sham treatment. Over two weeks, each participant underwent six sessions of electrical stimulation, with 20-minute sessions using a barely noticeable 2 mA current. The aim was to demonstrate the potential of tRNS in reducing appetite.

Arrowhead to start two new obesity trials

After wrapping up its work on a cardiovascular candidate in the clinical stage, Arrowhead Pharmaceuticals is now turning its focus to two new obesity treatments, both slated to begin clinical trials in early 2025.

The company introduced two next-generation candidates: ARO-INHBE and ARO-ALK7. These are designed to address obesity and related metabolic disorders.

In preclinical studies, both candidates demonstrated the ability to reduce body weight and fat mass through a novel mechanism of action that could help preserve lean muscle mass, offering a potential advantage over current therapies. Arrowhead plans to seek regulatory approval to start human trials for both candidates by the end of this year, aiming to initiate clinical studies in obesity early next year.

As Dr. Carel le Roux, a metabolic medicine expert from University College Dublin, noted during the investor call:

Weight loss alone isn’t a sufficient value proposition for continuing medication. You need to see health and functional improvements as well.

According to Arrowhead’s chief of discovery and translational medicine, Dr. James Hamilton, when tested as monotherapy and in combination with tirzepatide in diet-induced obesity mouse models, ARO-INHBE and ARO-ALK7 both led to reduced body weight and fat mass while preserving lean muscle mass, resulting in improved body composition. Dr. Hamilton added that with the recent approval and positive clinical impact of new obesity treatments, emerging therapeutic strategies with novel mechanisms of action could represent the future of effective obesity and metabolic disease management.

Your responses and feedback are welcome!

Source: “KERI advances neuromodulation technology for appetite suppression in obesity treatment,” News-Medical.net, 8/14/24
Source: “After clearing out heart disease drug, Arrowhead maps out obesity development plans,” FierceBiotech.com, 8/14/24
Image by CDC on Unsplash

Fat and Happy… Not

Just for grins, compare the latest statistics on the world’s happiest countries and the most obese countries. Recently, writer Frank Jacobs noted,

As usual, the country ranking in the annual World Happiness Report is topped by Nordic countries.

According to the Gallup World Poll, they are Finland, Iceland, Sweden, and Denmark. How do those felicitous lands stack up against the most obese countries? There are different ways to compare the statistics, mainly by “mean BMI of both sexes.” But BMI has been discredited and while most places still go by it, the more advanced have switched to other metrics, like the combined male and female obesity rate.

Still, according to the currently accepted standard of measurement, in the four happiest countries, the percentage of obese adults looks pretty good with these figures: Finland 22.2%, Iceland 21.9%, Sweden 20.6%, Denmark 19.7%.

In contrast: When measured by the combined obesity rates of both sexes, the “percentage of obese adults,” in the world’s direly affected countries is as high as 61% (Nauru), 55.0% (Cook Islands), 55.3% (Palau) and 52.9% (Marshall Islands).

Big picture, little picture

So, on a global scale, and for many reasons, the happiest humans and the most overweight humans constitute very different populations. However, narrowing the assessment down to a certain population, the professional comedians of the world look pretty darn euphoric. Of course, laughter is not always synonymous with happiness, as they will be the first to attest.

An entire sub-genre of professional comedians have suffered from the belief that if they give up their addictions — whether to alcohol, downers, uppers, food, or whatever — they will no longer be able to either mentally generate material, or perform in front of crowds. One way they handle this almost ubiquitous problem is by organizing for mutual help toward the practice of self-help.

In Atlanta, for instance, an outfit called Stand Up 4 Recovery was founded by comic Ricky Satori who, now more than 10 years sober, told reporter Kenny Murry about the early stage of his recovery process:

I could be onstage, I could say something confessional about my drug use … and I could follow it up with a punchline and experience the therapeutic value of not being suffocated with secrecy. Also, if it came up in court, I could say, “I was just kidding!”

This innovator is registered as a Certified Addiction Recovery Empowerment Specialist, and is qualified to train people to use naloxone (which saves users who overdose on opiates). He runs a mobile comedy club that honors individuals celebrating their Soberversaries by giving them support, encouragement, and even gifts. He also created a special array of “mocktails” for customers to enjoy. Collaborators include comedian/actor Taylor Neely, who also hosts the podcast “Sober Boyz.”

