By Amy Norton
HealthDay reporter
THURSDAY, May 6, 2021 (HealthDay News) – Weight loss drug Saxenda may shed extra pounds – but combining it with exercise brings bigger payoff, new clinical study finds.
The study found that some longstanding advice is valid: Prescription weight loss drugs work best when used in conjunction with, rather than in place of, lifestyle changes.
Saxenda (liraglutide) is a prescription drug approved in the US to promote and maintain weight loss when added to calorie restriction and exercise.
Whether the drug plus exercise is better than the drug alone – or alone – hasn’t been rigorously tested.
The new study, published May 6 in the New England Journal of Medicine, did just that. And it turned out that the combination won over a year and helped people lose more pounds and especially body fat.
Experts not involved in the study said this underscores the importance of a “comprehensive” tactic to save extra weight.
“The standard in treating all obesity treatments – drugs and surgery – is to use them as a complement to ongoing behavior changes,” said Dr. Scott Kahan, a spokesman for the Obesity Society.
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Sustainable diet changes and regular exercise are key, said Kahan, who also directs the National Center for Weight and Wellness in Washington, DC
Weight loss drugs are useful, Kahan said, but not “magic cures”. However, some doctors might prescribe them without adequate support to patients on the lifestyle side of the coin.
Several weight loss drugs are approved in the United States. These include Xenical (orlistat), Qsymia (phentermine topiramate), and Contrave (naltrexone bupropion).
Liraglutide is sold under two brand names: Saxenda, the weight loss drug, and Victoza, for type 2 diabetes. Saxenda contains a higher dose of liraglutide and, according to drug manufacturer Novo Nordisk, mimics the effects of an appetite hormone called GLP-1.
The drug is taken every day by injection.
For the new study, funded by Novo Nordisk, the researchers recruited 195 overweight adults who ate a low-calorie diet for eight weeks. They were then randomly assigned to one of four groups: medication plus exercise; medication only; just train; or a placebo group who were given inactive “drugs” and asked to maintain their normal level of activity.
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In contrast, the exercise groups had a fairly intense routine. They were encouraged to take group classes twice a week and exercise alone twice a week, with running, cycling, and brisk walking being the main activities.
All four groups received advice on long-term dietary changes.
After one year, the drug / exercise group had lost an average of 16% of their starting weight. This compared with 11% in the exercise group and 13% in the medication group.
The combo approach was also most effective at changing body composition: these patients lost about twice as much body fat and cut off more of their waist than those using either strategy alone.
They also maintained their muscle mass, according to the researchers, led by Signe Torekov from the University of Copenhagen in Denmark.
“The big point here is that the study confirms that combining medication with exercise is more effective,” said Dr. Reshmi Srinath, who leads the weight and metabolism management program at Mount Sinai in New York City.
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She had some limitations: the patients in the study were quite young – early 40s on average – and healthy. Such vigorous exercise may not be suitable for older adults or those with certain health conditions such as painful arthritis.
“We generally recommend going home or doing strength training for these patients,” said Srinath.
But, she added, the bottom line remains: “Medications should be used as a complement to lifestyle changes.”
That’s not only true for Saxenda, but also prescription weight loss drugs in general, Kahan and Srinath said.
When it comes to choosing a drug, Srinath said, it is a case-by-case decision that takes into account side effects and potential health conditions for a patient. In this study, the most common side effects among Saxenda users were nausea, diarrhea, and dizziness.
Srinath noted that personal preferences also influence drug decisions. “Some patients are reluctant to take a daily injection,” she said.
What is important, Kahan said, is that people who have “tried again and again” to lose weight know that there are treatments that could help.
“People often don’t realize it because we’re full of counterfeit weight loss products in this wild west,” he said. “But there are good, legitimate options that have been scientifically studied.”
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More information
The US National Institute of Diabetes and Digestive and Kidney Diseases is more concerned with weight management.
SOURCES: Scott Kahan, MD, MPH, Director, National Center for Weight and Wellness, Washington, DC, and Spokesperson, The Obesity Society, Silver Spring, Md .; Reshmi Srinath, MD, Assistant Professor of Endocrinology, Diabetes, and Bone Diseases, and Director of the Weight and Metabolic Management Program at the Icahn School of Medicine on Mount Sinai, New York City; New England Journal of Medicine, May 6, 2021
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