Diet as a Diabetes Medication? The Present and Future of Obesity TreatmentProfessor Lim Su Lim, Department of Endocrinology, Seoul National University HospitalBundang

Please tell us about the current status of obesity treatment and treatment.

Since the coronavirus, the amount of exercise has decreased and the amount of food consumed has increased, which has led to a significant increase in the number of obese people not only in Korea but also around the world.

The most commonly used drug to treat obesity is precisely GLP-1 analogues. GLP-1 is an enteric hormone secreted by the body, and it uses the principle that it can be injected externally as an injection or oral drug in the form of an analogue.

This drug acts on the satiety center in the brain, making you feel full early and keeping you hungry for longer. It also works by increasing the gastric emptying time so that you don't get hungry as quickly. In other words, it shows a weight loss effect through the central and gastrointestinal effects. It was first used as a treatment for diabetes, so it also helps control blood sugar.

In terms of prescribed and types of medicines, 'Saxenda', which contains liraglutide, is the most commonly used in Korea, and 'Wegovy', which contains semaglutide, which is used by Elon Musk and is said to have a great effect on dieting overseas, is used. In addition, the terzepatide ingredient "Monjaro" is also widely used. All three ingredients have been approved by the FDA, Wegovy has been approved by the Korean Food and Drug Administration, and Monjaro is still in the approval process.

Are there any precautions when using anti-obesity medications?

All of the preceding anti-obesity drugs are approved for obese people. Approved through a well-thought-out clinical study, the drug is currently only available for BMI with a BMI of 30 or higher, or a BMI of 27 or higher, with obesity-related comorbidities.

In addition, not all drugs are designated as prescription drugs that can only be prescribed by a medical professional, so not everyone who wants to lose weight can get it.

Are there any new anti-obesity drugs that are highly anticipated?

In addition to the aforementioned anti-obesity drugs, several other ingredients or formulations of anti-obesity drugs are either awaiting approval or in clinical trials.

First of all, GLP-1 analogues are also available as oral drugs. In this way, even if the ingredients are the same, the formulation is different, or existing drugs require clinical trials to add new indications. Oral drugs currently undergoing clinical trials include semaglutide-based 'Libelsus' and 'Wolfoglifron'. Among them, wolfoglifron is undergoing clinical trials in Korea. If the results of the clinical trial are positive, there is a possibility that the drug may be changed from injectable to oral.

Semaglutide has been shown in large-scale clinical trials around the world to reduce weight loss and cardiovascular disease. Of particular note is that in clinical trials conducted in Korea and Japan, there was a 13.5% weight loss effect. Beyond obesity, it has been found to help with early-stage Alzheimer's disease and fatty liver, and many clinical trials are currently underway in this regard.

It was developed as a diabetic drug, but it has been expanded to include comorbidities and obesity.

Are there any side effects of obesity medications?

All medications have side effects, and obesity medications in particular should be kept on the lookout.

The most common side effects of GLP-1 are abdominal discomfort, constipation, and diarrhea. However, these side effects could be controlled by gradually increasing the dose from a small dose to using the drug in stages.

What are the future prospects of obesity treatment and what would you like to ask?

Currently, the atmosphere of obesity treatment is good. Various obesity solutions such as injections and oral drugs have been created, but there is a lack of social awareness about obesity. They don't recognize that obesity is a disease that requires a doctor's visit. Obesity treatment needs to be treated more aggressively with the recognition that it is a disease that is difficult to self-medicate like other diseases.

In addition, there needs to be a social atmosphere that discourages the wrong view of obese people, such as being lazy or lacking in self-care. Obesity should also be recognized as a disease that is difficult to solve without the management of medical institutions.

Obesity treatment is usually multidisciplinary and requires both dietary improvement by a dietitian and lifestyle improvement by an exercise prescriber. This is because only with such multidisciplinary treatment can the weight reduced by taking the drug be maintained.