Father of them all

Another example of this type of service organization is the Lenny Bruce Memorial Foundation, founded by the legendary comedian’s daughter Kitty Bruce. It provides scholarships for sober living programs aligned with the foundation’s core values, which include education on how to survive daily life without using substances; focus on positivity and spirituality; self-esteem building; volunteer work; and enjoyable sober experiences.

Your responses and feedback are welcome!

Source: “Mapped: The highs and lows of the world’s happiness landscape,” BigThink.com, 05/07/24
Source: “Most Obese Countries 2024,” WorldPopulationReview.com, undated
Source: “Atlanta comedians ‘Stand Up’ for addiction and mental health recovery awareness,” WABE.org, 01/23/24
Source: “The Lenny Bruce Memorial Foundation,” LennyBruce.org, undated
Image by Stand Up 4 Recovery

Dicey Substances and Treacherous Fakes, Part 2

This post continues a recent post, and this one is as disturbing as the other. Last month, Registered Dietitian Catherine Rall told Healthline.com,

Any time you’re taking an unregulated drug, you’re taking a huge risk since it could literally contain anything. The best case scenario, outside of the unlikely idea that someone is selling Ozempic at below-market prices, is that you get an inert placebo. There’s also a huge risk that you’re putting something dangerous into your body.

The article also notes the warning voiced by Registered Nurse Nancy Mitchell, that the customer risks receiving harmful toxins, including heavy metals:

Every year, hundreds of people show up in the ER with severe allergic reactions or lead poisoning that they acquired from some unknown generic source.

Of course, the World Health Organization warns the public about counterfeit websites, but given the high prices of bona fide pharmaceuticals, the widespread shortages, and the human tendency to hope for and believe in the impossible, caution is unlikely to be observed. Face it, most of us are nice people who can’t really believe that someone would sell us fake medicine that might be worse than useless.

Potential users are urged to verify the legitimacy of online pharmacies, but who knows how to do that?

And to be realistic, do people really care? The perils that may result from giving away any personal information online are just beginning to register in the average person’s consciousness. The world is full of endearing, lovely people who trust strangers enough to willingly fill out social media “get to know me” quizzes. Clever criminals collect all kinds of facts, and know more than anyone needs to about a person’s first pet, the color of their first car, and who their prom date was in 1980.

Be afraid… Be very afraid

A VanityFair.com piece by Katherine Eban reinforces all the caveats:

Under US law, drugs are supposed to travel seamlessly from a manufacturer’s loading dock to a distributor’s pristine warehouse to a pharmacy shelf through a protected chain of companies that follow strict requirements for handling medications and documenting sales.

“On the contrary,” says her story which traces the meticulous investigation into a particularly odious and huge batch of thousands of fake Ozempic pens that were dumped on the market last year, and also goes into the matter of drugs that are real enough, but “diverted” from the legitimate channels. Eban writes,

The drugs may well be authentic, but they might also be expired, improperly stored, or contaminated. Under FDA rules, diverted drugs are considered adulterated and not fit for human consumption, because their safety and quality cannot be guaranteed.

The globe is populated with criminals who “have been learning as they go how to breach America’s defenses in order to sell their counterfeit medicine in the most expensive, and lucrative, market in the world.” This market includes the proprietors of some weight-loss spas whose practices are unsavory, to say the least.

The Illinois Poison Center’s medical director, Michael Wahl, M.D., told the reporter that many patients have injected insulin disguised as Ozempic — which for non-diabetics can be seriously life-threatening, because if the body’s glucose level is too low for too long, irreversible brain damage may result.

In addition to the outright fakes and the stolen or “diverted” goods, there is the additional problem of legal but under-scrutinized and possibly untested substances. There are loopholes, under certain conditions of unavailability, that allow licensed “compounders” to manufacture drugs. Their ingredients are sometimes obtained from sources that cannot be described as either impeccable or acceptable:

Not every pharmacy compounder is equal in adherence to the law… The result has been a quality control disaster.

It looks as if people need to seriously ask themselves whether losing some pounds of flesh can be worth the price of losing an organ or even a life, especially when other methods, though difficult, are possible.

Your responses and feedback are welcome!

Source: “WHO Issues Global Warning About Fake Ozempic Being Sold Online,” Healthline.com, 06/24/24
Source: “Why Counterfeit Ozempic Is a Global-Growth Industry,” VanityFair.com, June 2024
Image by Richard Patterson/Attribution 2.0 Generic

How Technology Can Help Treat Obesity

Over the past decade, as childhood obesity rates have climbed, digital technology has advanced, offering new avenues in healthcare. The COVID-19 pandemic has accelerated both trends, highlighting the potential of digital health, such as mobile healthcare, to overcome barriers like accessibility and support healthier lifestyles in children.

