Team Metabolic Health

For a not insubstantial fee, many private clinics in the UK offer full-body MRI scans to detect disease and abnormalities at the earliest stage. Kim Kardashian and Kate Hudson are fans.

So how do these scans work and are they “life saving”, as Kardashian suggests?

MRI produces 3D detailed anatomical images of almost every internal structure in the human body, including the organs, bones, muscles and blood vessels. MRI scanners create images of the body using a large magnet and radio waves. Unlike X-rays or CT, it doesn’t rely on ionising radiation, which can very slightly increase the risk of cancer.

Prices of full body scans in the UK range from £1,000 to £3,000. While they give a good basic overview of your anatomy, they don’t optimise the view of each organ or system. Any unusual findings would need to be further investigated by specialised MRI scans for things such as the heart and prostate. This is because the machine needs to be adjusted to different parameters to optimise the imaging of different organs and systems.

It’s important to note that MRI scans cannot detect most preventable diseases. Heart disease, high blood pressure, high cholesterol and diabetes are responsible for most deaths. MRI scans cannot detect these conditions. They may show some structural changes, but other symptoms will probably have emerged first.

Full-body MRI scans may find abnormalities, often referred to as “incidentalomas” because they are just incidental findings, on scans being undertaken for other symptoms.

Studies looking at over 16,000 brain MRI scans of volunteers have shown that less than 4% of them contained abnormalities that required further investigation.

The kind of things found on brain scans include pituitary abnormalities, such as non-cancerous growths. Disrupted blood flow to the brain (without symptoms) has been detected in 7%, aneurysms in 1.8% and benign tumours in 1.6% of the population.

Small clusters of abnormal blood vessels, known as cavernomas, rarely cause symptoms and are seen in about one in 600 people on MRI scans. Those that do cause symptoms are seen in about one in 400,000 people.

Another area of the body that often throws up incidental findings is the spine. There is increasing use of MRI in back pain. This can lead to the discovery of incidentalomas such as harmless bone growths and haemangiomas, small growths of blood vessels on or in the spine.

Haemangiomas are seen in over 40% of people who receive MRI scans, 99% of which cause no symptoms and don’t need treatment. The 1% who have symptoms, such as pain, numbness or weakness, require surgery to prevent progression towards paralysis.

Tarlov cysts, an outpouching around nerves leaving the spinal cord in the sacral region (near the bottom of the spine) are seen in about 4% of the population. For most, there are no symptoms. But those who have symptoms, such as pain and numbness, may need surgery to prevent bone decay or damage to the nerve supply to the legs, pelvic structures and genitals.

Kim Kardashian wrote about her full-body scan on Instagram. Imago/Alamy Stock Photo

What about serious findings?

A meta-analysis (a study that combines data from many studies) suggests that serious problems that are picked up by chance on MRI scans are 1.4% for the brain, 1.3% for the chest and 1.9% for the abdomen.

There is also a risk that these scans give a false positive – things that look like disease but aren’t. Breasts (up to 97 false positives per 1,000 scans) and prostate (29 per 100 scans) are particularly susceptible to false positive results.

These scans may give some valuable information about what is going on beneath your skin. However, for many people, the reports and terminology used in them are hard to fathom. There is lots of evidence that the average person struggles to understand common medical phrases and often assign meaning opposite to what the doctor intended – for a single diagnosis. Reports resulting from these scans are about the whole body and will contain significantly higher levels of medical information than a single diagnosis – even when everything is normal.

Where people pay for these scans without the wherewithal to cover any follow-up medical investigation, it will be already overstretched healthcare systems that have to pick up the fallout and ensure that false positives and benign growths are confirmed as such.

These scans offer an opportunity to see what’s going on internally – for those with enough money to afford them – but the likelihood of finding something that needs urgent medical treatment is low. If I had the money to spend on one of these, I’d spend it on a holiday, which would be far better for my health.

Credit: The Conversation

Team Metabolic Health

In June, Gilead Sciences announced impressive early results from its PURPOSE 1 trial, which showed 100 percent efficacy of lenacapavir in preventing new HIV infections among cisgender women in Sub-Saharan Africa. Lenacapavir is being investigated as an injectable antiretroviral medication that can be taken once every six months as preexposure prophylaxis (PrEP) to prevent HIV. This is a marked shift from current PrEP options, which are only available as a once-daily pill or a bimonthly injection.

Once again, the HIV community finds itself at a scientific breakthrough moment. And once again, it remains an open question as to whether it will also prove to be a breakthrough moment for equitable access.

We have been down this road before. It was not so long ago that the very same drug manufacturer released similarly jaw dropping clinical trial results first for Truvada and then Descovy, the first two medications approved for the prevention of HIV; it led to widespread speculation of the end of HIV as an epidemic. And yet, more than a decade after the first approval for PrEP in the United States, we still see significant disparities in getting PrEP to communities of color and cisgender women in the US.

Health care advocates are already concerned that past will once again be prologue when it comes to this new PrEP modality, and there is pressure on the company to make commitments that could change all too predictable outcomes on disparate outcomes.

The $40,000 Question

The big question of course will be the price set for lenacapavir’s PrEP indication in the US. We already have some insight here. In May 2019, Gilead received Food and Drug Administration (FDA) approval for a limited HIV treatment indication for lenacapavir for individuals for whom other HIV treatment regimens have not worked. The drug is sold under the brand name Sunlenca, which Gilead launched with a list price of $42,250 per year. To put the Sunlenca price tag in context, the list price of Gilead’s leading brand-name oral medication for PrEP, Descovy, comes in at about $26,000 per year. The bimonthly injectable PrEP option made by Gilead’s competitor, ViiV Healthcare, comes in at a comparable $23,000 per year.

There is no reason to think that as the indication of lenacapavir expands to PrEP, Gilead will back down from its initial high price. And again, we don’t need to guess here, we need only look at past actions. The pricing strategy that Gilead used to set the whopping $1,000-per-pill list price for its curative treatment for hepatitis C was fully explicated in a congressional oversight report, which found that Gilead’s goal was “maximizing revenue, regardless of the human consequences.”

To be clear, the list price is and has always been a bit of a fiction. With the availability of rebates and discounts and low-income assistance programs, few payers or even consumers will ever pay close to that amount. But it does matter. The list price sets the ceiling from which the complex set of drug distribution players in the US negotiate a lower price. Start high and even with discounts, we’ll end high. For a drug with such public health significance as PrEP, the high list price also hamstrings the ability of state and local public health departments that perennially struggle with anemic budgets—some of whom qualify for discounts and some of whom do not—to purchase the drug and get it out to uninsured, low-income, and vulnerable populations.

Other innovative purchasing strategies, such as a subscription model in which safety-net programs pay manufacturers a set negotiated amount for unlimited access to a drug, may be another consideration for PrEP. Subscription models have gotten some traction as a way for state Medicaid programs to cover costly hepatitis C curative treatments, but much more work has to be done to assess how a subscription model might be applied to PrEP, where the volume is lower and where there are multiple effective regimens, including low-cost generics, on the market.

Finally, the high list price locks us into fragmented delivery from the very beginning. Low-income individuals without insurance will be dependent on manufacturer patient assistance to help them access lenacapavir. Those programs will only provide access to the drug and not any other services people need to actually take the drug, including the recommended HIV, sexually transmitted disease, and other testing recommended to safely take PrEP. So instead of a public health program that is able to provide integrated access to PrEP services—including the medication—consumers will have to navigate a web of disparate programs to patch together all the services they need.

