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What to know about prescription drugs promising weight loss

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Obesity is a major and growing problem around the world, but especially in the U.S., where more than 40% of adults and about 20% of children now meet the criteria for what doctors say has become an intractable chronic disease.

Rates of the disease have soared in recent decades, spurred by the complex interaction of genes that make people more likely to store food as fat, a food system that provides easy and cheap access to processed treats explicitly designed to be overconsumed, and social settings that limit access to healthy options and exercise for many people.

Obesity is linked to scores of health problems that can lead to disability or even death, including high blood pressure, diabetes, heart disease, stroke, cancer and joint problems.

Researchers have long looked for medications that can help people lose weight, mostly with disappointing and, in some cases, dangerous results. In recent years, however, drugs designed to help people with type 2 diabetes control their blood sugar levels have had the added effect of paring pounds.

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Ozempic, a Novo Nordisk drug approved to treat diabetes in 2017, skyrocketed in use after celebrities and ordinary people on TikTok reported that their doctors prescribed it “off label” for weight loss. Wegovy, a higher dose version of the same medication, called semaglutide, was approved for weight loss for adults in 2021 and for children aged 12 and older late last year.

Now, a new drug made by Eli Lilly and Co., called tirzepatide, is poised to become the most potent obesity drug on the market, promising users losses of more than 30 to 50 pounds over time. Already approved under the brand name Mounjaro to treat type 2 diabetes, tirzepatide is being considered for fast-track approval as a weight-loss drug based on the results of key trials, with the latest announced on Thursday.

The new study found that patients with diabetes — who find it notoriously difficult to lose weight — could shed about 16% of their body weight, or more than 34 pounds using tirzepatide. An earlier study found that people without diabetes lost up to 22% of their body weight, or more than 50 pounds on the highest dose of the drug.

Tirzepatide and other medications spur weight loss by targeting the metabolic conditions that lead to extra pounds. Here’s what to know about these new prescription drugs that promise weight loss.

What are these new weight loss drugs?

The drugs that have drawn the most attention have been a class of medications that activate a hormone known as GLP-1. They include Ozempic and Wegovy, which are two versions of the same medication, semaglutide.

Tirzepatide targets GLP-1, but also affects a second hormone, called GIP, which developers say contributes to its increased effectiveness. Mounjaro was approved to treat diabetes in May 2022.

The drugs are delivered through once-weekly injections. Users are advised to follow a healthful, reduced-calorie diet and to exercise regularly while using the drugs.

How do Ozempic, Wegovy and Mounjaro work?

The drugs work by mimicking the actions of hormones, found primarily in the gut, that kick in after people eat. The hormones help regulate blood sugar by triggering the pancreas to release insulin, another hormone, and slowing the release of sugar from the liver. People who are overweight or have obesity can become insulin-resistant, which means the body doesn’t respond to insulin properly.

The obesity drugs lower blood sugar and slow down digestion, so people feel full longer. They also affect signals in the brain linked to feelings of fullness and satisfaction, tamping down appetite, food-related thoughts and cravings.

Because people feel full longer, they eat less and lose weight.

How effective are the drugs?

In a trial, adults who took Wegovy saw a weight loss of nearly 35 pounds, or about 15% of their body weight. Adolescents lost about 16% of their body weight.

The latest study of tirzepatide studied the drug in more than 900 patients with diabetes who were overweight or had obesity over nearly 17 months. It showed weight loss of up to 16% of body weight, more than 34 pounds, when using the highest dose of the drug. Patients who received placebo, or dummy injections, lost about 3% of their body weight, or 7 pounds.

An earlier trial of tirzepatide showed weight loss of between about 15% and about 22% of body weight, or about 35 pounds to about 52 pounds, depending on the dose.

The drugs appear effective for chronic weight management over many months. In addition to weight loss, they also reduce health problems associated with obesity, such as high blood sugar and markers of heart and metabolic disease.

However, it appears that if people taking the drugs stop, they regain the weight they lost — and the health problems that came with it.

Why not just diet and exercise?

In a typical weight-loss program where participants rely only on diet and exercise, research shows only about a third of people will lose 5% or more of their body weight, said Dr. Louis Aronne, director of the Comprehensive Weight Control Center at Weill Cornell Medicine.

Many people find it difficult to lose weight because of the body’s biological reactions to eating less, he said. There are several hormones that respond to reduced calorie intake by ramping up hunger to maintain body mass.

What are the side effects of the drugs?

The most common side effects are short-lived gastrointestinal issues such as nausea, vomiting, constipation, diarrhea and stomach pain. Other possible effects include serious issues such as inflammation of the pancreas, kidney, gallbladder and eye problems. People with a history of certain thyroid cancers or a rare, genetic endocrine disorder should avoid the drugs, because it is not clear if tirzepatide causes thyroid problems, including cancer.

How much do these drugs cost?

The new anti-obesity medications are expensive. Wegovy costs about $1,300 a month and Mounjaro starts at about $1,000 a month. People with private insurance may be able to receive the drugs with only a small co-payment. However, many insurers don’t pay for the medications or they have restrictions regarding coverage. Medicare doesn’t cover most weight-loss drugs. Medicaid and the military insurer Tricare may cover them in some cases with prior approval.

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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.

It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.

Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”

Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.

Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.

A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.

On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.

Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”

But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”

“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.

Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.

Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.

Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.

“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.

“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”

This report by The Canadian Press was first published Sept. 13, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.

Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.

Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.

The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.

“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.

Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.

Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.

Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.

A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.

This report by The Canadian Press was first published Sept. 10, 2024.

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