Patients with type 2 diabetes that were treated with a weekly injection of the breakthrough drug Semaglutide were able to achieve an average weight loss of nearly 10kg, according to a new study published in The Lancet today.
Led by Melanie Davies, Professor of Diabetes Medicine at the University of Leicester and the Co-Director of the Leicester Diabetes Centre, the study showed that two thirds of patients with type 2 diabetes that were treated with weekly injections of a 2.4mg dose of Semaglutide were able to lose at least 5% of their body weight and achieved significant improvement in blood glucose control.
More than a quarter of patients were able to lose more than 15% of their body weight – far above that which has been observed with any other medicine administered to people with diabetes.
Professor Melanie Davies said:
“These results are exciting and represent a new era in weight management in people with type 2 diabetes – they mark a real paradigm shift in our ability to treat obesity, the results bring us closer to what we see with more invasive surgery.
“It is also really encouraging that along with the weight loss we saw real improvements in general health, with significant improvement in physical functioning scores, blood pressure and blood glucose control”.
This global multi-centre trial was conducted at 149 sites in 12 countries across North America, Europe, South America, the Middle East, South Africa and Asia, involving 1,210 patients with type 2 diabetes whose current treatment was not achieving sufficient blood sugar control, for instance through diet and exercise, or through the use of metformin and other glucose lowering medicines used to control the disease.
It is one of a portfolio of studies conducted as part of the Semaglutide Treatment Effect for people with obesity Programme (STEP) programme. Professor Davies has been involved in all four of the STEP clinical trials involving Semaglutide for weight management completed so far, where the medication was shown to help patients achieve an average weight of loss of between 10kg and 17kg of body weight.
Being overweight or obese is a significant contributor to type 2 diabetes. Many patients can manage their type 2 diabetes by eating a healthy diet, taking regular exercise, and using medications to help control blood sugar, or achieve glycemic control but for a significant minority of patients who have not seen much improvement in spite of these methods, semiglutide is a promising development.
The LDC has a world-renowned, multi-disciplinary research team, which is leading the way and providing the evidence behind the Leicester Diabetes Centre’s education programmes and widening the knowledge base for health and disease management.
In many studies, bariatric surgery has been highlighted as an almost magical method for weight loss and reversing type 2 diabetes. One question that has remained largely unanswered is how the effect of surgery differs from the effects of a strict low-calorie diet. This question has now been examined by researchers at Lund University in Sweden in a study published in the journal Diabetes.
By monitoring individuals who underwent a six-week low-calorie diet followed by a bariatric operation, they can for the first time show why several health markers improve.
“What we previously thought was an effect of the operation is actually due to the diet”, says associate professor Nils Wierup, who led the study with associate professor Peter Spégel.
In a bariatric operation, a so-called gastric bypass, a large part of the stomach and the first part of the small intestine are disconnected. The patient needs to lose weight before the operation in order to reduce the size of the liver and the amount of fat around the internal organs. This is done to reduce the risk of complications.
Normally, the patient follows a strict six-week diet of fewer than 1 000 calories per day in order to achieve the weight loss. Previous research has studied the combined effect of the diet and surgery. What has been seen, in addition to weight loss, is improved blood sugar control, which has been considered a result of an increase in the hormones GLP-1 and GIP and enhanced insulin release. As a bonus, individuals with type 2 diabetes “recovered” just days after the procedure.
In a new study, researchers at the Lund University Diabetes Centre (LUDC) and the Centre for Analysis and Synthesis (CAS) have for the first time studied the effects of the strict low-calorie diet and the operation separately. The results show that the diet alone accounted for the greatest positive effect.
“More than 90 per cent of everything that occurred, happened as a result of the diet. Very little changed after the surgery”, says Peter Spégel, who works at LUDC and CAS.
By measuring several hundred metabolites in the blood (substances formed by, among other things, sugar, protein and fat in our metabolism) before and after the low calorie diet and the operation, the researchers could see that the levels of the various metabolites after the diet went in the direction expected from a reduced food intake and improved health. The surgery itself caused very minor changes.
However, a few unique changes were observed that generally were the opposite of those that happened during the diet. The researchers could link some of these effects to the stress that surgery causes for the patient, and this was supported by the fact that virtually all the changes had disappeared six weeks after the operation.
