The very first Obesity Panacea post was written back in November 2008. The topic of that post was the removal from the European market of an obesity medication that had been previously heralded as a potential panacea (but was never approved in US or Canada). That drug was rimonabant (Acomplia), an appetite suppressant that works by blocking the CB-1 receptors of the endocannabinoid system – the same system which induces the “munchies” in response to smoking cannabis. Rimonabant not only suppressed appetite, but was associated with anxiety and depressive mood disorders – the same side-effects which initially prompted the US FDA to refuse approval of rimonabant back in 2007.
Two years later, another appetite-suppressing medication, sibutramine (Accomplia) was also withdrawn from the Canadian and US market due to increased risk of cardiovascular events and strokes.
Thus, over the past five years there was only a single obesity medication available to obese patients in Canada – orlistat (Xenical®). This agent reduces the absorption of ingested fat by about 30%. The 30% that doesn’t get absorbed ends up in the stool, which, as you’d expect, can result in some rather challenging gastrointestinal side effects (e.g. oily discharge).
All of that changed yesterday (Feb. 26), when Health Canada approved a new obesity medication. This new medication, liraglutide 3.0mg (Saxenda®), which is administered via a daily subcutaneous injection has actually been available in Canada but at a lower dose and marketed under a different name (up to 1.8mg, Victoza®) for the treatment of type-2 diabetes. Saxenda is approved for weight loss in addition to diet and exercise for patients with a BMI ≥30kg/m2 or a BMI≥27kg/m2 plus at least one weight-related illness (i.e. hypertension, dyslipidemia, or diabetes). This drug has been studied in a number of large clinical trials which suggest that patients experience an average reduction of 6.3-8.0 kg over and above that achieved with placebo (fake injection) at 1 year of therapy. This of course isn’t the most exciting magnitude of weight reduction, but keep in mind that most experts recommend that obese individuals only aim at 5-10% weight loss to reap health benefits.
More importantly, as we’ve highlighted ad nauseam, positive health behaviours – including a healthy diet and increase physical activity have a tremendous impact on your health regardless of your weight status. And these behaviours form the basis of ANY obesity therapy.
Nevertheless, obese Canadians who only had one option for a medication to help them lose weight (and have oily flatulence), now have another option.
Of course, obese folks in the US have many more pharmacological options – including two combination therapies (Qsymia® and Contrave®) – that remain unavailable in Canada or Europe.