Digital health, including mobile health (mHealth) and telemedicine, offers new tools for patient monitoring, clinical evaluation, and lifestyle interventions to manage and prevent obesity. These technologies provide personalized support through apps, websites, and devices that promote healthier lifestyles. Let’s take a quick look at how technology can help treat obesity.

A recent, multi-author, lengthy article in Frontiers discusses digital strategies for preventing and treating childhood obesity, evaluating their effectiveness and limitations. The article mentions that in 2020, the National Institute for Health Research (NIHR) launched the “HelpMeDoIt!” app, aimed at supporting weight loss in adults through goal setting, progress monitoring, and social support. However, weight loss interventions for children face additional barriers, including parental time constraints, low socioeconomic status, and lack of awareness. Educating and involving parents to improve children’s lifestyle habits is also a factor.

To explore technological innovations in childhood obesity prevention and treatment, the authors reviewed relevant studies published from 2013 to September 2023 using keywords related to pediatric obesity and digital health. Research was conducted through databases like PubMed and Scopus, and the findings were reviewed and approved by all co-authors.

What are digital health strategies?

Digital health, encompassing digital medicine (DM) and digital therapeutics (DTx), represents a growing field in healthcare. DTx involves software-guided therapeutic interventions to prevent and manage diseases, while DM uses algorithms, software, or hardware to monitor and improve health. The World Health Organization (WHO) defines mobile health (mHealth) as medical practice supported by mobile devices, which can enhance healthcare access, quality, and patient outcomes.

Smartphones, the most common portable electronic devices, have spurred the development of digital tools like apps to manage chronic diseases. Evidence shows that these tools, including mobile apps, web-based tools, and wearable devices, can be effective in preventing weight gain and treating obesity in children and adolescents.

Telemedicine and text messaging

Studies, including randomized control trials (RCTs), have explored its effectiveness through various methods such as phone consultations, video conferencing, and text messaging. While some interventions have led to modest but significant reductions in BMI z-Scores (BMIz), results vary, with some studies showing no significant differences between telemedicine and in-person care.

Text messaging has also been associated with positive changes in health behaviors, such as increased fruit and vegetable consumption and reduced screen time, alongside lower dropout rates in weight management programs. Despite its benefits, telemedicine faces challenges, including high costs, variability in study outcomes, and limitations in generalizing results due to diverse participant demographics. A combined approach of telehealth and in-person visits may offer better outcomes, the authors concluded.

Mobile apps

Studies have shown their effectiveness in promoting weight loss and healthy behaviors, both as standalone tools and in combination with traditional treatments. The apps the authors mention include MetaWell, OBEST, and MINISTOP 2.0. Let’s not forget Dr. Pretlow-designed W8 Loss 2 Go and BrainWeighve either.

The ability to rechannel displacement into less harmless activities rather than succumbing to urges is behind the behavior modification app, BrainWeighve, currently ramping up for a trial through the University of California Los Angeles (UCLA). The trial focuses on weight loss for obese teens using a self-directed, physician-supervised program withdrawing from one problem food at a time.

Web-based tools and social networks

Online communities, forums, and public health campaigns provide resources and shared experiences that can motivate healthier lifestyle choices. However, the quality of online information varies, with some content being misleading or discouraging.

Videogames

Videogames, traditionally seen as sedentary, are now being leveraged to combat obesity through exergames and serious videogames that encourage physical activity and healthy behaviors.

Exergames like “DDR Dance Dance Revolution” and “Wii Boxing” engage children in physical activity, promoting fitness while playing. Studies show these games can improve body composition, reduce weight, and enhance psychological well-being.

Serious videogames, which focus on nutrition education and behavioral change, have also shown promise. For example, “Food Rate Master” improved children’s ability to distinguish between healthy and unhealthy foods and reduced unhealthy food intake.

Virtual reality (VR) games offer immersive experiences that can motivate physical activity, though more research is needed on their safety and effectiveness for young children. Of course, there’s a caveat — food brands using video games to stealthily promote junk food.

The bottom line

Telemedicine and mHealth tools offer significant potential but require internet access, powerful devices, and user engagement. The success of these tools often depends on patient and family involvement, particularly during the development phase. Parents play a key role in shaping their children’s habits, and their involvement in mHealth strategies is vital.