As we’ve seen with numerous other new-to-market drugs, a high list price for lenacapavir for PrEP will profoundly limit access for millions of uninsured Americans—a group that is disproportionately Black, Brown, and transgender and gender nonconforming. As noted above, the price point forecloses a public health response to PrEP, forcing individuals to jump through complex hoops to cobble together access. The decision on price made now could set the stage for more than a decade of inequitable access; Gilead has indicated in its most recent 10-K filing (page 7) that it expects lenacapavir to remain on patent and face no significant competition until 2037.

But Wait, Does Research And Development Justify A High Price?

Developing a new drug is an expensive endeavor. And indeed, high price tags are often justified by pointing to the immense costs of research and development. To be fair, Gilead undoubtedly invested in its PURPOSE trials, which have been far more comprehensive than the trials the company oversaw to secure a PrEP indication for Descovy, for which Gilead primarily conducted research among White gay and bisexual men and completely excluded cisgender women and transgender men.

But the cries that high prices are necessary for innovation seem somewhat disingenuous when they are rarely backed by transparency around the funding mix that goes into research and development of any one drug. And such claims deserve scrutiny when researchers have recently shown that lenacapavir could be made for less than $40 per person each year.

Past, again, may be prologue here. According to a Senate Finance Committee report on the development and marketing of Sovaldi, the first curative therapy for hepatitis C, “Gilead failed to provide costs attributable solely to the development of” its blockbuster hepatitis C cure despite repeated requests from Congress. The company from which Gilead acquired sofosbuvir estimated that the final Phase 3 studies would cost only $125.6 million, nowhere near an amount that would justify a $1,000-per-pill price tag. Following the December 2013 FDA approval, Gilead recouped its research costs and then some with $10.3 billion in 2014 sales of stand-alone sofosbuvir along with $2.1 billion in 2014 sales for Harvoni, a single tablet regimen of sofosbuvir combined with another direct-acting antiviral.

Recent research has also unearthed a very different investment story supporting the research and development for Gilead’s first approved PrEP medication, Truvada, finding that the federal government invested $143 million in the research leading to Truvada’s approval, far more than initially estimated and undermining Gilead’s justifications for steep price increases for Truvada following its July 2012 FDA approval as PrEP.

To be fair, developing breakthrough medications requires investment, and manufacturers should have incentives to embark on the long and arduous process of drug development that more often than not leads to a lot of failures before success. However, we should interrogate assertions that any policy aimed at identifying a fair price will imperil research and development incentives. Researchers have directly contradicted this assertion, modeling the impact of federal drug pricing reform and finding that the impact on new drugs coming to market is minimal.

What Can We Do Differently?

There is always hope we will learn from our past mistakes and do things differently the next time around. Advocates and academics alike have been calling for a federally funded national PrEP program to ensure widespread access to PrEP, particularly for un- and underinsured individuals. President Joe Biden included the program in his last three budget requests to Congress; it would provide the infrastructure necessary for the government to work meaningfully with Gilead to come up with an access strategy for lenacapavir at a price point that would work for a public health response. Should that come to pass, the US could really see the potential of this innovation for communities other than cisgender White men.

But even in a scenario in which the government steps in to work with Gilead to solve the access problem for uninsured populations, this pricing will create the same challenges for insured populations that have always existed in the US. Insurers will be absolutely disincentivized to encourage new PrEP users to access lenacapavir, particularly with affordable daily oral generic options at less than $20 per month. And with a price point for lenacapavir $10,000 to $15,000 above Descovy per year, we can anticipate payers’ strong resistance to even transitioning existing PrEP users over to lenacapavir. Even with a US Preventive Services Task Force Grade A for PrEP, which because of an Affordable Care Act (ACA) provision requires most private insurance plans to cover PrEP without cost sharing, there is no mandate for private insurance plans to cover every formulation of PrEP. Efforts are underway to improve insurance compliance with the ACA preventive services requirements for PrEP in general, but that advocacy faces an uphill road when Gilead is able to set whatever arbitrary starting price point it wants.

Another concern is that as new products, such as lenacapavir, come online, fullcourt marketing efforts may undercut the nascent market for generic oral forms of PrEP, which are safe, effective, and at less than $1 per pill, high quality but dirt cheap. This is exactly what happened when Gilead’s new oral PrEP regimen was approved the year before its first brand-name project went generic.

In the US, newer is often automatically dubbed better. And while the clinical trial results for lenacapavir are certainly impressive, it is not at all clear that the future of PrEP should be to push everyone onto long-acting brand-name products. Given the dismal uptake during these first few years of Apretude, the ViiV long-acting injectable for PrEP, it is also unclear if the market for long-acting products is quite as large as manufacturers say it is. At the end of the day, choice of the PrEP product that works best for the individual is the gold standard. What makes that choice possible is a fair price.

In the face of seemingly intractable drug access challenges in this country, there is still always the potential for an alternative future here. We can envision a scenario in which Gilead—perhaps facing significant pressure from the US advocacy community and the US government—commits to working with existing public health programs and, eventually, a national PrEP program to set a public health price point for lenacapavir to ensure a simple, transparent, and intuitive pathway for uninsured populations. This would be a new, bold approach—not a repeat of past charitable and donation programs that fail to provide an integrated approach to PrEP delivery. Instead, it would be a true, significantly lower price point that empowers public programs and health departments to come up with simple and comprehensive financing and delivery mechanisms that are highly accessible for end users. Only then will we stop repeating the same pattern in which the bang of a big scientific breakthrough is followed by the whimper of inaccessibility.

Credit: healthaffairs.org        

Team Metabolic Health

Common Lifestyle Mistakes

You may be unknowingly making some common mistakes that may impact your nervous system. It can affect nervous system regulation and also contribute to chronic stress, as opposed to reducing it. It is important to make a few small changes to your routine that can make a big difference. Scroll down to find out about the five simple habits that you need to change.

Checking Your Phone

Avoid checking your phone the moment you wake up. It can trigger a stress response by overwhelming you with notifications in the form of work emails and social media updates, says Marina Wright, a nutritionist.

Not Taking Breaks

You must take breaks from work, because constantly working without a pause can lead to ‘mental fatigue’ and reduced productivity, the nutritionist says, adding that it can keep the nervous system in a state of ‘continuous activation’.

Skipping Meals

According to Wright, skipping meals can cause your blood sugar levels to drop. It can trigger a stress response and disrupt the normal functioning of the nervous system. Skipping a meal can also lead to irritability, anxiety and fatigue. 

Spending Time Indoors

It is not wise to spend time indoors all day every day. It can limit your exposure to natural light, which can impact your mood negatively, and also increase stress. When there is a lack of sunlight, your circadian rhythm gets affected and you may feel a drop in energy levels.

Too Much Caffeine

Overconsumption of caffeine can stimulate the nervous system, and not in a good way. According to the expert, too much caffeine can put you in a constant state of alertness that can heighten your stress and anxiety. Consuming it late in the day can also disrupt your sleep. 

Credit: thehealthsite.com

Team Metabolic Health

Thyroid is a gland located at the base of the neck responsible for producing thyroxine (T-4) and triiodothyronine (T-3). These hormones help in normal growth and metabolism of the body. Thyroid issues are common in women and can be treated with hormonal supplements. However, swelling of the thyroid gland can indicate other conditions, and should be treated with urgency. In an interview with HT lifestyle, Dr. Satish Nair, academic head and consultant – Skull Base Surgeon and ENT – Head and Neck Surgeon, Manipal Hospital Old Airport Road, Bengaluru, explained thyroid swelling and how it should be treated. “Although thyroid swelling is common among females, men are also affected by it,” said Dr. Satish Nair.

Thyroid swelling is seen as swelling in the front portion of the neck which gradually increases in size. (Credit: Unsplash)

Thyroid swelling: What does it indicate?

