Obesity and weight loss with Saxenda

It is very important to follow the guidelines given by your Doctor for a correct administration of Saxenda

Obesity and overweight have become a global health problem in recent decades.

WHO basic facts

• Obesity has tripled since the 70s almost worldwide.
• In 2016, over 1900 million adults were overweight, and more than 650 were obese.
• In the child-youth population, overweight and obesity rates exceed 340 million, of which 41 million are under 5 years old.

What is overweight and obesity?

Overweight and obesity are defined as an abnormal or excessive accumulation of fat that can be harmful to both physical and mental health. We refer to an overweight condition when the Body Mass Index (BMI) is over 25, and obesity when BMI is greater than 30 (kg/m2).

Although there are disorders that can cause obesity (hypothyroidism, Prader-Willi syndrome, etc.), the most frequent one is related to an unhealthy lifestyle, which results in an imbalance between calorie intake (excess), and calories burned (physical activity).

Why is it so important?

Beyond the purely aesthetic, overweight and obesity increase the risk of numerous health problems, such as:

• Cardiovascular diseases: heart disease, stroke
• Arterial hypertension
• Diabetes
• Arthrosis
• Cancer (endometrium, breast, ovary, prostate, liver, gallbladder, kidney and colon)
• Obstructive sleep apnea syndrome
• Fatty liver (hepatic steatosis)
• Hypercholesterolaemia
• Depression
• Anxiety

Mental health and obesity

Obesity and depression are two of the main public health problems, both of which are highly prevalent.

Both not only have a significant impact on people’s health and functionality, but also have a huge impact on a country’s health spending.

Numerous studies show how obesity is a risk factor for mood disorders, but also vice versa!

Basic facts about mental health and obesity:

• Over 40% of the population with depression are obese.
• Being obese entails a 55% more risk of suffering from depression.
• In addition, it has been observed that the treatment of one of these two (for example, obesity), significantly improves the other (i.e., depression). [Jantaratnotai N, Mosikanon K, Lee Y, McIntyre RS. The interface of depression and obesity. Obes Res Clin Pract, 2017].
• Overweight in childhood increases the risk of suffering depression in adulthood. [Gibson-Smith D et al. Childhood overweight and obesity and the risk of depression across the lifespan. BMC Pediatr, 2020].
• Obese children and adolescents are at increased risk of depressive symptoms, especially women and non-western population. [Quek YH1, Tam WWS2, Zhang MWB3, Ho RCM1.
• Exploring the association between childhood and adolescent obesity and depression: a meta-analysis. Obes Rev., 2017]
• Anxiety is more common in overweight and obese subjects than in the general population [Amiri s, Behnezhad S. Obesity and anxiety symptoms: a systematic review and meta-analysis. Neuropsychiatry, 2019]
• Maternal obesity (more than paternal) is associated with a higher number of reports of children with attention problems and hyperactivity. [Robinson SL et al. Parental Weight Status and Offspring Behavioral Problems and Psychiatric Symptoms. J Pediatr., 2020]

Given all of the stated above, depression and obesity should be treated jointly, as a synergy, and not as two independent entities.

How can we treat obesity?

It is well known that conventional methods (diet and exercise) often fail.

Until recently, bariatric surgery was the only realistic alternative for patients who couldn’t reduce their weight in a significant and healthy manner despite multiple attempts to modify their lifestyle; moreover, often leading to frustration and discomfort.

There is only one recent medication to date specifically designed to treat obesity. This revolutionary medication, initially used for diabetes, has proven to be an effective alternative for many of these patients, significantly improving their overall health, and ultimately their quality of life. I am referring to none other than Saxenda (Liraglutida).

What is Saxenda?

Saxenda is liraglutide, a GLP-1 agonist. When Saxenda binds to the GLP-1 receptor (GLP = Glucagon-Like Peptide), it has the following effects: release of insulin (thus also being useful for type 2 diabetes), stimulates satiety center, decreases glucagon release, slows down gastric emptying, which in turn generates a feeling of fullness and slows down the absorption of glucose. By generating a feeling of fullness, appetite is reduced as well as the amount of food intake, thereby resulting in weight loss.