Further research is needed to understand how digital engagement influences the effectiveness of these interventions. While children are heavy users of technology, it’s important to balance the benefits with the risks, particularly in terms of exposure to subtle marketing tactics through advergames.

Your responses and feedback are welcome!

Source: “Time to act on childhood obesity: the use of technology,” Frontiers, 2/14/24
“Digital health programs and childhood obesity,” Contemporary Pediatrics, 8/8/24
Image by Jessica Lewis thepaintedsquare on Unsplash

Dicey Substances and Treacherous Fakes, Part 1

Both traditional news outlets and newer social media platforms are bulging at the seams with advertisements and celebrity endorsements that lead to ever-increasing sales of bogus anti-obesity drugs, as well as horrendously complicated and expensive problems for law enforcement agencies at every level. Unlicensed pharmacies that operate online are happy to fulfill the demand for semaglutide.

Problem is, consumers tend to receive some totally different substance; or the real stuff but it’s contaminated with something else; or it’s the real stuff but less than the advertised amount, or — and apparently this has actually happened — the genuine item, but a larger dose than was specified in the advertising. Whatever a person injects, to receive close to 40% more of it than they intended to take is a serious drawback.

Pharmacovigilance is called for

Plenty of bargain-priced or even full-priced stuff is on the market, except it turns out to be ineffective, dangerous, falsified, unregistered, misbranded, unapproved, or some other kind of bogus. And/or dangerous. Health-wise, the best-case scenario is the simple non-delivery scam, which one news source implied can at least do no one any harm, other than losing some money.

But even that consolation is false. Some of these crooks who never intended to send any goods want not only the money, but the customer’s credit card number and additional personal information for other nefarious purposes. Meanwhile, shipments actually sent out have caused an alarming increase in emergency calls to poison control centers.

Literally hundreds of websites are selling purported Ozempic, Wegovy, Mounjaro, and other fakes. For CBC news, Sheena Goodyear reported that last year alone, one security firm managed to get more than 250 of these criminal sites banished from cyberspace. But the crooks, and the tech wizards who use their powers for evil, are standing by ready to replace each deleted site with another one, or several more.

A different cybersecurity firm got 1,600 fake pharmacies removed from the web last year, at least a couple hundred of which had been peddling spurious GLP-1 concoctions. Here is an interesting sentence:

BrandShield said it had the fake pharmacy websites taken down by collecting evidence against them, and submitting that to the service providers hosting the sites.

Sadly, there is no guarantee that the service providers are conscientious and honest citizens, either. The ISPs that host advertising by irresponsible and greedy criminals might be equally craven, avaricious, and unprincipled. In these cases, international law enforcement agencies must step in, and matters become truly complicated. Some countries simply are not interested in playing nice, or being good global neighbors.

Goodyear quoted health law expert Lawrence Gostin, who has been tracking this sort of activity for at least a decade: “Few people understand that the international market in counterfeit drugs is massive.” He also emphasizes that if a person does order weight-loss injections from an online source, they’d better hope the substance that arrives is nothing worse than normal saline.

Sadly, the web is not the only source of danger. Many Americans have been offered stolen, “diverted,” or fake meds in unconventional locations, like a shopping center parking lot, by someone selling from the trunk of a car. Or perhaps in a college dorm.

And even, as journalist Katherine Eban reported for Vanity Fair, at the annual convention of the Obesity Action Coalition, where a dicey character, who was not even a registered attendee, sidled up to the medical professionals in a “stalker-ish” manner. Eban wrote:

Approaching doctors at the conference, he held up a crumpled piece of notebook paper with his contact information and his product list. The sales pitch was simple: [his company] could provide automated refills for “Ozempic, Saxenda, Mounjaro, etc.” at roughly one third of the going US price.

Shame and blame

Another factor that drives some people to online pharmacies is reluctance to face their own doctors, because correctly or not, they perceive bias or criticism coming from that direction. They are afraid their own physician will just plain refuse. Or the doctor might say that the newest weight-loss drug is unavailable — which the patient “knows” to be untrue, because obviously there it is, all over the World Wide Web.

The scary thing about this is, anyone who is taking even the genuine GLP-1 meds needs to be carefully monitored because they may wind up with stomach paralysis, intestinal blockage, or pancreatitis. And once a plethora of unknown substances enters the picture, anything can happen.