“Thyroid swelling is seen as swelling in the front portion of the neck which gradually increases in size. Although thyroid swelling is common among females, men are also affected by it. It can be accompanied by hormonal disturbances too. A swelling in the thyroid can be a simple cyst or nodule or a tumor or cancer in rare cases. 90% of thyroid swelling in women is non-cancerous whereas thyroid swelling in men has a 95% chance of being cancerous,” said Dr. Satish Nair.

Thyroid swelling: Evaluation process

Dr. Satish Nair explained the three-test procedure that is recommended in evaluating thyroid swelling – “When you notice a swelling in the neck that is persistent for more than 3 weeks, it is advisable to consult an ENT / Head and Neck Surgeon. There are three tests that are required for diagnosing thyroid swelling. First is the thyroid hormone test followed by an ultrasound scan of the neck which shows the size, site, and nature of the swelling. The third test you will be advised is a needle aspiration test from the swelling (FNAC – fine needle aspiration cytology) which is done to know the type of cells (cancerous or tumor) in the swelling.”

Thyroid Swelling: Treatment procedures

“Wait and watch is recommended in a female patient with a small swelling of less than 1 cm. Generally, it is advised that a thyroid swelling more than 4 cm in size, swelling in a male, age more than 55 years, and if the tests point towards cancer or swelling is accompanied by pressure symptoms (difficulty in swallowing, breathing, and voice change), it requires surgery as the mainstay of treatment. The decision to remove either partial or complete thyroid gland depends on the test results,” added Dr. Satish Nair.

Disclaimer: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

Credit: Hindustan Times

Team Metabolic Health

As a sleep enthusiast, I must confess that there’s nothing quite like the rejuvenating power of a good nap. When that afternoon slump rolls around, I’m always on the lookout for a cozy nook where I can catch a few winks and recharge my batteries.

But in this fast-paced world, we don’t always have the luxury of time to indulge in a full siesta. That’s where the elusive ‘five-minute nap’ comes into play – but does it really work? Can such a brief snooze actually make a difference in our day-to-day lives?

I’ve often found myself wondering about this very question as I lay down for those precious moments of shut-eye. As someone who’d gladly be an ambassador for napping if given the opportunity, it feels almost too good to be true that we could reap any benefits from such a short slumber.

So, let’s dive into the science behind these mini-naps and see if they’re truly worth incorporating into our daily routines!

The Benefits Of Napping

Oh, you must be joking! Who would ever think that a short nap could actually have any benefits?

I mean, it’s not like countless studies and sleep experts have continually proven the positive effects of napping on our mood, focus, and overall well-being. And let’s not even mention those meditation techniques that can work wonders with just a few minutes of practice each day.

But seriously, who needs all that when we can simply push through our days in a state of constant fatigue and mental fog?

As a dedicated sleep enthusiast, I can assure you that napping is no laughing matter. It has been shown to improve memory consolidation, enhance creativity, and even boost your overall cognitive performance.

Plus, did you know that naps are actually an effective way to experience different sleep stages in a short amount of time?

So the next time you find yourself feeling sluggish or unable to concentrate on your tasks, remember that a quick nap might be just what you need to recharge your batteries and get back on track. Don’t underestimate the power of some shut-eye; even five minutes can make all the difference!

What Happens During A Nap?

I’m a huge fan of napping, and I’m so interested in learning more about what’s happening to my body and brain while I’m snoozing! I’m curious to discuss how my bodily reactions and brain activity are impacted by a five minute nap.

Bodily Reactions

Isn’t it amazing how our bodies respond to even the briefest moments of rest?

When we allow ourselves to take a quick nap, the mind-body connection kicks into high gear, rejuvenating us from head to toe.

With cognitive stimulation on pause, our brain takes this opportunity to consolidate memories and refresh neural connections.

Meanwhile, our muscles relax and our heart rate slows down, allowing for a momentary respite from the daily grind.

It’s truly remarkable what just five minutes of shut-eye can do for us – who wouldn’t want to embrace such a simple yet powerful tool in maintaining our overall well-being?

Brain Activity

Now, let’s dive deeper into the fascinating world of brain activity during a nap, shall we?

As a sleep enthusiast, I find it incredibly interesting how mindful sleeping can significantly impact our cognitive abilities.

When we catch some Zzz’s, even for a short while, our brain starts working its magic – cycling through various sleep patterns and allowing us to recharge mentally.

During this time, our mind is busy processing information, sorting memories, and strengthening neural connections – all crucial for optimal functioning.

So next time you’re feeling sluggish or overwhelmed, don’t hesitate to give your brain the much-needed break it deserves with a power nap!

How To Take A Five-Minute Nap

Now that we’ve explored the wonders of what happens during a nap, let’s dive into the magic of five-minute power naps! Though it might seem like a short amount of time, a five-minute nap can actually provide some benefits. Power naps are an excellent way to recharge your brain and boost your productivity throughout the day.

To make the most out of your five-minute nap, try these three simple napping techniques:

1. Find a quiet and comfortable place where you can sit or lie down without any distractions.
2. Set a timer for exactly five minutes to ensure that you don’t oversleep.
3. Close your eyes and take slow, deep breaths as you drift off into a light sleep.

Remember, practice makes perfect! The more you incorporate power naps into your daily routine, the better you’ll become at falling asleep quickly and reaping the rewards of this energizing slumber.

So go ahead – give yourself permission to take a break and indulge in a quick snooze; you deserve it!

The Science Behind Quick Naps

You might be wondering if a quick five-minute nap can really make a difference in your day. Well, let me tell you, as a sleep enthusiast, I’ve always been curious about the science behind quick naps and how they affect our sleep quality. It turns out that short naps, also known as “power naps,” can indeed provide some benefits to our alertness and overall cognitive functioning.

The key to understanding the effectiveness of quick naps lies in our sleep cycles. During the course of a normal night’s sleep, we go through several stages of light and deep sleep, each lasting approximately 90 minutes. When we take a short nap, we’re only able to experience the lighter stages of sleep – but that’s not necessarily a bad thing! In fact, research suggests that even brief periods of rest can help us feel more refreshed and focused. Just take a look at this handy table that highlights the benefits of different nap durations:

So while it may seem counterintuitive at first glance, there is indeed some value in taking those ultra-short five-minute naps. They may not offer the same rejuvenating effects as longer snoozes, but when time is limited or you just need a quick pick-me-up during your busy schedule, don’t hesitate to close your eyes for those precious few moments. You’ll likely find yourself feeling more awake and ready to tackle whatever comes your way!

Is A Five-Minute Nap Worth It?

So, you might be wondering, is a five-minute nap even worth it?

Well, as a sleep enthusiast, I can tell you that it certainly has its merits! Although it may not be as restorative as a longer snooze, there are some short-term effects of taking such a brief nap that can be beneficial.

For one thing, it can provide a quick energy boost and help to improve your mood. Additionally, it can also help with enhancing focus and alertness in the moments immediately following the nap.

Now, when considering the long-term impacts of consistently taking five-minute naps, there’s not much evidence to suggest that they’ll have any significant effect on your overall sleep health.

However, if these brief naps are helping you feel more energized and focused throughout your day without disrupting your regular sleep schedule at night, then why not give them a try?

Just remember that everyone’s sleep needs are different, so it’s essential to listen to your body and adjust accordingly.

Conclusion:

So, does a quick five-minute nap truly make a difference? As a sleep enthusiast, I must say that even the shortest of naps can provide an energy boost and increase alertness. However, it’s essential to remember that while we may enjoy the benefits of a power nap, it shouldn’t replace proper sleep.

In my experience, finding the perfect balance between work, life, and rest is crucial. Sure, we might not always have time for a full siesta but squeezing in a brief five-minute nap can help us reset and recharge. We cannot forget the importance of longer naps or quality nighttime sleep for overall health and well-being.

