From gossip magazines to the cover of Science. GLP-1 analogues, drugs used to treat diabetes and weight loss, have dominated the discussion throughout the year. They started with messages from celebrities like Elon Musk and Oprah Winfrey, who recently spoke openly about their consumption. They bring the cultural debate around obesity to the table, not as a moral issue or lack of will, but as a disease. Since the days of Botox and Viagra, no drug has entered the collective imagination in this way. Then they jumped to the salmon sides. Its two most popular commercial formulations, Ozempic and Wegovy, made its manufacturing company, Denmark's Novo Nordisk, the most valuable in Europe and saved Denmark from recession. Throughout this time, it was constantly featured in scientific journals, where it demonstrated its effectiveness in weight loss and reducing cardiovascular accidents. And that's how the year ends, as Science magazine has named the GLP-1 analogues the scientific breakthrough of 2023.
These medications mimic the hormones that naturally make us feel full after eating. And every time they do it better and longer. Although they have been prescribed since 2017, their effectiveness has increased significantly in recent years. Semaglutide (a molecule marketed as Wegovy) can result in a 15% reduction in overall weight, a historic percentage never achieved with medication. “But perhaps the most important thing of all, apart from the weight loss itself, is that they demonstrate a reduction in morbidity and mortality,” says Juan José Gorgojo, head of nutrition services at Fundación Alcorcón University Hospital.
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A study published this year showed that these drugs reduce the risk of heart attacks and strokes by up to 20% in obese people. “Also, the same medication [semaglutida 2,4mg] “It has shown clinical benefits in patients with heart failure,” adds Dr. Gorgojo added. “These are more than enough reasons to highlight it as one of the advances of the year.” The magazine highlights these “two historic clinical trials” and emphasizes that they have shown benefits “that go beyond weight loss.” In addition, the unexpected side effects of GLP-1 analogs, which altered the addictive behavior of many patients, have opened the door to possible future applications. “Several studies are currently underway examining its use in the treatment of drug addiction, Alzheimer’s and Parkinson’s,” the journal says.
Science's announcement comes a day after Nature magazine, the other major reference in the scientific world, named biochemist Svetlana Mojsov, a key figure in the discovery of GLP-1, as one of the ten scientists of the year. Mojsov's role is doubly relevant in this story. Firstly, for his scientific contribution to these drugs, as he identified and characterized the hormone and created the peptides on which this entire technology is based. But his story is also relevant because it illustrates the patriarchal mechanisms of the scientific world. For years, industry magazines and awards praised the work of their male colleagues, doctors Daniel Drucker, Joel Habener and Jens Juul Holst, while systematically ignoring their own. After years of struggle, Serbian biochemistry has gained the recognition it has previously been denied. Journals such as Cell and Nature, which initially silenced his contributions, were forced to publish corrections to equate his name with those of his colleagues.
Costs and rebound effect
Dr. Gorgojo understands that in the Spanish context, where GLP-1 agonists are financed only for cases of type 2 diabetes, social security should take note of this and start financing the treatment of patients with obesity and related problems. The difference means that the weekly wage falls from 130 euros to around four euros. The expert admits that this involves an expense for the state treasury, but in the long term it could lead to savings. Obesity is the gateway to more than 200 cardiovascular diseases and problems. According to the OECD, the complications caused by it account for 9.7% of total health expenditure in Spain.
The bad thing is that this effort would not be punctual but constant. “Obesity is a chronic disease,” says Gorgojo. “There is no treatment for a chronic disease that lasts a few months. “Treatment should be continued for life.” A recent clinical experiment with tirzepatide (an even more potent molecule marketed under the name Mounjaro) has proven this maxim. After 36 weeks of treatment, patients experienced an average weight loss of 20.9%. From then on, they withdrew the drug from some of the patients and replaced it with a placebo. These experienced a 14% weight gain, while those who continued taking the medication continued to lose up to 5.5% more in the following weeks. The rebound effect is pronounced and begins at the same time as the drug is discontinued.
Cristóbal Morales, an endocrinologist at the Virgen de la Macarena Hospital in Seville and a prolific researcher in the field, highlights how these drugs have changed society's perception of obesity. “The big change is that we have recognized that it is a social disease,” he explains. “There is a lack of evolutionary adaptation. We have prehistoric genes from the Pleistocene, and our context is not the same as it was back then. “We live in an obesogenic environment,” he reflects. Old genes, coupled with our new environment, push us to eat too much. Ultra-processed foods act as real designer drugs, capable of releasing large amounts of dopamine in bodies that react in this way to sugar and fat, which are less common in natural foods. “The good thing is that science has made progress to find an answer to this lack of adaptation, to this metabolic deregulation,” says Morales.
Drug treatment for this disease can be effective. But its visible effects should not unsettle us, says the expert. “This cannot be solved with drugs alone, the most important revolution must be changing society,” he emphasizes. We don't have to look for an individual solution, but rather a social and ecological one. According to the 2020 European Health Survey in Spain, 24% of people with low socioeconomic status suffer from obesity, while the prevalence among people with more resources is 9%. Obesity is a class problem and the emergence of these drugs, which will in the future be available to everyone for a few hundred euros a week, can only reinforce this fact. For this reason, experts call for these drugs to be understood as a tool that improves health and not aesthetics, and to accompany scientific progress with a social and multifactorial approach.
“Homo Sapiens always needs parts of their history to tell their story,” Morales reflects. “And we were missing pieces to tell this story, pieces of epigenetics to understand why we are suffering from this pandemic.” Now that we have it, now that obesity is understood as a disease of a social and environmental nature and not As a result of a weak character or lack of will, we can begin to find solutions, explains the endocrinologist. Science notes that 2023 was the year of GLP-1 agonists. “I think 2024 will be the year we address the problem of obesity and reduce the number of its complications,” the expert adds.
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