Those drugs should never be sold without a legitimate prescription from trained medic who has actually examined the patient — just as no patient should trust any alleged drug that has not been prescribed by a medical professional. Then, since these drugs come loaded into self-injection devices, there is the non-trivial fact that the needles might not be sterile.

(To be continued…)

Your responses and feedback are welcome!

Source: “Safety and Risk Assessment of No-Prescription Online Semaglutide Purchases,” JAMANetwork.com, 08/02/24
Source: “Hundreds of websites are selling fake Ozempic, says company,” CBC.ca, 04/19/24
Source: “Why Counterfeit Ozempic Is a Global-Growth Industry,” VanityFair.com, June 2024
Image by danieljordahl/Attribution 2.0 Generic

GLP-1 Drugs Are Coming in Pill Form

A person is holding two red pills in her hand.

Most of us are aware of injectable GLP-1 drugs for type 2 diabetes and obesity, like Ozempic and Wegovy. However, did you know there are also pill versions of these drugs, with more potentially on the way?

Rybelsus is an oral form of semaglutide, a GLP-1 drug used to treat type 2 diabetes alongside diet and exercise. It is produced by Novo Nordisk, the same company behind Ozempic and Wegovy.

Approved by the FDA for type 2 diabetes since 2019, Novo Nordisk is exploring whether a higher dose of oral semaglutide can be as effective as the weekly injectable Wegovy for weight loss. Eli Lilly is also developing an oral GLP-1 called orforglipron to treat obesity or overweight in adults. Eli Lilly’s phase 2 results show orforglipron, a daily oral nonpeptide GLP-1 receptor agonist, achieved up to a 14.7% mean weight reduction at 36 weeks in adults with obesity or overweight.

Pfizer is entering the oral GLP-1 market with an experimental pill called danuglipron for adults with obesity, intended for daily use rather than the weekly injectables. “Obesity is a key therapeutic area for Pfizer, and the company has a robust pipeline of three clinical and several pre-clinical candidates,” said Mikael Dolsten, M.D., the chief scientific officer and president of research and development at Pfizer.

But will oral GLP-1s change the game and appeal to those turned off by injectables? According to experts, it depends.

Britta Reierson, M.D., a metabolic health and primary care physician and the medical director of Knownwell, said:

I don’t think we’re going to shift away [from injectables] because that wave of interest is already happening… but there needs to be oral options as well… There needs to be a broadened toolkit available because we know that this treatment isn’t one-size-fits-all across the board.

How oral GLP-1s could impact treatment

Oral GLP-1 drugs could improve drug access, especially if refrigeration is an issue, noted Marc-Andre Cornier, M.D., the director of the division of endocrinology, diabetes, and metabolic diseases at the Medical University of South Carolina and president-elect of The Obesity Society. Injectable GLP-1s like Ozempic or Wegovy require proper storage at low temperatures, which can be challenging in certain parts of the world. An oral version could circumvent this issue.

Dr. Reierson added that oral GLP-1s could help address the drug shortage issues common with injectables, as they are generally easier to manufacture. “We need to focus more time and energy on developing GLP-1s in an oral form to make this treatment more sustainable, because there is a crisis in supply and demand with the injectables,” she said.

Aside from supply issues, some people might be deterred by needles or have safety concerns about injections. An oral version of semaglutide could alleviate these worries.

However, Dr. Cornier pointed out that many people who find injectables effective do not mind the needle format and might prefer a weekly injection over a daily pill. For some, a weekly injection could be more convenient than daily medication.

Rybelsus, for instance, must be taken on an empty stomach with no more than 4 ounces of water. Users need to wait 30 minutes before eating, drinking, or taking other oral medications. In contrast, Ozempic can be taken anytime, with or without food.

Cost and side effects remain major factors

Even if the needle is removed, side effects still exist for oral medications. If someone cannot handle the side effects of an injectable GLP-1, an oral pill likely will not solve the problem. “The GI side effects, nausea, vomiting, and constipation…those seem to be across the board. The higher the dosage of the oral medication, the more likely those side effects are,” Dr. Reierson said.

Affordability is also a significant concern. Unless oral medications are significantly cheaper than injectables, access will remain an issue for those needing GLP-1 drugs. Currently, the out-of-pocket costs for Rybelsus are almost the same as for Ozempic.

It makes sense that the drugmakers are rushing to flood the market with currently popular drugs and pave the way for research on new versions in different forms and potency.

