Diabetes, Weight Loss Drug Works Better With Exercise

By Amy Norton
HealthDay reporter

THURSDAY, May 6, 2021 (HealthDay News) – Weight loss drug Saxenda may reduce extra pounds – but when combined with exercise, it is more beneficial, according to a new clinical trial.

The study found that some long-standing advice holds good: Prescription weight loss medications work best when used with – not instead of – lifestyle changes.

Saxenda (liraglutide) is a prescription drug approved in the United States to stimulate and maintain weight loss when added with calorie reduction and exercise.

But whether the drug plus exercise is better than the drug alone – or exercise alone – has not been rigorously tested.

The new trial, published on May 6 in the New England Journal of Medicine, did exactly that. And he found that over a year the combination gained, helping people lose more pounds and, in particular, body fat.

Experts not involved in the lawsuit said it underscored the importance of “comprehensive” tactics to keep the extra weight off.

“The standard of care with all obesity treatments – drugs and surgery – is to use them as an adjunct to ongoing behavior changes,” said Dr. Scott Kahan, spokesperson for the Obesity Society.

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Sustainable dietary changes and regular physical activity are essential, said Kahan, who also directs the National Center for Weight and Wellness in Washington, DC.

Weight loss drugs are helpful, Kahan said, but “magic cures” are not. Still, some doctors, he noted, may prescribe them without giving patients sufficient lifestyle support.

There are several drugs approved in the United States to help with weight loss. They include Xenical (orlistat), Qsymia (phentermine-topiramate), and Contrave (naltrexone-bupropion).

Liraglutide is sold under two brand names: Saxenda, the weight loss medicine, and Victoza, for type 2 diabetes. Saxenda contains a higher dose of liraglutide and works by mimicking the action of an appetite hormone called GLP-1, according to the drug’s manufacturer, Novo Nordisk.

The drug is given by injection every day.

For the new trial, funded by Novo Nordisk, researchers recruited 195 obese adults who spent eight weeks on a low-calorie diet. After that, they were randomly assigned to one of the following four groups: drugs plus exercise; drugs only; exercise only; or a placebo group who were given inactive “drugs” and told to stick to their usual level of activity.

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The exercise groups, on the other hand, had a fairly vigorous routine. They were encouraged to attend group classes twice a week and exercise on their own twice a week, with running, cycling and brisk walking being the main activities.

All four groups were given advice on long-term dietary changes.

After a year, the drug / exercise group had lost 16% of their starting weight, on average. This compared to 11% in the exercise group and 13% in the drug group.

The combined approach was also the most effective in changing body composition: these patients lost about twice as much body fat and reduced their waistlines more, compared to those of either strategy alone. .

They also preserved their muscle mass, according to the researchers, led by Signe Torekov, of the University of Copenhagen in Denmark.

“The big point here is that the study confirms that yes, combining drugs with exercise is more effective,” said Dr. Reshmi Srinath, who leads the Weight Management and Metabolism Program at Mount Sinai in New York City. .

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She had a few caveats: The patients in the trial were quite young – in their early 40s, on average – and in good health. Such vigorous exercise might not be suitable for the elderly or for people with certain health conditions, such as painful arthritis.

“With these patients, we generally recommend walking or incorporating some weight training at home,” Srinath said.

But, she added, the bottom line remains: “Drugs should be used as an adjunct to lifestyle changes.”

This applies not only to Saxenda, but to prescription weight loss drugs in general, Kahan and Srinath said.

When it comes to choosing a drug, Srinath said, it’s a case-by-case decision, taking into account side effects and any health conditions a patient might have. In this study, the most common side effects among Saxenda users included nausea, diarrhea, and dizziness.

Personal preferences are also a factor in the medication decision, Srinath noted. “Some patients are reluctant to take a daily injection,” she said.

What’s important, Kahan says, is that people who have “tried again and again” to lose weight know that there are treatments that might help.

“People often don’t realize it because we’re in this Wild West full of bogus weight loss products,” he said. “But there are good, legitimate options that have been scientifically studied.”

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More information

The US National Institute of Diabetes, Digestive and Kidney Diseases has more on weight management.

SOURCES: Scott Kahan, MD, MPH, director, National Center for Weight and Wellness, Washington, DC, and spokesperson, The Obesity Society, Silver Spring, Maryland; Reshmi Srinath, MD, assistant professor, endocrinology, diabetes and bone disease, and director, weight management and metabolism program, Icahn School of Medicine in Mount Sinai, New York City; New England Journal of Medicine, May 6, 2021

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