In conclusion, as someone who loves their sleep, I encourage everyone to embrace the power of napping – even if it’s just for five minutes! The key is to find what works best for you and make sure you prioritize rest when needed.

Remember, every little bit counts when it comes to catching those precious Zzzs!

Credit: https://tiptopsleep.com/

Team Metabolic Health

Eli Lilly and Company (NYSE: LLY) has announced Zepbound (tirzepatide) 2.5 mg and 5 mg single-dose vials are available for self-pay for patients with an on-label prescription, significantly expanding the supply of Zepbound in response to high demand. The single-dose vials are priced at a 50% or greater discount compared to the list price of all other incretin (GLP-1) medicines for obesity. This new option helps millions of adults with obesity access the medicine they need, including those not eligible for the Zepbound savings card program, those without employer coverage, and those who need to self-pay outside of insurance.

“We are excited to share that the Zepbound single-dose vials are now here, further delivering on our promise to increase supply of Zepbound in the U.S.,” said Patrik Jonsson, executive vice president, and president of Lilly Cardiometabolic Health and Lilly USA. “These new vials not only help us meet the high demand for our obesity medicine, but also broaden access for patients seeking a safe and effective treatment option. In a clinical study, the 5 mg maintenance dose helped patients achieve an average of 15% weight loss after 72 weeks of treatment and has been a powerful tool for millions of people with obesity looking to lose weight and keep it off.”

Lilly has created a new self-pay pharmacy component of LillyDirect where patients with a valid, on-label prescription from the health care provider of their choice can purchase the vials. Distributing the vials via this channel ensures patients and providers can trust they are receiving genuine Lilly medicine, building on the company’s efforts to help protect the public from the dangers posed by the proliferation of counterfeit, fake, unsafe or untested knock-offs of Lilly’s medications. Lilly has also taken a vocal stance against the use of obesity medicine for cosmetic weight loss; a multi-step verification process will help ensure the vials are dispensed only to patients who have a valid, on-label electronic prescription from their health care provider. Patients can also purchase ancillary supplies, like syringes and needles, and will have access to important patient-friendly instructional materials on correctly administering the medicine via needle and syringe.

“People living with obesity have long been denied access to the essential treatment and care needed to manage this serious chronic disease,” said James Zervos, chief operating officer, Obesity Action Coalition. “Expanding coverage and affordability of treatments is vital to people living with obesity. We commend Lilly for their leadership in offering an innovative solution that brings us closer to making equitable care a reality. Now, it’s time for policymakers, employers and insurers to work with pharmaceutical companies to ensure no one is left behind in receiving the care they deserve and need.” 

A four-week supply of the 2.5 mg Zepbound single-dose vial is $399 ($99.75 per vial), and a four-week supply of the 5 mg dose is $549 ($137.25 per vial) – less than half the list price of other incretin medicines for obesity and in line with the Zepbound savings program for non-covered individuals. The self-pay channel enables a transparent price by removing third-party supply chain entities and allowing patients to access savings directly outside of insurance.

“Despite obesity being recognized as a serious chronic illness with long-term consequences, it’s often misclassified as a lifestyle choice, resulting in many employers and the federal government excluding medications like Zepbound from insurance coverage,” said Jonsson. “Outdated policies and lack of coverage for obesity medications create an urgent need for more innovative solutions. Bringing Zepbound single-dose vials to patients will help more people living with obesity manage this chronic condition. We will also continue to advocate for a system that better aligns with the science.”

In a clinical study, tirzepatide 5 mg, along with a reduced calorie diet and increased physical activity, achieved an average of 15% weight loss over 72 weeks compared to 3.1% for placebo. Zepbound is the first and only obesity treatment of its kind that activates both GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1) hormone receptors. Zepbound tackles an underlying cause of excess weight. It reduces appetite and how much you eat. Zepbound is indicated for adults with obesity, or those who are overweight and also have weight-related medical problems, to lose weight and keep it off. Zepbound should be used with a reduced-calorie diet and increased physical activity. It should not be used in children under 18 years of age or with other tirzepatide-containing products or any GLP-1 receptor agonist medicines. Zepbound has not been studied in patients with a history of pancreatitis, or with severe gastrointestinal disease, including severe gastroparesis, and it is unknown if patients with a history of pancreatitis are at higher risk for developing pancreatitis on Zepbound.

Zepbound is also available in 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, or 15 mg per 0.5 ml doses in a single-dose pen (autoinjector). The recommended maintenance dosages are 5 mg, 10 mg, or 15 mg injected subcutaneously once weekly.

Credit: www.lilly.com

Team Metabolic Health

For sausage, salami and steak lovers, the news has not been good. Scientists have been consistently finding links between red and processed meat consumption and heart disease, some types of cancer and earlier death.

And now, two recent studies have added to the growing body of evidence that a meat-heavy diet may increase the risk of Type 2 diabetes.

In one of the studies, published today in The Lancet Diabetes and Endocrinology, researchers analyzed data from nearly two million adults participating in 31 studies across 20 countries, including the United States and parts of Europe and Asia.

The researchers reviewed survey data on participants’ diets and then looked at their health an average of 10 years later. After adjusting for other risk factors like smoking, a higher body mass index, physical inactivity and a family history of diabetes, they found that for every 1.8 ounces of processed meat the participants ate each day, their risk for Type 2 diabetes increased by 15 percent. (This is equivalent to a medium-sized sausage or two to three slices of bacon.) For every 3.5 ounces of unprocessed red meat they consumed daily, their risk increased by 10 percent.

The data also suggested that one serving of poultry per day was associated with an 8 percent increase in Type 2 diabetes risk, but this finding was less consistent and only significant in the European studies, so more research is needed, said Dr. Nita Forouhi, a professor of population health and nutrition at the University of Cambridge who led the study.

The takeaway, she said, is that the less red and processed meat you eat, the better.

Credit: Getty Images

Why Eating Meat Might Increase Your Risk

These findings jibe with previous research, including a large U.S. study published in October.

There are several potential explanations for why regular meat consumption might increase Type 2 diabetes risk, Dr. Forouhi said.

One is that red and processed meats tend to be higher in saturated fats than in unsaturated fats, a composition associated with greater insulin resistance, which can lead to Type 2 diabetes.

People who eat more meat may also eat fewer healthful foods, like fruits and vegetables, Dr. Forouhi added.

Cooking meat at high temperatures, such as through pan frying or grilling over an open flame, can also form certain compounds that may cause cell damage, inflammation and insulin resistance — all of which can contribute to Type 2 diabetes.

A study published last week in the journal Nature Metabolism added evidence for another longstanding hypothesis: that heme iron — a type of iron found in high levels in red meat (and to a lesser extent in fish and poultry) — may contribute to Type 2 diabetes.

The researchers followed nearly 205,000 predominantly white U.S. adults for up to 36 years, during which time about 21,000 of them developed Type 2 diabetes.

Those with the highest heme iron consumption — mainly coming from eight to 10 servings of unprocessed red meat per week — were 26 percent more likely to develop Type 2 diabetes than those with the lowest consumption. They also had higher lipid levels, markers of insulin resistance and inflammation, and other compounds linked with Type 2 diabetes in their blood, the study revealed.

This added to existing evidence suggesting that heme iron is likely an important player in the link between red meat and Type 2 diabetes, said Dr. Frank B. Hu, a professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health who led the study.

On the other hand, heme iron did not explain the link between processed red meat and Type 2 diabetes, Dr. Hu said. Other components, such as their preservative and sodium levels, are probably more important to the risk of processed meats, he added.

Iron is an essential nutrient, but too much may cause inflammation and damage the pancreas, increasing diabetes risk, said Dr. Dariush Mozaffarian, a cardiologist and professor of medicine at Tufts University, who was not involved with the study.