Doug Baker, VP of industry relations for The Food Industry Association, said, “In the next few years, we could see anywhere from 12 to 36 million people that could be potentially on this”, noting that FMI has knowledge of 70 different trials in the works at the Food and Drug Administration for new GLP-1 drugs. Also, data gathered from 5,577 U.S. adults in early March for a Gallup poll revealed that 6% of U.S. adults have tried GLP-1 drugs for weight loss, and 3% are currently using them.

Your responses and feedback are welcome!

Source: “Would You Be More Likely to Take GLP-1s If They Came in Pill Form?,” VeryWellHealth.com, 8/6/24
Source: “Nearly a third of U.S. consumers could begin using GLP-1 drugs,” SupermarketNews.com, 8/5/24
Source: “Bernstein poll: 6% of US adults have already tried GLP-1’s for weight loss,” Investing.com, 8/5/24
Image by Kateryna Hliznitsova on Unsplash

Are Important Questions Being Asked?

A ScientificAmerican.com article published last year was not alone in raising a valid point or two. Writer McKenzie Prillaman speculated on the validity of welcoming the GLP-1 drugs as some sort of medical messiah:

Another unknown is who will respond to these drugs — and who won’t. It’s too early to tell now, but the drugs seem to be less effective for weight loss in people with type 2 diabetes than in those without. Conditions such as fatty liver disease and having fat around the organs, known as visceral body fat, might also affect how people respond to different drugs.

Aspersions have been cast by, among others, Matthias Tschöp, a German physician and scientist. Who will respond to these drugs and who won’t? Hesitancy and caution bring up other questions that many professionals feel really must be answered first: exactly who needs to respond to these drugs, and why do they need to? Because there is still doubt in some minds about whether “obesity” is such an enormous problem after all.

The link between excess weight and health is not proven to the satisfaction of everyone. Why?

One study found that nearly 30% of people who are considered obese are metabolically healthy. Another showed that other health problems tend to be a better predictor of someone’s risk of death than is weight, demonstrating the need to consider factors other than weight when judging health.

And indeed, it is possible that a person whose eyelashes fall out or whose fingernails show grooves is more likely to develop some fatal condition than an obese person is. Biology and medicine are two fields that never run out of surprises, so who knows?

Keeping up, or being led by the nose?

Then along comes another expert, like biologist Timo Müller, to point out that times have changed, especially after semaglutide arrived on the scene. Previously, using pharmacology to reduce weight by more than 10% had proven to be unsafe for patients’ overall physical well-being.

Still, these newer drugs held out the promise of performing other services, like improving cardiovascular health. Tirzepatide increased the “wow” factor even more, with its ability to rival the effectiveness of bariatric surgery by enabling the loss of, in some cases, 20% of the patient’s body weight.

And yet… did that individual really need to be changed into four-fifths of their former self? Misgivings were expressed by psychologist Sarah Nutter, whose main areas of interest are body image and weight stigma. The particular concern here is that patients are letting themselves in for a lot of misery, what with nausea and vomiting and so forth — “to escape weight stigma, rather than to serve a true health need.” There is also concern that people are overly influenced by reports from celebrities, and by news stories aiming to convince folks that once they lose weight, all their pesky life problems will disappear.

Celebration or desperation?

There is a feeling in some quarters that the public is being brainwashed into paying well over $1,000 a month to solve what just possibly might be a non-problem. Perhaps these individuals could be better served by spending that money on psychological counseling, or any kind of therapy, rather than ingesting substances that may not offer permanent health, and indeed might cause actual harm.

The insurance companies that balk at dishing out the dollars may not be solely motivated by reluctance to part with the cash. Their reluctance to pay for “vanity drugs” might even indicate genuine concern for the patients’ well-being. After all, stranger things have happened. But then, the other side comes along with multiple proofs of the enormous damage that can be caused by untrammeled obesity.

When a large number of 20-year studies about GLP-1 drugs and their close relatives have been completed, we can rest assured that someone will always say, “That is all well and good, but what about the 30-year studies? We need those.” It might be that some answers will never satisfy.

Your responses and feedback are welcome!

Source: “Breakthrough’ Obesity Drugs Are Effective but Raise Questions,” ScientificAmerican.com, 01/10/23
Image by airpix/Attribution 2.0 Generic

FAQs and Media Requests: Click here…

Profiles: Kids Struggling with Weight

Profiles: Kids Struggling with Obesity top bottom

The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources