PHA2022 Group 24 Final Podcast

Hello, and welcome to Mindful Health. I'm your host, Dan, and I'm joined by my co-host, Frank. Hi, everyone. Today, we'll be discussing the recent controversy surrounding the introduction of anti-obesity drugs into the market, which target obesity in teens. We're joined today by a few guest speakers who will be providing their different perspectives on the issue. Starting with Dr. Chloe Smith, who is a pediatrician from the Royal Children's Hospital in Melbourne to tell us about the health benefits of anti-obesity drugs for teens. Thank you so much for inviting me onto this panel. I'll just start by laying some groundwork on what exactly being overweight and obese means. In accordance to the World Health Organization, being overweight and obese is defined as an abnormal or excessive fat accumulation, which provides a risk to health. The way for calculating this is via BMI, or body mass index, which takes into account height and weight. A body mass index of over 25 is considered overweight, and a body mass index over 30 is obese. Of course, there are multiple factors like muscle mass, bone mass, and fat mass, which affect BMI. So speak to your GP today if you are concerned about being overweight and obese. Oh, so how big is the obesity issue? More than 1 billion people worldwide are obese. That's 650 million adults, 340 million adolescents, and 39 million children. I'd like to raise everyone's attention to the fact that we are living in a world where illnesses like type 2 diabetes, cancer, and cardiovascular disease are seen in higher and higher prevalence. This is due to the fact that more and more individuals are becoming overweight and obese, and developing these diseases potentially as a side effect, and I'll call these side effect diseases comorbidities. Insulin resistance is a well-established association and complication of obesity, and around 80% of patients with type 2 diabetes are obese. Up to 70% of patients with obesity have issues with their lipid levels, leading to high cholesterol levels, which can then go on to lead to heart attacks from occurring. These are just a few of the statistics shown. Due to this happening, overweight and obese children are highly likely to develop these diseases down the line when they become adults. Do we want our children of the future to be burdened with these diseases later on in life? Are you saying that those children will definitely go on to develop type 2 diabetes? I'm not saying that the development of these diseases will be guaranteed, but the occurrence of it is much, much higher. Pharmacotherapy or taking drugs for weight loss is a good choice for select overweight and obese teenagers, as teens who are not able to lose weight easily, whether it be due to their genetic make-up, financial inconvenience, or any other factors. Denying them these weight loss drugs is, in my opinion, a form of neglect. That's quite a bold statement to make, Dr Smith. What makes you say that? Well, morbidly obese teens are not able to lose the weight by themselves. They need assistance. It can be complex cases where multiple factors contribute to a teen's overweightness. Limiting these teens' ability to access drugs, which will help their quality of life, help boost their self-esteem, allowing them on a path of a healthier lifestyle, is a form of medical neglect on our behalf. Imagine these teens not being able to do anything to lose weight and developing these comorbid diseases. This is inhumane. We, as a society, need to ponder whether this is fair or not. That's all from me. Thank you for that, Dr Smith. You made some really solid points there, particularly with the statistics on the potential disease implications with obesity in children. Now let's hear from Dr David Phillips, a researcher at the Monash University Pharmacology Department, to inform everyone of the potential safety concerns and long-term effects of these drugs. Thank you, Frank, for that lovely introduction. As Dr Smith just mentioned, the use of weight loss drugs in teens is sure to have beneficial outcomes. However, currently there's a lack of research to back up safety in long-term use of these drugs for teenagers. Firstly, let's focus on why these drugs may have to be taken long-term rather than as a short-term solution. Time and time again, it's been shown that if you were to lose weight with reliance on weight loss drugs, you'd need to continue taking the medication forever in order to keep the weight off. One particular study published in 2022 followed 2,000 adults without diabetes as they took semaglutate, which is a weight loss drug, for 68 weeks. They were then told to stop taking the drug, and within a year, two-thirds of these participants regained their prior body weight, which is not great. Oh, wow. Could you possibly explain to our listeners why this might happen? Yeah. So many anti-obesity drugs, such as Azambic, which you may have heard of before in the news, mimic a naturally occurring hormone that lets the brain know that you're full, reducing your appetite. So if the drug isn't taken, your body wouldn't be able to adapt to this, so your appetite