The one most surprised by the results is Nils Wierup, who previously, unlike Peter Spégel, was convinced that it was the surgical procedure and the hormonal changes that accounted for the improved effect.
“What we previously thought was linked to the gastric bypass surgery is actually not. I have had to change my viewpoint”, he says.
“It was very good for this project that at the start we had such differing expectations and hypotheses on the effects bariatric surgery and diet have on metabolism. We have therefore looked very carefully at all the results to elucidate the study from all conceivable angles”, adds Peter Spégel.
The results are not to be interpreted as the low-calorie diet being beneficial in itself or that the operation is unnecessary. The procedure is necessary in order for the patient to maintain a limited food intake for a long period.
“A low-calorie diet is usually not harmful. The fact that we have now shown the effects previously associated with surgery actually arise during the preceding low-calorie diet, and not as a response to the surgery, may perhaps make gastric bypass surgery less magical.
However, as a result of this, we can also point to bariatric surgery not having any negative metabolic consequences”, says Peter Spégel.
“If you are seriously overweight, calorie restriction is not necessarily harmful. Gastric bypass is a good treatment method for obesity. In addition to the weight loss being more considerable and long-lasting compared to a low-calorie diet, the surgery has the added effect that the patient’s diabetes reverses”, states Nils Wierup.
The results also raise new questions.
“If metabolism is primarily affected by the diet and not the surgery, what then is the function of the hormones GLP-1 and GIP?”, says Nils Wierup.
The answers will possibly emerge from forthcoming studies in which the researchers will conduct a long-term follow up and compare their results in a European study.
“Eat a big breakfast to lose weight fast – you’ll ‘burn twice as many calories’,” reports The Sun.
The advice to eat more at breakfast than at dinner has long been proposed to help people trying to lose weight. The idea is that calories consumed at the start of the day are more likely to be burned off than those consumed in the evening.
German researchers say they found that people do burn off more calories after breakfast than dinner. They also feel less hungry in the afternoon and evening if they have a bigger breakfast.
However, their study included just 16 people, who were all healthy young men. None of the participants were trying to lose weight and the study did not measure weight loss.
We do not know whether eating a big breakfast every day would lead to weight loss in real-world conditions, or whether the results are relevant to women or people who have health complications due to being overweight or obese. The study was also just a 3-day laboratory experiment in which men ate only set meals provided and did no physical exercise.
However, other studies have suggested that eating a healthy breakfast may help people to eat less during the rest of the day. This could help people stick to a weight loss diet, rather than skipping breakfast and eating more later because they are hungry.
The researchers who carried out the study were from the University of Lubeck in Germany. The study was funded by the German Research Foundation and published in the peer-reviewed Journal of Clinical Endocrinology and Metabolism on an open access basis so it is free to read online.
The report in The Sun overstated the results. The Sun report says that “The researchers claimed the hour of the day – when you eat and how frequently you eat – is more important than what you eat and how many calories you eat.”
This is not true – the researchers only said that the time a meal was eaten had an effect on calories burned and appetite. They did not say that this was “more important” than what people eat or how much they eat.
The report by the Mail Online was more balanced, making it clear that a big breakfast was only helpful if balanced by a small dinner. Both news reports included photographs of a fried full English breakfast, which is high in fat and salt and not likely to be a very healthy start to the day.
What kind of research was this?
This was an experimental crossover study carried out in a laboratory.
These types of studies may be helpful to establish how the body behaves under controlled conditions. However, these studies may be of less immediate relevance in the real world.
What did the research involve?
The researchers recruited 16 men in their early 20s. The participants were all:
a healthy weight
free of a range of medical conditions
not taking any kind of medicine
not misusing drugs or alcohol
non-smokers
not working shifts
The researchers said they excluded women “to avoid possible effects of the female hormone cycle on energy metabolism”. If such effects exist, that means the study results do not apply to women.
The men stayed at a research centre twice, 2 weeks apart, for 3 days on each stay. On the evening of their arrival they had a standard evening meal. For the next 2 days, they had either:
a low-calorie (11% of daily calories) breakfast, standard (20% of daily calories) lunch, high-calorie (69% of daily calories) dinner
a high-calorie breakfast, standard lunch and low-calorie dinner
The researchers took measurements at regular intervals during the day, including before and after meals, of:
resting energy expenditure – measured by comparing oxygen consumption and carbon dioxide production over a set period, using a hood to capture gases breathed in and out
blood glucose
blood insulin
how hungry the men felt
how much they craved sweets
The men were allowed to read, draw, watch television, play games, listen to music and spend time at a computer, but could not do any exercise.