There are other GLP-1 agonists, such as exenatide and semaglutide (OZEMPIC). Nonetheless, Saxenda has been the only one used specifically for obesity so far.

What are the side effects?

The most common side effects are nausea, a feeling of heaviness, diarrhea, constipation, vomiting, flatulence and grastroesophageal reflux. These effects are usually temporary (they disappear after a few days or weeks); in order to reduce the risk of having side effects, a progressive dose titration is applied (a weekly increase). It is important to stay hydrated. If nausea appears, drink in small amounts to avoid vomiting.

Although initially marketed as a treatment for diabetes (the drug is called VICTOZA), the risk of hypoglycaemia (i.e. producing low blood glucose levels) is low since the hypoglycaemic effect of GLP-1 agonists is dependent on blood glucose levels. This means that if glucose levels in blood start to be low, the drug stops having that hypoglycemic effect, so the levels cease to drop.

Other less common side effects are headaches, dizziness, increased pulse rate (2 beats per minute in studies, so it is not clinically significant).

Cases of pancreatitis and gallstones have also been detected, but these complications seem to be more related to speedy and considerable weight loss rather than the drug itself. However, in case of severe abdominal pain, it is important to seek medical help.

How is it administered?

Saxenda comes as a pre-filled pen that is injected subcutaneously on a daily basis. The needle is very thin, similar to the insulin one used by diabetics.

Typical areas of administration are the abdomen, the front of the thighs, or the upper arm area.

It should be administered daily around the same time, regardless of food intake or time of day. Simply choose the time that is most convenient for you.

It is important to follow the doctor’s instructions for a correct administration.

Unused pens should be kept in a refrigerator. Once the pen enters in use, it does not need cooling, it can last for a month at room temperature (up to 30ºC).

The initial dose is 0’6 mg, which can be increased weekly (06→ 1’2 → 1’8 → 2,4 → 3), once there ar signs of tolerance. If not well tolerated, wait before increasing the dose. If it is well tolerated, it is not necessary to reach a maximum dose, and the patient can maintain the dose that has shown to be effective and tolerable.

Safety

Saxenda was marketed in Spain in 2016, and a little earlier in the USA. It was approved in January 2015 by the CHMP (Committee for Medicinal Products for Human Use) as a safe and effective drug for weight loss along with dietary measures and physical exercise. It is indicated in subjects with a BMI equal to or greater than 30 kg/m2 (obese), or with a BMI from 27 kg / m2 (overweight) and a comorbidity associated to overweight (prediabetes, type 2 diabetes, OSAS, AHT, etc.).

Off-label use is not recommended, and should ONLY be used UNDER PRESCRIPTION and MEDICAL SUPERVISION.

There are no studies of Saxenda used in minors, pregnant women or people over 75 years of age, therefore its use in these population groups is not recommended, since its safety is not known.

The same is true for people with severe kidney failure, severe liver failure, or severe heart failure.

There are no specific drawbacks, unless an allergic reaction were to appear.

Since its commercialization, studies continue to be carried out to further knowledge of its use, both on its safety and possible application in other areas (hepatic steatosis or polycystic ovary syndrome); in the future, we will be able to expand this section of the article.

Effectiveness

Saxenda has been shown to be clinically effective in several clinical studies involving 5800 obese and overweight subjects, in which Saxenda was tested against a placebo. In these studies, Saxenda showed a 7,5% weight loss compared to the 2,3% loss in patients who were treated with placebo. Moreover, subjects using Saxenda continued to lose weight during the first 40 weeks of treatment. Weight loss was greater in women than in men.

If it is not effective after twelve weeks with a maximum dose (3 mg/day), it is recommended to abandon treatment.

It is important that subjects using Saxenda combine it with healthier eating and exercise habits to maintain the results obtained.[/vc_column_text][/vc_column][/vc_row]