wouldn't be suppressed, which makes it incredibly hard to remain in a calorie deficit, which may lead to weight regain. So the only solution has been to continue taking the drug for extended periods of time to keep the weight off. But then this comes with several downsides. Currently, the long-term effects of anti-obesity drugs on teenagers is mostly in unknown territory, because typically we've only mass-prescribed these drugs to adults and not to children. Based on some known long-term dangerous side effects of anti-obesity drugs for adults, it can be suspected that they would potentially pose similar risk to teens if they were to be used long-term. An example that comes to mind is the recall of Locasarin, almost a decade after it was released into the market. This weight loss drug was approved by the FDA in 2012 for adults, and it was able to decrease the emotional response to appealing foods by stimulating serotonin receptors in the brain, which is the happy hormone. This alone had potential risks of psychiatric disorders, such as depression, as well as cardiovascular side effects in some patients. But years down the line, it was found that the long-term use of Locasarin was found to increase the risk of developing pancreatic, colorectal and lung cancer for 1 in 407 users treated for a minimum of a year. Oh, those are some scary figures. Yeah, and the FDA also agreed, because in 2020 they requested the drug manufacturer to voluntarily withdraw it from the market. And this is just one example of a weight loss drug that was initially approved for adult use, but was later found to have adverse side effects in long-term use. So the risk of this occurring for a drug such as this is definitely a valid reason to not prescribe anti-obesity or weight loss drugs for teens, because there's a lack of research on the long-term effects of many weight loss drugs for teens, let alone adults. And look, I could probably spend hours talking about the wide array of side effects of these drugs, but I think you understand what I'm trying to get at, and that's the fact that we must take into account the potential adverse side effects before mass prescribing anti-obesity drugs for teens. Thank you for that, Dr. Phillips. Now let's hear from federal government financial adviser Kate Minnick, who will touch on the economic impact that obesity is having on Australia. Hey everyone, thank you so much for having me. Some really interesting points by Dr. Smith and Dr. Phillips have certainly kick-started this conversation, and I'd like to build upon what Dr. Smith has already mentioned, but come at it with a slightly different perspective. So as someone who works with the government and their finances, I see firsthand the threat that obesity in adults and teens is posing to our Australian economy. I also see that it's having a major economic burden on individuals and their families. Now, so I'm going to be throwing a few figures at you guys, and I just want you to take on board the weight of the costs associated with obesity currently. So in 2018, $12 billion Australian dollars was spent on both direct hospitalisation costs and on indirect community costs. And now these community costs were on things like disability care, premature death, and the loss of years of productivity or quality life in each patient who potentially go on to develop a chronic disease like stroke or type 2 diabetes. Now the PwC, which is an accounting firm that posits economic solutions to global challenges, has performed an economic analysis of obesity, and they found that if nothing is done to curb costs of overweight and obese adolescents, by 2025, $88 billion will be what the Australian community is spending on obesity and associated diseases that develop because of such obesity. I see. And so how do all these figures relate to anti-obesity drugs? Okay, so think about overweight and obese young adults and teens developing these diseases at a much earlier stage in their life compared to the majority of other stroke or heart disease patients. And simply just the lifetime economic burden that is associated with these types of diseases. It's quite overwhelming, but it is also preventable. So by implementing known pharmaceutical interventions at an appropriate time in teenagers, we can eradicate these costs. And even by 2025, we may see that an economic benefit of around $3 billion can result from that. So I think that to prevent this impending and inevitable financial and healthcare system burden because of obesity, we can take actions now and take drastic measures such as prescribing anti-obesity medication to enable a better economic future for all of us. Thank you for that, Kate. You made some really solid points there, particularly with how Australia could be spending $88 billion on obesity-related problems very soon. Now let's hear from Dr. Heidi Marley, who is a paediatrician from Monash Children's Hospital to speak about alternative measures to anti-obesity drugs. Hi, everyone. I'm Dr. Marley. And while I do understand where Kate is going, but what if we thought about preventing high levels of obesity in our future adults from an entirely