Overweight and Obesity
Overweight and obesity is determined when a person’s weight is greater than expected for a designated height. Body mass index (BMI) is customarily used to screen for overweight and obesity despite its known limitations. BMI is calculated by weight in kilograms divided by the square of height in meters, indicating a person’s body fat. Higher BMIs signify high body fat.¹ For this reason, BMI screens for weight categories associated with increased risk for health complications and is not useful to diagnose body fatness or health status.¹
- Body mass index ranges <18.5 is considered underweight as normal weight fall between ranges 18.5 to 24.
- BMI ranges 25 to 29 is described as overweight.
- BMI ranges 30 or greater falls within the obesity range, which further categorizes into classes to identify severe obesity.
Obesity is a Public Health Concern
Obesity is a chronic disease affecting close to 70 percent of American adults and requires long-term management.² An estimated nearly 650 million adults live with obesity globally.³ Prevalence in the US was about 42.4% spanning years 2017 to 2018 with double prevalence of severe obesity. It is associated with numerous serious health complications and soaring health costs. In the US, obesity costs approximately $147 billion dollars annually with medical costs of more than $1,429 dollars compared to healthy weight individuals.⁴
Obesity significantly decreases one's lifespan causing preventable and premature deaths. Most notably, obese patients were at an increased risk for being severely ill or having prolonged hospitalization following a COVID-19 infection.⁵
Obesity-related complications include:
- Obstructive sleep apnea syndrome
- Heart disease
- Non-alcoholic fatty liver disease
- Type 2 diabetes mellitus
- Increase risk for certain types of cancer
The risk for obesity is impacted by multiple complex factors. The most challenging factor being where one lives as that can greatly affect access to healthier food options, preventative medical care, and the ability to implement lifestyle modifications.
Management of Obesity
Many implemented strategies fail to shift the obesity trend despite the evidence showing decrease cardiovascular disease risk in obese and overweight patients who lose five to ten percent of weight.²
Management includes a weight loss program focused on diet and exercise. Such programs aim for continual lifestyle changes for weight loss, which promote the following:
- Eating a colorful and healthy diet
- Monitoring of calorie intake
- Increasing physical activity
- Reducing stress
- Aiming for adequate sleep
Often, surgical interventions and medications add to weight loss efforts when diet and exercise are unsuccessful in lowering weight. The quest continues for effective combination therapy to decrease obesity.
New Medication Wegovy™ Approved for Weight Loss
In June 2021, the FDA approved semaglutide (Wegovy™) 2.4 mg injection under the skin once weekly for chronic weight management in adults with obesity or overweight with at least one health condition (e.g., high blood pressure, high cholesterol, type 2 diabetes mellitus, or obstructive sleep apnea) in addition to participating in a weight management program.
Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that acts by mimicking the bodily hormone GLP-1, which targets the hunger center in the brain regulating appetite. Thus, it stimulates weight loss by decreasing hunger sensation and increasing the feeling of fullness.⁶ Consequently, individuals eat less causing further decrease in their calorie intake.
Wegovy™ is the first and only once weekly GLP-1 receptor agonist medication approved for adults with obesity or overweight since 2014 based on clinical trial results.² The STEP (Semaglutide Treatment Effect in People with obesity) phase 3a program was a set of four trials with approximately 4,500 adults enrolled with obesity or overweight.² Those individuals without type 2 diabetes treated with Wegovy™ had an average weight loss of 17-18 percent maintained over 68 weeks of treatment.² ⁶
Wegovy™ Side Effects
Participants tolerated Wegovy™ well without serious side effects. The most common side effects of medication include:
- Gastrointestinal symptoms: nausea, vomiting, diarrhea, constipation, abdominal pain, abdominal distension, gastroenteritis (intestinal infection), belching, flatulence, or indigestion/ gastrointestinal reflux disease
- Hypoglycemia (low blood sugar)²
Medication dose should be increased slowly over 16 to 20 weeks to a final dose of 2.4 mg once weekly to lower gastrointestinal side effects.²
Other adverse effects include:
- inflammation of the pancreas (pancreatitis)
- gallbladder conditions
- acute kidney injury
- damage to the eyes' retina (retinopathy)
- increased heart rate
- suicidal thoughts²
Wegovy™ Boxed Warning
- There is a boxed warning of potential risk for thyroid C-cell tumors, so no patients with a personal or family history of medullary thyroid carcinoma should use Wegovy™.
- Also, patients with multiple endocrine neoplasia syndrome type 2 (MEN-2) should avoid Wegovy™.²
- Wegovy™ should not be used in combination with another GLP-1 receptor agonist or weight loss products (such as prescription drugs, herbal products, or over-the-counter weight loss drugs).²
- This medication has not been studied in individuals with a history of pancreatitis.² Patients should discuss these risks with their treating clinician to make sure there is no reason to avoid Wegovy™.
Overall, Wegovy™ provides another tool in the toolkit in tackling obesity with promising results based on clinical evidence so far.
Be Strong, Be Healthy, Be in Charge!
Ula Abed Alwahab, MD and Tiffany Cochran, MD
- Body Mass Index (BMI). Center Disease Control and Prevention. Accessed July 8, 2021.
- FDA News Release. Food Drug Administration. Accessed July 8, 2021.
- Obesity and Overweight. World Health Organization. Accessed July 8, 2021.
- Adult Obesity Facts. Center Disease Control and Prevention. Accessed July 8, 2021.
- O’Hearn M, Liu J, Cudhea F, Micha R, and Mozaffarian D. (2021). Coronavirus disease 2019 hospitalizations attributable to cardiometabolic conditions in the United States: A comparative risk assessment analysis. Journal of the American Heart Association, 10(5): e019259. doi:10.1161/JAHA.120.019259.
- Novo Nordisk A/S. Wegovy™ (semaglutide 2.4 Mg), the first and only once-weekly GLP-1 therapy for weight management, approved in the US. GlobeNewswire News Room, Novo Nordisk A/S, 4 June 2021. Accessed July 8, 2021.
About Dr. Ula Abed Alwahab
Ula Abed Alwahab, MD is an Internal Medicine physician who specializes in endocrinology, diabetes and metabolism at Cleveland Clinic and sees patients in the Center for Specialized Women's Health.
About Dr. Tiffany Cochran
Tiffany Cochran, MD is a Women's Health Fellow in Cleveland Clinic's Specialized Women's Health Fellowship program. Dr. Cochran received her Bachelor of Science from Valdosta State University and her Doctorate of Medicine from Morehouse School of Medicine. She also has an MA in Healthcare Administration.
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