Clinical Trials Canada magazine editor Saaqshi Sharma sat down with bariatric researcher and physician Dr. Arya Sharma (no relation) to discuss obesity and the future of pharmaceutical management for this chronic condition.
Dr. Arya M. Sharma
Professor of Medicine & Chair for Obesity Research and Management at the Department of Medicine
University of Alberta
Edmonton, Alberta, Canada
Obesity blog: DrSharma.ca
Saaqshi Sharma: Dr. Sharma, can you tell me a little bit about the role of pharmaceuticals in obesity and the importance of this role?
Arya Sharma: We know that diet and lifestyle alone only helps most patients sustain quite modest weight loss. The average weight loss with diet and lifestyle is 3-5% of initial body weight which has good health benefits- for example a 5% reduction in body weight reduces diabetes risk by 60% – but many patients need to lose more than this amount. This is where pharmacotherapy potentially comes in, but the problem is not a lot of pharmaceuticals are out there for the management of obesity.
Saaqshi Sharma: Is there a reason there aren’t a lot of pharmaceuticals available for obesity treatment?
Arya Sharma: Obesity is something that is very difficult to treat. There are lots of mechanisms in the body which prevent weight loss and promote weight regain which makes the maintenance of weight loss very difficult. Our body essentially resists weight loss. Not a lot of drugs can interfere with this complicated biological system and if they do, they often come with side effects. This has been a major problem because drugs in the past that suppressed appetite or burned more calories [to promote weight loss] often caused other side effects and this ultimately resulted in their removal from the market.
Saaqshi Sharma: The FDA is considering approval of a new drug called Qnexa for the treatment of obesity. You acted as a consultant for the maker’s of Qnexa, can you tell us a little bit about how Qnexa is different?
Arya Sharma: Qnexa is different from other drugs because it is a combination of two drugs: phentermine which is most widely used in U.S. and has been on the market for over 30 years and topiramate which was first used as an anti-epileptic drug and is now used for the prevention of migraines. Because the drugs are already on the market we have an understanding of the long-term effects and how they work.
Like any other medical condition, we need to balance the side effects associated with obesity drugs and the risk of not treating obesity at all because it can lead to all sorts of complications. There is a risk with Qnexa in pregnant women, so the way the drug is going to be available is going to be very controlled for women of childbearing age. We’re not sure what the final program will be, but the company has suggested the drug only be available in pharmacies in a controlled fashion so that educational programs can be catered to women who may become pregnant.
Saaqshi Sharma: As a bariatric doctor and researcher, I’m sure you’re optimistic and excited about this new development. Do you think there is the same sentiment from a patient perspective? Is this something patients are advocating for?
Arya Sharma: Well, definitely from a medical treatment perspective, there is no question that there is a big treatment gap. Diet and exercise induce an average 3-5% weight loss from initial body weight, and bariatric surgery results in a 20% weight loss, so between that 5% and 20%, there are few options available, and this gap can theoretically be filled with medications. Unfortunately, we don’t have the drugs.
We know most people can’t maintain weight loss on their own and are looking for other treatment options. Similar to other chronic conditions such as hypertension, diabetes or elevated cholesterol, one drug will unlikely work for everyone.
Since obesity is a chronic condition, a drug has to not only help people lose weight but also keep weight off. This means that if the drug suits you well, you would be taking it for a very long time. The more options patients have, the greater their chances of successfully maintaining weight loss.
Saaqshi Sharma: Is there anything else you would like to share with our readers?
Arya Sharma: It’s important to think of obesity as a chronic condition and to remember there isn’t an easy treatment. Obesity is a root cause of other conditions and being able to treat obesity effectively and thereby reduce other problems is something we should all be very interested in and be supportive of.