On their second visit, the men were given the reverse to their original meals. Those who had a high-calorie breakfast and low-calorie dinner now received a low-calorie breakfast and high-calorie dinner, and vice versa.
The researchers used the difference between resting energy expenditure before and after a meal to calculate diet-induced thermogenesis (DIT), or the amount of energy used while digesting a meal. They compared DIT after high- or low-calorie meals at breakfast or dinner.
What were the basic results?
Researchers found that the men’s DIT, the measure of how many calories were burned digesting a meal, was around 2.5 times higher after breakfast than after dinner. It did not make a difference whether the meal was high or low calorie.
Their blood glucose, a measure of how much sugar is in the bloodstream immediately after a meal, was 44% higher after a high-calorie dinner, compared to a high-calorie breakfast. This suggests that glucose peaks more after an evening meal than a morning meal. The difference was 17% higher after dinner when both meals were low calorie.
Their concentrations of insulin, which the body releases to help it metabolise sugar, were also 40% higher after a high-calorie dinner than after a high-calorie breakfast.
The men said they felt less hungry after dinner than after breakfast, regardless of whether dinner was high or low calorie. Compared to hunger before breakfast, hunger decreased 5 hours after a high-calorie breakfast whereas it increased 5 hours after a low-calorie breakfast.
The men said they were hungrier in the period before dinner if they had a low-calorie breakfast, compared to those who had a high-calorie breakfast. They also craved sweets during the day more if they had a low-calorie breakfast compared with a high-calorie breakfast.
How did the researchers interpret the results?
The researchers said: “Our results show that a nutritional pattern with an extensive breakfast and few calories in the evening has a favourable effect on energy as well as glucose metabolism.”
They added: “An extensive breakfast should therefore be preferred over large dinner meals to reduce the risk of metabolic diseases.”
Conclusion
Small, experimental studies such as this may help scientists establish how the body works under experimental conditions – at least in the case of the healthy young men included in the study. It is unclear whether they are relevant to the wider population.
The study is limited by its nature. It included only 16 men and tracked their consumption and resting energy expenditure over a short time period. We do not know exactly what food they ate – only the calorific value and the balance of carbohydrates, protein and fat.
The study shows us that these 16 men burned off more calories after their morning meal than their evening meal, regardless of how many calories in that meal. Because of the standardised conditions of the experiment, we do not know how the results would have been affected by doing physical exercise. The effect the different regimes had on the men’s weight was not measured.
This makes it hard to know how relevant the results are to people trying to reduce their weight in the real world. People’s choices about when and what they eat are affected by many things, including caring responsibilities, work schedule and the preferences of family members.
The important thing about dieting to lose weight is to find a healthy diet that ensures you are getting all the nutrients you need. It should also be something that you are able to stick to.
Many people have found the NHS weight loss guide helpful for losing weight steadily and safely.
Researchers propose new disease classification system for obesity
Researchers are proposing a new scientifically correct and medically actionable disease classification system for obesity, according to a paper published online in Obesity, the flagship journal of The Obesity Society.
The proposed disease classification system is based on the concept Adiposity-Based Chronic Disease (ABCD). The diagnostic term reflects both the pathophysiology and clinical impact of obesity as a chronic disease. The proposed coding system has four domains: pathophysiology, body mass index (BMI) classification, complications, and complication severity; and incorporates disease staging, specific complications that impact health, the basis for clinical intervention, individualized treatment goals and a personalized medicine approach.
“The coding reflects ‘what we are treating’ and ‘why we are treating it’, and, hopefully, will provide impetus for greater access of patients to evidence-based treatments,” said W. Timothy Garvey, MD, Butterworth Professor in the Department of Nutrition Sciences and Director of the Diabetes Research Center at the University of Alabama at Birmingham. Garvey is also a GRECC investigator and staff physician at the Birmingham Department of Veterans Affairs Medical Center. Garvey is the corresponding author of the study.
The diagnosis of obesity is currently based only on BMI that conveys no indication of the impact of excess adiposity on a person’s health. The International Classification of Diseases (ICD) code for obesity reads “obesity due to excess calories,” which experts say is not medically meaningful and does not reflect obesity pathogenesis.
