Obesity is a growing concern worldwide, including in low- and middle-income countries (LMICs). Addressing this issue involves various strategies, including dietary and lifestyle changes, medical treatments, and professional support. Recently, some weight loss drugs have emerged as a potential tool in managing obesity.

This article offers basic explanation of how these drugs work, their potential in LMICs, associated risks, and how dietitians can ensure their safe and effective use.

How Do Weight Loss Drugs Work?

Many modern weight loss medications are GLP-1 receptor agonists, such as semaglutide (marketed as Ozempic and Wegovy) and tirzepatide (eg Mounjaro and Zepbound). These drugs mimic the action of the natural hormone GLP-1 (glucagon-like peptide-1). This hormone plays a role in regulating appetite and blood sugar levels. In very simple terms, GLP-1 receptor agonists function in three main ways.

1. Reduces appetite: It sends signals to the brain, making you feel full after eating smaller amounts.
2. Slows down digestion: Food stays in the stomach longer, keeping you feeling satisfied for extended periods.
3. Improves insulin function: It helps regulate blood sugar levels, which is particularly beneficial for people with type 2 diabetes.

Potential of the New Weight Loss Drugs in LMICs

These new weight loss drugs have shown promising results in reducing obesity and related complications like type 2 diabetes and cardiovascular disease. If made accessible and affordable, these medications could be a game-changer in LMICs, where obesity often coexists with undernutrition. Their use could reduce the healthcare burden associated with obesity-related diseases, ultimately benefiting communities and economies. However, the high cost of these drugs and limited healthcare infrastructure in LMICs present significant challenges. For example, semaglutide-based drugs can cost hundreds of dollars per month, putting them out of reach for most people in LMICs. Also, while GLP-1 receptor agonists can be effective, they are associated with potential side effects, primarily gastrointestinal issues such as nausea, vomiting, diarrhea, and constipation. These side effects are usually mild and tend to decrease over time. More serious adverse effects have been reported, though they are less common. Furthermore, the long-term effects of these medications on the body are not yet fully understood. Thus, it is crucial to use these medications under proper medical supervision.

How Can Dietitians Help?

There is limited research available on the use of the new weight loss drugs in LMICs. Dietitians in LMICs can however play a vital role in ensuring the safe use of the new weight loss drugs for patients who may be using them in the following ways;

1. Assessing Suitability: Dietitians can help determine if weight loss medications are appropriate for an individual, considering factors like nutritional status and potential drug-nutrient interactions.
2. Providing Nutrition Education: Dietitians can offer guidance on balanced diets and healthy eating habits, which are essential to complement the effects of weight loss drugs.
3. Monitoring Side Effects: Dietitians can monitor patients for adverse reactions and work with healthcare teams to manage any issues that arise.
4. Promoting Sustainable Lifestyle Changes: Dietitians can emphasize the importance of combining medication with dietary and lifestyle modifications, such as increased physical activity and behavioural changes, to achieve long-term weight management.

In summary

Weight loss drugs hold great potential for managing obesity in LMICs, but their success depends on more than just availability. Understanding how these medications work, addressing the risks, and ensuring their safe use are critical. Dietitians in LMICs are key players in this process, guiding individuals toward safe and effective weight management.

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Written by Dr. Laurene Boateng (PhD, RD)
Dr. Laurene Boateng is a Registered Dietitian and Senior Lecturer in the Department of Dietetics, University of Ghana. She is the founder and editor-in-chief of Full Proof Nutrition, a website committed to providing reliable, evidence-based, and practical healthy eating advice.

References

Almandoz, J. P., Wadden, T. A., Tewksbury, C., et al. (2024). Nutritional considerations with antiobesity medications. Obesity (Silver Spring), 32(9), 1613-1631. https://doi.org/10.1002/oby.24067

Sodhi, M., Rezaeianzadeh, R., Kezouh, A., & Etminan, M. (2023). Risk of gastrointestinal adverse events associated with glucagon-like peptide-1 receptor agonists for weight loss. JAMA, 330(18), 1795–1797. https://doi.org/10.1001/jama.2023.19574