How Much is Too Much?

While regular consumption of both red and processed meats have been associated with poorer health, processed meats have the strongest and most consistent link with Type 2 diabetes and other conditions, Dr. Mozaffarian said. This is clearly a “class to avoid,” he added.

Processed meats include not only stereotypically unhealthy products like hot dogs and bacon, but also potentially healthy-seeming ones like turkey sausages and deli meats.

This doesn’t mean you should never eat these foods, Dr. Mozaffarian said. Instead, think of them as occasional treats, he added.

As for red meat, there’s not enough data to say exactly how much is too much, Dr. Hu said, but based on the current evidence, a serving or two per week — like a small pork chop or a couple meatballs over spaghetti — is probably OK.

Dr. Hu recommended shifting from a “meat centric” diet to one that incorporates plenty of plant-based foods like whole grains, fruits, vegetables and legumes — all of which have been linked with a lower risk of Type 2 diabetes.

Credit: The New York Times

Team Metabolic Health

Weight-loss medications such as Ozempic, Wegovy or Monjaro may not just suppress appetite but could also speed up metabolism. This is according to a (opens in a new window)new study carried out at St Vincent’s University Hospital (SVUH).

A randomized controlled trial led by Professor Donal O’Shea, SVUH and UCD School of Medicine, found that there was a strong relationship between the amount of weight lost and increases in metabolic activity caused by daily use of medications based on the hormone Glucagon-like peptide-1 (GLP-1). 

Ozempic is a diabetes medicine that in recent years has become popular as a new an anti-obesity medication Credit: Chemisy4U

The findings published in the Journal of the Obesity Society challenges the belief that recent weight loss medications work just by simply causing those who use them to eat less. 

“It always seemed oversimplistic to me that these new treatments were just making people eat less,” said Professor O’Shea.

“So, this study finding is an exciting step forward in our understanding of how these new medicines for obesity work.”

Adding: “This study challenges the main narrative about these newer treatments which is that they simply make you eat less, and that any action on energy burn is minimal.

“The findings also provide science to support the fact that the treatment of obesity is not simply to eat less and move more – that’s the prevention piece – treatment is more complex than that.”

In the randomised controlled trial, which involved 30 patients, those who had low metabolic activity before starting treatment benefited the most from medications such as Ozempic, Wegovy and Monjaro. 

The patients had specialised imaging of the fat within their abdomen using a PET-CT scanner, with scans carried out before and after six months of treatment. 

The results were showed a strong correlation between the increase in metabolic activity and the degree of weight loss. Furthermore, those with low metabolic activity before starting treatment benefited the most from it.
“The strength of the association is surprising given the relatively small numbers studied and suggests this increase in metabolic activity is a significant contributor to how these drugs work,” said Professor O’Shea.

“Safe medical treatment for obesity is still in its infancy and we need to understand fully how the treatment works. Understanding how these agents increase energy burn should be an important part of future research. 

“I hope the companies involved in the development of these treatments will examine this area in more detail because these are very expensive studies to carry out and we are very grateful to the Health Research Board and University College Dublin for supporting it.” 

The study ‘(opens in a new window) GLP‐1 therapy increases visceral adipose tissue metabolic activity: lessons from a randomized controlled trial in obstructive sleep apnea’ was co-authored by (opens in a new window) Professor Silke Ryan, SVUH, funded by the Health Research Board and supported by University College Dublin.

Credit: University College Dublin

Team Metabolic Health

We’ve all heard of the metabolism: how well—or poorly—your body processes energy. Metabolism is often talked about in terms of weight loss or gain, but fundamentally, metabolism is about “converting the potential energy in food to a usable form of energy that powers our cells,” says Casey Means, MD, best-selling author of Good Energy: The Surprising Connection Between Metabolism and Limitless Health and a co-founder of Levels, a metabolic health tracking device. Your metabolism dictates a lot of things (weight included, but not exclusively), and when it’s unhealthy, it can lead to a range of diseases from type 2 diabetes to Alzheimers to behavioral disorders to cardiovascular issues to autoimmune diseases.

Metabolic health, on the other hand, is about far more than your BMI—which is an outdated metric. It refers to the optimal functioning of the entire metabolic system, including blood glucose, blood pressure, blood lipids, history of cardiovascular disease, and adiposity. According to a recent survey, 93.2 percent of Americans aren’t metabolically healthy.

This term is not really in our everyday vocabulary and is even relatively new to the medical field—partly because it requires a holistic look at our bodies, which Means says is lacking in our current healthcare system. “There’s this interesting phenomenon happening where the more we actually spend on healthcare in the United States—now 4.5 trillion dollars per year—the sicker Americans are getting,” she says. “It’s much more profitable to wait for people to get sick and then treat their various symptoms and conditions with whack-a mole medicine and chronic disease management for life.”

But failing to take a holistic approach is impacting people’s quality of life. “Metabolic health controls everything,” says Dr. Markyia Nichols, MD, chief medical officer at Ciba Health, a root-caused healthcare organization. “It’s really maintaining the overall balance; it affects every system of the body.” When metabolic health is optimized, people often experience increased energy, improved mental clarity, better physical performance, and even an increased feeling of well-being. Conversely, poor metabolic health can contribute to chronic fatigue and brain fog, making it harder to engage in everyday activities and fully enjoy life. Plus, “if you get your metabolic health under better control, it’s slashing the risk of almost every chronic symptom and disease,” says Means.

Now, medical providers have more tools at their disposal to get a comprehensive look at your metabolic health through a detailed lifestyle questionnaire, blood glucose monitoring, wearable data tracking, blood work panels, blood pressure testing, and weight circumference measurements. These assessments help identify underlying issues that might not be apparent through traditional health metrics like weight or BMI alone. If testing comes back outside of optimal ranges, Nichols and her team would dive in to find the underlying triggers and influences based on lifestyle. “We’re not just treating one symptom, we’re really looking at it all,” says Nichols. Even if you can’t see a root-cause or preventative healthcare provider, you can get most of these lab tests covered by insurance—you just may need to be proactive and ask your doctor.

If you’re not already metabolically healthy, not all is lost: You don’t just naturally have “fast” or “slow” metabolism, as we once assumed. “The empowering part,” says Means, “is that there is so much we can do to improve our mitochondrial function.” According to Michal Mor, cofounder of Lumen, a metabolic tracking device, we can influence our metabolic health by prioritizing four lifestyle categories: Nutrition, movement, sleep, and stress levels.

Ultimately, the most powerful things you can do to optimize your metabolic health aren’t novel—they’re pretty on par with recommendations from nearly every health and longevity expert. Get enough sleep, eat a nutrient-rich diet of real foods, incorporate daily movement (with at least some of it strenuous), and keep those damn stress levels under control.

Credit: GQ

Team Metabolic Health

The new glucose-responsive insulins promise to end constant glucose monitoring, and could allow patients to swallow a pill or inject insulin once every morning.

People with type 1 diabetes will in future need to take insulin once a week, say experts… The effect of new glucose-responsive insulins would be similar to that produced by a functioning pancreas, which only releases insulin when it is needed in the body

“The funded six new research projects address major shortcomings in insulin therapy. Potentially minimising the risk of hypoglycaemia through an insulin-glucagon combination would ease one of the major concerns associated with insulin therapy today. Therefore, these research projects, if successful might do no less than heralding a new era in insulin therapy,” Tim Heise, Vice Chair of Novel Insulins Scientific Advisory Panel of the Type 1 Diabetes Grand Challenge, said.

What is Type 1 Diabetes?

