Copycat GLP-1s and more: perspectives across metabolic and obesity care – 3/26


  • Copycat, compounded drugs for weight loss – multiple stories herehere and here.
  • Altimmune presents an interim analysis this week on 160 subjects in the MOMENTUM Phase 2 Obesity Trial.
  • Higher plasma caffeine concentrations were associated with lower body mass index and fat mass, as well as a lower risk of type 2 diabetes.


  • Not a ton of excitement this week, but I will be at the ViVE digital health extravaganza conference in Nashville this week, and at SAGES minimally invasive conference in Montreal later in the week, with an intent to catch up if you are interested to engage more deeply in twenty30 health. Just reach out via social media or email anytime.


  • More news on ‘…unregulated, copycat drugs for weight loss’ focused upon lower priced versions of semaglutide from compounding pharmacies. Really worrying is that Robin Langois, a patient who was prescribed Wegovy last year and could not afford it, ‘…was initially hesitant, because of safety concerns, but she eventually found a telehealth provider to write her a prescription.’ I am not only concerned for Ms. Langois, but also for the telehealth provider who is writing a prescription for a compounded version of GLP-1 medications – seems like this might be a short-lived practice for said telehealth provider.


  • Isabella Cueto and Theresa Gaffney in STAT News call out the American Academy of Pediatrics recent guidelines on childhood obesity, with respect to ‘…early diagnosis, intense counseling, and two new aggressive options for children with obesity…’ inclusive of weight loss drugs and bariatric surgery. The article tackles a number of issues, though I could not agree more with the ‘…focus on weight instead of health…’ in that weight loss is important, though my experiences with my patients have focused upon their goals of treatment toward resolution of diabetes, not needing to inject themselves with insulin, resolution of sleep apnea and not needing to use the CPAP machine anymore, and being able to participate in family activities such as going on a bike ride with their young children.
  • STAT News is indeed going overtime on obesity, with Isabella and Theresa focused upon ‘…an association between social media use and body image or eating disorders…’ taken from a review published in PLOS Global Public Health by ‘…Komal Bhatia and Alexandra Dane of the Institute for Global Health at University College London.’ We are in the midst of a multifactorial issue, though in our always online society, I cannot help but agree with Rachel Rodgers, an associate professor in the Department of Applied Psychology at Northeastern University’s Bouve College of Health Sciences: ‘…the social focus on physical appearance as a strong element of social capital has increased, and that the desirable appearance has become less attainable’ in addition to the authors of the STAT News article to write ‘…having preexisting body image concerns could put users at higher risk of disordered eating and worsened self-image.’
  • Jia Tolentino titles her article in The New Yorker, ‘Will the Ozempic era change how we think about being fat and being thin?’ closely followed by the first sentence ‘The ideal female body of the past decade, born through the godless alliance of Instagram and the Kardashian family’ ‘…was as technologically mediated as the era that produced it’ and an ode to ‘…the wealthy and the professionally attractive … showing newly prominent clavicles and rib cages.’ Of course, the key ingredient here is Ozempic, or semaglutide synonymous with GLP-1 medications. The article continues with focus upon compounded semaglutide, the recent pediatric guidelines, and ease of access through multiple telehealth encounters.
  • An Editorial in The Lancet, with a title ‘Let’s talk about obesity’ is well worth a quick read with a focus upon ‘…Obesity is complex. The causes are varied and multidimensional so management must be too.’ I commend the ‘…A person-centred approach is important for tackling the obesity crisis’ and cannot be more aligned with my thoughts upon whole-person, individualized, end-to-end, multimodal delivery of care for obesity, akin to the oncology care model.
  • I appreciate the opening lines of recent MIT Technology Review article focused upon the experience of Michael Edenfield to not only shed 129 pounds over the bulk of 2022, but more importantly, to be rid of ‘…his sleep apnea machine, his high-blood-pressure medication, and a diuretic pill he had used to alleviate fluid retention in his legs.’ The medical literature, as well as mass media continues to focus upon weight loss in a quantitative fashion, or in before and after pictures keyed in upon body image, and — my opinion — the resolution of medical conditions is rarely a story of note. The article continues with details upon the medications developed and popularized by Novo Nordisk and Eli Lilly, with focus on social media influencers, compounded versions of semaglutide, direct to consumer telehealth platforms to prescribe said medications, and weight regain after one comes off the drug. All important and timely issues.


  • Altimmune, a NASDAQ-listed, publicly traded ‘…clinical stage biopharmaceutical company developing peptide-based therapeutics’ for obesity, non-alcoholic steatohepatitis and chronic hepatitis B, with a market cap of just over $200M, presented an interim analysis this week on 160 subjects in the MOMENTUM Phase 2 Obesity Trial of the drug pemvidutide, a peptide-based GLP-1/glucagon dual receptor agonist. The study was led by the well known Dr. Louis Aronne, Professor of Metabolic Research and Professor of Clinical Medicine at Weill Cornell Medicine, stating ‘The weight loss achieved was impressive…’ and revealed ‘…Mean weight loss of 10.7% (placebo-adjusted 9.7%) at 2.4 mg dose at Week 24… [and] … Robust reductions in waist circumference, serum lipids and blood pressure without meaningful increases in heart rate.’ The 48-week results will be presented in late 2023, which shall be eagerly awaited, with an onward focus upon nonalcoholic steatohepatitis, or NASH.
  • The release above was covered by Allison DeAngelis at STAT News, who was not so complimentary on the side effect profile in that ‘…pemvidutide was tough on the gastrointestinal system. Half of the people who dropped out of the Phase 2 trial cited problems with nausea and vomiting.’
  • In BMJ Medicine, an open access journal, researchers from Sweden, Bristol University and my alma mater, Imperial College London, investigate ‘…the potential causal effects of long term plasma caffeine concentrations on adiposity, type 2 diabetes, and major cardiovascular diseases.’ The thermogenic effects of caffeine were implied, with respect to genetic variations in almost 10,000 individuals of European ancestry ‘…that are associated with slower caffeine metabolism [and] consume, on average, less coffee but have higher plasma caffeine concentrations.’ The two key takeaways are that first, ‘Genetically predicted, lifelong, higher plasma caffeine concentrations were associated with lower body mass index and fat mass, as well as a lower risk of type 2 diabetes,’ and second, ‘…Approximately half of the effect of caffeine on type 2 diabetes was estimated to be mediated through body mass index reduction.’ The senior author, Dr. Gill, is also an affiliate to the Chief Scientific Advisor Office at Novo Nordisk, though perhaps his most recent work will have Starbucks, La Colombe and Dunkin Donuts knocking on his door to engage in consulting services too.
  • The study was picked up by news outlets, including The Guardian newspaper, with the suggestion that ‘…calorie-free caffeinated drinks being used to reduce obesity and type 2 diabetes.’ I would stress the ‘calorie-free’ element – it is of concern to me that a white chocolate mocha with whipped cream contains over 600 calories, 67mg of cholesterol and 74g of sugar.

Kind regards, Raj


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