“These inadequacies contribute to lack of access of patients to evidence-based therapies and appreciation of obesity as a chronic disease,” said Garvey.
The American Association of Clinical Endocrinologists (AACE) and the European Association for the Study of Obesity (EASO) have both embraced the concept of ABCD.
“There is increasing recognition globally that BMI and other simple metrics of obesity do not accurately reflect the complexity of the disease or the circumstances of patients. The Garvey and Mechanick proposal for a scientifically accurate and medically actionable four domain classification system is most welcome, and builds on previous initiatives of the AACE and EASO, explaining obesity as an ‘adiposity-based chronic disease.’ It is time for obesity to enter the era of precision medicine, with novel classification systems based on functionally established endpoints,” said Gema Frühbeck, first author of the EASO paper on ABCD.
“AACE has historically supported efforts in advancing the clinical evaluation and therapy of obesity beyond just a disease of weight based upon BMI, including guidelines recommending more nuanced diagnosis based upon exam and clinical evaluation to classify and stage the severity of disease. It is critical to match the intensity of therapy to the severity of disease and pathophysiology of disease, thus AACE followed its guidelines with a position statement proposing ABCD as a new diagnostic term for obesity. This proposed ICD coding structure supports the clinical efforts of personalizing individual diagnoses with more precision and nuance, which will benefit customized therapeutic plans for patients with obesity,” said Karl Nadolsky, DO, FACE, chair of the Nutrition and Obesity Disease State Network at AACE.
“The framework provides a well-organized way to help practitioners and payers conceptualize obesity beyond an erroneous framework of this patient eats too much and is not active enough,” said Jamy Ard, MD, professor of epidemiology and prevention at Wake Forest School of Medicine and co-director of the Weight Management Center at Wake Forest Baptist Health in Winston-Salem, NC. Ard was not associated with the research.
Ard added that the biggest challenge he foresees with this approach is that providers currently underdiagnose obesity using the simple BMI-based coding. “This more advanced approach will require a significant amount of education and outreach to change providers’ behaviors. However, if better reimbursement is tied to this type of coding system as the authors aspire, it may help to drive broader adoption and implementation,” said Ard.
There are so many reasons why people with particular medical conditions are advised to lose weight.
For example, for people with diabetes, it is necessary to lessen insulin resistance which can be caused by obesity. Interestingly many people have gone into remission from type 2 diabetes through sensible eating and weight loss.
In the case of some other conditions such as multiple sclerosis weight loss is needed to counteract the weight gain caused by medications prescribed for the condition.
But for a number of medical conditions, however, weight loss is important because of the impact of obesity on the joints. Arthritis is just one such example. It is important not to put too much pressure on the joints when moving so as to minimize pain among other problems. Thus weight loss becomes a priority for anyone diagnosed with arthritis.
There are a number of ways of losing weight which people may wish to consider. But it is very important that you consult a medical practitioner prior to embarking on any course of action like this.
However, there are a number of different options you may want to consider in conjunction with your Doctor.
Weight loss or bariatric surgery. Yes, this is pretty extreme but it is very effective. The downside is that a lot of patients report that returning to normal eating is very hard.
A specialist but paid for a diet such as Our Path or Weightwatchers. My wife has used Our Path which combines diet with mindfulness techniques with great success. The downside is that, of course, they are expensive. But those that encourage permanent change in diet and other behaviors seem to be the most successful in stopping the effect of “yoyo” dieting.
Calorie counting or cutting out carbohydrate diets. It can work well in the short term but these diets are hard to keep up in the longer run.
Exercise. We love it here. I do yoga and cycling and find it really helps with my weight. But both types of exercise are also recommended for people with multiple sclerosis and fibromyalgia. For some advice on how to lose weight with arthritic knees, for example, the link is a great resource.
Alcohol. Even a few drinks brakes down our will power to keep up with our good habits and eat foods we know are bad for us. Alcohol itself is full of empty calories so many dieticians suggest you should give it up completely or at best have only one drink.
Drink water instead of sodas and fizzy drinks. I have been suggesting drinking up to three liters of water a day. That is around six pints. Will help you lose weight.
Finally try and find a way of living which you enjoy rather than thinking weight loss is a chore.
So what have you used to lose weight and how has it worked? Why not use the comments box below to share your experiences with your fellow readers.
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