Context:

The obesity treatment landscape is poised for a significant transformation with the emergence of new amylin-based medications that promise fewer side effects and enhanced efficacy compared to existing GLP-1 drugs. Major pharmaceutical companies, including AstraZeneca and Eli Lilly, are developing these drugs, which target different hormonal pathways, potentially enabling more substantial weight loss outcomes. Recent trials show that combination therapies like CagriSema may lead to over 20% weight loss, raising critical questions about the limits and ethics of medical weight loss. As these powerful treatments become available, concerns about misuse and the health implications of extreme weight loss are growing, necessitating careful oversight and guidance from healthcare professionals.

Dive Deeper:

• In a trial, participants using cagrilintide, an amylin-based drug, lost approximately 12% of their weight over 16 months, while those on semaglutide (Ozempic) lost around 15%. Notably, users of the combination drug CagriSema experienced over 20% weight loss.

• Thomas Lutz, a pioneer in amylin research, began his work in the early 1990s, demonstrating the appetite-reducing effects of amylin, despite initial skepticism from the broader scientific community, which was focused on GLP-1.

• Pramlintide, an earlier amylin analogue approved for diabetes in 2005, required multiple daily injections and yielded less significant weight loss compared to newer amylin drugs like cagrilintide.

• Experts suggest that combination drugs targeting multiple hormones could lead to more effective weight-loss treatments, as the body adapts to single-mechanism drugs, making combinations necessary for sustained effectiveness.

• Doctors caution that not all patients need extreme weight loss; some may face health risks if their weight loss results in a BMI below 18.5, highlighting concerns about societal pressures and the potential for misuse of weight-loss medications.

• The availability of GLP-1 medications has already led to off-label use for appearance enhancement, drawing parallels to anabolic steroid misuse, with warnings from healthcare professionals about the dangers of excessive weight loss, including loss of muscle and bone density.

• With more potent weight-loss options on the horizon, the medical community is grappling with how much weight loss is appropriate and safe, reflecting a significant shift in obesity treatment discussions over recent years.