Blood sugars, also called blood glucose, are the primary source of energy in the body. When you eat food, the body breaks down most of it into glucose, which is released into the bloodstream. When glucose levels go up, the pancreas releases the hormone insulin, which helps glucose to be used as energy by your cells.

Those with type 1 diabetes have a pancreas that either cannot produce insulin or produces very little of it. High levels of glucose can lead to heart disease, kidney problems, extreme fatigue and other serious illnesses.

What is the Difference Between Type 1 and Type 2 Diabetes?

Type 1 diabetes is an autoimmune disease in which the body cannot make any insulin at all. The insulin-producing cells have been attacked and destroyed by the body’s immune system. While in type 2 diabetes, the body does not make enough insulin.

Type 1 diabetes affects 8% of people living with diabetes and type 2 diabetes affects 90% of people living with diabetes.

The risk of developing type 1 diabetes depends on family history and genes, and is often diagnosed in childhood or when you are under 40.

Type 2 diabetes develops with age, and your ethnicity can increase your risk. For instance, if you are white and over 40, the risk of developing type 2 diabetes is higher, whereas in African-Caribbean, Black African, Chinese or South Asians, chances of developing the illness increase if you are over 25.

In India, there are around 8.6 lakh people with Type 1 diabetes, with one in six young people dying without a diagnosis. An estimated 77 million people above the age of 18 years are suffering from type 2 diabetes, and nearly 25 million are prediabetics (at a higher risk of developing diabetes in near future), according to the World Health Organization.

The 10 countries with the highest estimated prevalence — USA, India, Brazil, China, Germany, UK, Russia, Canada, Saudi Arabia and Spain — account for 5.08 million or 60% of global cases of Type 1 diabetes.

What is the Need for a Better Insulin?

The glucose levels in the body constantly change depending on your stress levels, whether you have exercised, the foods you eat and the hormone levels. This makes it hard for the people with type 1 diabetes to maintain a stable blood sugar level, even with the latest technology to administer insulin.

A standard insulin can stabilise blood sugar levels for a certain time, but it cannot typically help with future fluctuations. It means patients often need to inject more insulin again within just a few hours.

Faster insulins are also needed to improve the function of insulin pumps and hybrid closed loop technology – a system that relies on the stored insulin responding in real-time to changing blood sugar levels.

What is a Smart Insulin?

The new glucose-responsive insulins (GRIs) become active when they detect a change in sugar levels in the blood to prevent hyperglycaemia (high blood glucose). They become inactive again when levels drop below a certain point, avoiding hypoglycaemia (low blood glucose). In future, patients may only need insulin once a week, experts believe.

The effect of a smart insulin would be similar to that produced by a functioning pancreas, which only releases insulin when it is needed in the body.

The GRIs promise to end constant glucose monitoring, and could allow patients to swallow a pill or inject insulin once every morning.

What are the 6 Research Projects for Smart Insulins?

The six projects include teams at Stanford University in the US, Monash University in Australia and Zhejiang University in China. The aim is to accelerate development and launch trials as soon as possible.

The Monash University project involves development of a second generation of nano sugar-insulin system, based on advanced nanotechnology. These nano sugars react to very small changes in blood glucose and release insulin only when glucose levels are outside a range, without any intervention from the patient.

Researchers at the Wayne University are working to develop a “smart insulin” which can detect changes in blood glucose levels and respond by releasing the right amount of insulin at the right time.

The third project, conducted by researchers at the Jinhua Institute of Zhejiang University in China, involves novel insulins that respond immediately to rising blood glucose levels.

At the University of Notre Dame, US, researchers developed a smart insulin delivery system that uses tiny particles called nanocomplexes, which contain insulin. These nanocomplexes can also be injected under the skin to create a reservoir to automatically release insulin if blood sugar rises.

Scientists at the Stanford University, US are working on developing and testing an ultrafast-acting insulin that’s only active when needed and could reduce the risk of blood glucose highs and lows in people with type 1 diabetes.

A team of researchers at the Indiana University, US will combine insulin and glucagon in their project, to prevent the highs and lows in blood glucose.

Dr Elizabeth Robertson, the director of research at Diabetes UK, said, as quoted by The Guardian, the projects had the potential to revolutionise type 1 diabetes treatment. “By supporting these groundbreaking research projects, we are aiming to develop new insulins that more closely mimic the body’s natural responses to changing blood sugar levels.

Credit: News18

Team Metabolic Health

Newspaper headlines are warning eating “a ham sandwich a day” increases a the risk of type 2 diabetes – but experts say it is not that simple.

A study of nearly two million people from 20 different countries found a link with both red and processed meats, such as steak, bacon and sausages.

While the research has been done well, the findings are nuanced and should not cause fear or panic.

It is sensible to limit intake, in line with healthy-eating guidelines, they say, but the study should not wipe meat off the menu.

Pix Credit: Getty Images

Link not proof

The research, in The Lancet Diabetes and Endocrinology journal, has an inevitable limitation – it cannot prove meat causes diabetes, because it is impossible to fully discount all the other possible risk factors, such as other foods people in the study ate and the lifestyle they led.

Dr Duane Mellor, of the British Dietetic Association, said: “The authors did try to control for other risk factors associated with increased risk of developing type 2 diabetes, including having a higher body weight, smoking, alcohol, low vegetable intake.”

There was some missing data for the effect of family history and waist circumference, which can be associated with diabetes, but the researchers say they are confident in the link that they found.

Studies such as this have to rely on participants telling the truth and accurately recalling what they eat.

Does that mean the findings should be entirely dismissed?

No – not at all. It adds to a growing picture of what foods – and how much – might be good or bad for us.

Prof Naveed Sattar, an expert in cardiometabolic medicine at the University of Glasgow, said: “This is an important study which, despite the inevitable observational nature of the evidence, is very well done.

“The data suggest cutting red and processed meats from diets may not only protect people from heart disease and stroke but also from type 2 diabetes, a disease on the rise worldwide.”

Bowel cancer

In the study, two thick slices of ham a day (50g; 1.7oz) or a small (100g) steak appeared to be a risk.

The findings around chicken and other white meat were less clear.

The NHS already advises people eating more than 90g (cooked weight) of red or processed meat a day to cut down to 70g, because experts believe eating too much processed meat can cause bowel cancer.

The International Agency for Research on Cancer puts it in the same category of risk as tobacco smoking and asbestos.

Processed meat has been modified, for taste or to extend shelf-life.

The chemicals and methods used, such as smoking, curing, or adding salt or preservatives, could be a factor.

And while meat is a good source of protein, vitamins and minerals, it sometimes also contains a lot of saturated fat, which has been linked to high blood-cholesterol levels, a risk factor for coronary heart disease.

Blood-sugar levels

Lead researcher Prof Nita Forouhi, from the University of Cambridge, said: “Our research provides the most comprehensive evidence to date of an association between eating processed meat and unprocessed red meat and a higher future risk of type 2 diabetes.

“It supports recommendations to limit the consumption of processed meat and unprocessed red meat to reduce type 2 diabetes cases in the population.”

Type 2 diabetes is high blood-sugar levels due to the body making too little of a hormone called insulin – or the insulin it makes not working properly.

Risk factors include:

• Obesity or being overweight
• High blood pressure
• Ethnicity
• Family history

Dr Mellor warned people considering cutting down on meat to ensure they still got enough vital nutrients, such as iron and vitamin B12.

“It is important when considering reducing or taking a type of food out of the diet, that any replacement foods provide the same nutrients to maintain a healthy diet overall,” he said

Good sources of vitamin B12 include:

• Milk
• Cheese
• Eggs
• Fortified yeast extracts, such as marmite
• Fortified breakfast cereals
• Fortified soya products

Credit: BBC News

Team Metabolic Health

The world of weight loss medications is being reevaluated following a study led by Professor Donal O’Shea of St. Vincent’s University Hospital (SVUH) and the UCD School of Medicine. The research focused on the medication Ozempic, a drug that has been under public scrutiny for some time. The study’s findings, published in the Journal of the Obesity Society, challenge the prevailing belief that weight loss medications like Ozempic, Wegovy, or Monjaro primarily work by promoting satiety and reducing food intake.

