Episode Details

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In part 1 we talked about a request that has been submitted for the World Health Organization (WHO) to add diet drugs to their list of “essential medicines.” We discussed who was making this request and the justification that they were using. Today we’re going to take a deeper dive into the research that they used to try to support this request, and in part three will look at the research around harm and “efficacy,” as well as “cost effectiveness.” (I was originally going to write this in two parts, but I realized that it was just ridiculously long, and there is time before the WHO meets about this, so I’ve decided to break it into three parts.)

Just a reminder that I don’t hyperlink to studies or articles that come from a place of weight stigma, though I do provide enough information that someone could google them.

In their ”Summary statement of the proposal for inclusion” they say

“The use of GLP-1 RAs in the treatment of ob*sity has been well studied and meta-analyses of various GLP-1 RAs have demonstrated that this class of medications can lead to clinically significant weight loss. Compared to control groups, GLP-1 RAs were found to lead to more significant weight loss with a mean difference of approximately 7.1 kg as well as an improvement in glycemic control, with low concern for hypoglycemia[3].”

The single paper they cite to back this up (Iqbal et al. Effect of glucagon-like peptide-1 receptor agonists on body weight in adults with ob*sity without diabetes mellitus-a systematic review and meta-analysis of randomized control trials, 2022) looked at weight loss on these drugs among “ob*se” adults without type 2 diabetes (so hypoglycemia would have been unlikely anyway.) It included 12 trials with a total of 11,459 participants. 80% of the participants were white, 10% were Black or African Americans and 5% were Asians. It is concerning that they are making a global recommendation based on a study population that is overwhelmingly white.

There is also the issue of follow-up. Some of the trials were as short as 14 weeks and the longest trial included was only 3 years. The average weight loss was 15.6 lbs more in the group taking the drugs than in control, but some subjects on the drugs lost as little as 5.5 lbs. Those on the drugs also experienced vomiting, nausea, dyspepsia (indigestion,) diarrhea, constipation and abdominal pain as common side effects. There is no way to know how much of this (short-term) weight loss is due to experiencing these common side effects. These drugs also have significant (possibly life-threatening) side effects and the short-term follow-up included here is not likely long enough to capture those. Also, remember that the recommendation is for people to take these drugs for the rest of their lives (since, if they don’t, their weight shoots right back up and they lose cardiometabolic benefits,) and they are making that recommendation (globally) on just 14 weeks to 3 years of data.

The authors of this study cite no conflicts of interest. Per LinkedIn, someone with the same name as the lead author is a product specialist at Novo Nordisk but I imagine that must be a coincidence or surely it would have been listed as a COI. The article was published in “Ob*sity Reviews” which is an official journal of the “World Ob*sity Federation” (WOF). The WOF took over $5.3 Million dollars from Novo Nordisk (whose weight loss drugs are covered by this recommendation) over three years. Th