The world of weight loss medications is being reevaluated following a  study led by Professor Donal O’Shea of St. Vincent’s University Hospital (SVUH) and the UCD School of Medicine. The research focused on the medication Ozempic, a drug that has been under public scrutiny for some time. The study’s findings, published in the Journal of the Obesity Society, challenge the prevailing belief that weight loss medications like Ozempic, Wegovy, or Monjaro primarily work by promoting satiety and reducing food intake.

The research involved a randomised controlled trial with 30 patients and focused on medications based on the hormone Glucagon-like peptide-1 (GLP-1). The findings reveal a strong relationship between increased metabolic activity caused by daily GLP-1 treatment and the amount of weight lost. Interestingly, individuals with lower metabolic activity before beginning treatment experienced the most significant benefits.

This study challenges the main narrative about these newer treatments, which is that they simply make you eat less and that any action on energy burn is minimal, said O’Shea. The strength of the association is surprising given the relatively small number of participants, suggesting that this increase in metabolic activity is a significant contributor to how these drugs work.

O’Shea emphasised the importance of understanding the full mechanism behind these treatments. Safe medical treatment for obesity is still in its infancy, and we need to fully understand how the treatment works. Understanding how these agents increase energy burn should be an important part of future research.

The study was co-authored by Professor Silke Ryan, SVUH, funded by the Health Research Board and supported by University College Dublin. The 30 subjects had specialised imaging of the fat within their abdomen using a PET-CT scanner, with scans carried out before and after six months of treatment.

The findings of this study are significant as they challenge the existing understanding of how these weight loss medications work. It reveals that these drugs do not just suppress appetite but also significantly increase metabolic activity, contributing to weight loss. This is especially true for individuals with lower metabolic activity before treatment.

This study also highlights the need for a more comprehensive understanding of these treatments. As O’Shea points out, safe medical treatment for obesity is still in its infancy, and there is a need to fully understand how these treatments work. This includes understanding how these agents increase energy burn, which should be an important part of future research.

The findings of this study also shed light on the uncomfortable truth about the diet industry. The industry has been long criticised for its inhumanity and the unrealistic standards it promotes, especially among people in the public eye such as actors and models. Some of these individuals have been candid about their struggles to maintain the size zero figure. This study brings to the fore the need for a more humane and realistic approach to weight loss and body image.

Credit: https://www.ibtimes.co.in/

Team Metabolic Health

• Zepbound, a popular weight loss drug from Eli Lilly, may help people with sleep apnea.
• Based on recent findings, Eli Lilly plans to submit the material to the U.S. Food and Drug Administration to expand the use of the drug for obstructive sleep apnea.
• Sleep experts explain the findings.

Study: Weight Loss Drug May Help Sleep Apnea Towfiqu Photography – Getty Images

Medications like semaglutide (the main active ingredient in Ozempic and Wegovy) and tirzepatide (the main active ingredient in Zepbound and Mounjaro) have been rising in popularity for helping people with obesity lose a significant amount of weight. Researchers continue to find secondary benefits of going on these drugs. Now, new research on the weight loss drug Zepbound, from drugmaker Eli Lilly, finds that the medication may help those with sleep apnea, a disorder where breathing stops and restarts multiple times throughout sleep.

The U.S. Food and Drug Administration (FDA) approved Zepbound for the treatment of obesity in November 2023. Some prescribe the weekly injection off-label to those with sleep apnea, driving Eli Lilly to test the drug for obstructive sleep apnea back in June 2022. Over 400 participants were enrolled in the trial.

In their preliminary findings, researchers found that adult patients with obesity and obstructive sleep apnea treated with Zepbound for a year saw improvement in their sleep apnea compared to adults who did not receive the drug. After a year, those with moderate-to-severe obstructive sleep apnea who were taking the medication and not using PAP therapy (a machine that will pump pressurized air into a person’s airway to keep it open and prevent breathing problems while they sleep) saw a reduction of 27.4 events per hour, compared with a reduction of 4.8 events per hour in the participants who got the placebo.

Researchers then went one step further to see how the use of Zepbound may impact those who were already using the gold standard for sleep apnea treatment, PAP therapy. They found that people who used or planned to use PAP therapy and took the drug saw a slightly larger reduction in the number of events they had while they were sleeping. At 52 weeks, those who took the drug saw an average reduction of 30.4 events per hour compared with an average reduction of six events per hour in people who got a placebo.

Based on results from trials in people with sleep apnea, Eli Lilly said it plans to submit the material to the FDA to potentially expand the use of Zepbound to those with the condition. Note that the results of this study have yet to be peer-reviewed or published, but the drug maker has noted that these findings will be presented at a meeting of the American Diabetes Association in June.

Sleep apnea is a disorder where the throat closes when we fall asleep, causing difficulty breathing and lower oxygen levels, explains Abhay Sharma, M.D., sleep physician leading the University of South Florida’s ENT Sleep and Snoring Center. People with untreated sleep apnea repeatedly stop breathing during their sleep, sometimes hundreds of times during the night, and often for a minute or longer, adds Chris Allen, M.D., board-certified sleep medicine physician and sleep science advisor at Aeroflow Sleep. “This causes a significant disturbance in sleep quality and can have profound impacts on our health,” says Dr. Sharma.

Weight plays an important role in the development of sleep apnea, says Dr. Sharma. “Though it is not the only important factor, increased weight predisposes people to sleep apnea.” Therefore, it makes sense that weight loss drugs such as Zepbound may improve these factors by supercharging the weight loss process, notes Dr. Sharma.

Therefore, tirzepatide’s ability to significantly aid in weight loss can play a critical role in reducing one of the primary causes of sleep apnea. As of now, the weight loss aspect of the drug appears to be the main contributing factor in reducing sleep apnea side effects. “By mitigating one risk factor, Tirzepatide not only improves sleep quality but potentially reduces the risk of cardiovascular diseases and type 2 diabetes, which are often comorbid with obesity and sleep apnea,” explains Dr. Allen.

These findings confirm that a drug that effectively contributes to weight loss may also be used for treating sleep apnea, says Dr. Sharma. “This is substantial because it provides another option for people struggling to treat their sleep apnea because 40 to 50% of people are unable to use the gold standard for treatment of sleep apnea: CPAP.” One of these studies specifically enrolled patients who could not use CPAP and therefore provides an important addition to treatment, Dr. Sharma explains.

So can all semaglutide and tirzepatide drugs (like Ozempic, Wegovy, and Mounjaro) help with sleep apnea? Dr. Sharma says yes. “Though there could be unique effects of some of these drugs on sleep apnea, the most important reason for improvement in sleep apnea severity is the amount of weight loss,” he explains. However, the efficacy can vary based on the specific drug’s effect on weight loss, dosing, and the individual’s response to the treatment, notes Dr. Allen.

But these medications don’t come without side effects. Reports of gastroparesis (stomach paralysis), upset stomach, and more deter some patients from the medications. And, if you do not fit the drug criteria (having overweight or obesity), the drug may not be for you.

The bottom line

As access to weight loss drugs like Zepbound that activate both GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1) hormone receptors increase, we will see improvements in our ability to treat sleep apnea, says Dr. Sharma. “It is important to realize these drugs will not cure all sleep apnea. Instead, they will provide an adjunct to treating patients who are unable to use CPAP.”

And, patients need to realize that stopping these drugs result in the recurrence of weight gain, and therefore, sleep apnea, notes Dr. Sharma, so “patients must be ready to start a medication that they likely need to continue indefinitely.”

If you suffer from sleep apnea, particularly if overweight or obese, consult your healthcare provider about the possibility of using GLP-1 receptor agonists like Zepbound, advises Dr. Allen. “It’s essential for patients to evaluate their overall health condition, consider their current treatment regimen, and discuss potential benefits and side effects of GLP-1 receptor agonists,” he explains.

Credit: Yahoo

Team Metabolic Health

Weight loss is complex and super personal, especially for women (more on this soon), so, there is no one-size-fits-all answer to “Where do you lose weight first?” The truth is, whether the waistband of your jeans gets looser or your arms tone up faster than other areas of your body depends on a variety of factors, experts say.

First, it’s important to call out that you can’t “spot treat” specific areas of your body to lose weight from. “Trying to target certain areas for weight loss is just not feasible,” says Mir Ali, MD, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center. Where you hold and lose fat will largely depend on genetics, he says.

That said, it’s natural to want to drop weight in a specific area of your body. What you can do is focus on overall weight loss, says Keerthana Kesavarapu, DO, an associate professor and gastroenterologist at Rutgers Robert Wood Johnson Medical School. When you do this, you’ll naturally lose weight in those specific areas and body parts you’re hoping to change.

Here’s what experts have to say about where, exactly, you tend to trim down first—and why.

Meet the experts: Mir Ali, MD, is a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA. Keerthana Kesavarapu, DO, is an associate professor and gastroenterologist with advanced training in nutrition and obesity sciences at Rutgers Robert Wood Johnson Medical School. Dina Peralta-Reich, MD, is an obesity medicine specialist and founder of New York Weight Wellness Medicine. Romy Block, MD is an endocrinologist, member of the American Thyroid Association, and co-founder of Vous Vitamin.

Factors That Impact Where You Lose Weight First

Genetics

Your DNA plays a significant role in obesity and weight loss, says Dina Peralta-Reich, MD, an obesity medicine specialist and founder of New York Weight Wellness Medicine. “[Doctors] have pinpointed several genes that are linked to a genetic predisposition for obesity,” she says. For example, one of them is the leptin (LEP) gene, which plays a major role in appetite regulation, energy expenditure, and more, per a 2022 study published in the International journal of molecular sciences.

Your family history has a lot to do with your weight, too, since patterns of obesity often emerge among siblings, parents, and even extended family members like aunts and uncles, Dr. Peralta-Reich adds. So, if your mom tends to lose weight in her arms first, for example, you might have a similar tendency.

Age

Struggling to lose weight in a specific area of your body could also be due to age. FYI, your metabolism—the way your body converts food into energy—changes with age, per the National Institutes of Health (NIH). It tends to reach its peak early in life (around 9 to 15 months old), stays relatively stable in your 20s through 60s, and declines significantly after age 60, per a 2021 study published in Science.

Women during the perimenopausal stage of life may find it harder to lose weight due to a variety of barriers, like difficulty managing diet and activity, stress, and lack of time, according to a 2022 study of women ages 40 to 55 published in the journal Menopause. And getting older doesn’t just make you more likely to gain weight—it can also impact where you gain it. Fat tends to build up around the center of your body after age 30, according to the U.S. National Library of Medicine.

Biological Sex

“Men and women tend to lose weight differently based on the types of fat they contain and childbearing factors,” says endocrinologist Romy Block, MD. For example, women generally have more subcutaneous fat, a type of fat that deposits right underneath the skin, than men.

Additionally, men typically experience quicker weight loss than women due to the lack of comparable hormonal fluctuations, says Dr. Peralta-Reich. Unlike men, women also tend to hold weight in their butt, thighs, and hips as the body prepares for pregnancy and birth, she adds.

Generally speaking, the first place men typically lose weight is the belly, while women tend to lose weight all over, but may hold onto weight in the thighs and hips more so than men, Dr. Block says.

How do I get rid of visceral fat?

There are two distinct categories of fat: subcutaneous and visceral. Visceral fat is deep in your abdominal region and surrounds your organs, while subcutaneous fat sits just under your skin, Dr. Peralta-Reich says. Visceral fat is linked to health issues like diabetes, heart disease, and stroke, per Cleveland Clinic, but it can be harder to lose.

The best way to get rid of both types of fat is similar, though: Try to adopt a balanced, nutritious diet and exercise regularly, says Dr. Peralta-Reich. Maintaining a calorie deficit can also help you lose the weight faster, Dr. Ali adds. (Check out our guide to calculating a calorie deficit or use this tool from the National Institutes of Health to learn more.)

What’s the best way to start losing weight?

Experts agree that weight loss is a marathon, not a sprint. “Small changes [to your diet and exercise plans] can make big differences over time and impact your health and energy in a significant way,” Dr. Block says. A high-protein diet, consuming more fiber, and adopting a regular, consistent exercise routine will support your long-term weight loss goals. Approaches like mindful eating, intuitive eating, and practicing body neutrality can also help you stay confident throughout your weight loss journey.

How much weight is safe to lose at a time?

It’s generally safe for women to lose one to two pounds per week, says Dr. Peralta-Reich. People who lose weight at this pace are more likely to keep the weight off than those who lose it at a faster pace, according to the Centers for Disease Control and Prevention (CDC). But, of course, there is an asterisk here. “If a patient is heavier and has more weight to lose, it [might be] safe to lose weight at a faster pace,” Dr. Ali says. “But if they’re only looking to lose a few pounds, it may be better to lose weight at a slower pace.” Always consult your doctor, a registered dietitian, or both to determine the safest plan for you.

Credit: www.womenshealthmag.com

Team Metabolic Health

The recent study aimed to determine whether obesity or dynamic changes in body weight were associated with the development of IMSDs.

Childhood obesity may have an impact on immune-mediated skin disorders (IMSDs), such as psoriasis, atopic dermatitis, and alopecia areata, according to a study published on Wednesday. According to a study that examined 2,161,900 Korean youngsters from 2009 to 2020, maintaining a healthy weight may help lower the risk of developing specific skin conditions. The quality of life of children with IMSDs and their families is negatively impacted, with negative effects on emotional, physical, social, and functional well-being.

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Know about the study

The research, which was published in the Journal of Investigative Dermatology, highlights how crucial it is to maintain a healthy weight and encourage good eating habits to prevent atopic dermatitis in obese children, especially those who are not yet school-age.

While several biologics have shown promise in the treatment of paediatric psoriasis and atopic dermatitis, there are still significant obstacles in the management of children with IMSDs due to a paucity of clinical trials and a shortage of treatment choices.

The prevalence of childhood obesity has increased significantly in recent years, making it an unquestionable public health emergency that has been made worse by the pandemic’s effects and countrywide lockdowns.

Uncertainty surrounds the exact mechanisms by which obesity contributes to the development of chronic inflammatory skin illnesses, such as psoriasis, atopic dermatitis, and skin cancers.

“Previously, many studies have looked at the link between childhood obesity and IMSDs. However, most of these studies only looked at data from one point in time or compared groups with and without the condition (i.e., obesity or overweight), and they had small sample sizes. Very few studies have followed children over a long period to see how their body weight affects the development of these skin conditions,” said Seong Rae Kim, Department of Dermatology, Seoul National University College of Medicine, in Korea.

“This means we still don’t know for sure whether being obese or overweight causes atopic dermatitis and psoriasis or if the opposite is true. Also, no studies have yet looked at the effect of body weight on alopecia areata or how dynamic changes in a child’s weight affect the development of common IMSDs,” Kim added.

Credit: IndiaTV With IANS Inputs