different angle? So instead of prescribing these drugs with little known long-term health effects, I think that a responsible government and responsible associated health advisers should instead be focusing on alternative measures. So yes, overweight and obesity is a problem in our population today, as highlighted by Dr. Smith. And yes, there are pharmacological options to help teens to lose this excess weight. However, I think that saying yes to prescribing these drugs negates the fact that other lifestyle measures can also be addressed before alterations to hormones should even be considered. Also, we need to remind ourselves that overweight and obesity is a multifactorial problem that includes so many different factors like environmental conditions, like lifestyle behaviours, food accessibility, and even things like sleep quality, ethnicity and socioeconomic status also play a part. So instead of putting big amounts of money into pharmacological interventions, what if we were to focus our attention on promoting campaigns that address these fundamental challenges? We could introduce measures at the school level where students from lower socioeconomic backgrounds who may not have access to proper nutrition are provided healthy food alternatives at school. Or how about implementing fitness programs in schools that lack these types of exercise and fitness programs currently? What if we implemented advertisements at grocery stores that suggest healthy alternatives to unhealthy foods so that families and individuals can actually make an informed and educated choice? I just think that throwing drugs at teens who may be overweight or obese due to a multitude of different reasons is entirely a quick fix solution. And we need to advocate and educate young children as well as their parents about healthier options and come at this problem in a more holistic way so that down the line we're not facing major problems due to the unknown nature of long-term prescriptions of anti-obesity drugs like Dr. Phillip mentioned earlier. Thank you for that Dr. Marley. Now let's hear from psychologist Dr. Marley. Dr. Phillips-Harry on how anti-obesity drugs is able to improve psychological outcomes in teens with obesity. Thank you Dan and Frank for inviting me to Mindful Health. Now I want to mention that the points Dr. Phillips illustrated were very valid points. Not knowing the long-term effects of anti-obesity drugs. However, I believe as a psychologist that taking the risk of long-term effect is worth the psychological advantages that these drugs provide for kids. For teens struggling with obesity, body image issues can be particularly challenging and it affects teens' mental health. Studies show that there is a significant positive association between mental health issues and obesity in teens as teenagers are at risk of having less self-confidence, feeling less sociable and having less self-esteem. Social isolation is another significant concern where teens with obesity may avoid social isolation due to fear or judgment or discomfort in social settings. It's no secret that obesity has become a major health concern for teens. But I think what's being overlooked here is their psychological concerns as well. This being the issue, anti-obesity drugs provide the solution for these psychological problems as teens can lose weight very quickly. As reported on various research, as 20, 62% of teens using anti-obesity drugs lost at least 10% of their body weight after one year. Now with this short period of time, the psychological benefits that the teen may experience will outweigh many other negatives in my expert opinion. Thank you for that Dr. Harry. Now let's hear from psychologist Dr. Hannah Roberts on how the introduction of anti-obesity drugs may actually have detrimental mental health effects. Yeah, thanks for that introduction. And yeah, thanks for that Dr. Harry. Like you, I'm a psychologist with a focus on adolescent mental health. I agree with you and with everyone else who spoke before, all really valid points. And I do agree with the fact that obesity is a problem in Australia right now. But I think that psychological effects of drug therapy are often really overlooked. I believe that you must also view, you know, the societal and social media influence on anti-obesity drugs, which may contribute to the development of certain mental health disorders in the future. To me, it seems as if the main issue with obesity and its links to negative effects on the mental health of teenagers is due to the facilitation of it through the perhaps overexposure of anti-obesity drug advertisements on social media. I think that we can all agree, you know, regardless of our stance, that social media plays a very big role in adolescents' lives and that most of us nowadays do get our news and information on a variety of media like, you know, TikTok, Twitter, Instagram and Facebook, just to name a few. And I've actually really recently read a really interesting study in which a group of researchers actually looked into the interest of anti-obesity drugs on social media. And this was specifically done on Twitter. In reading the study, in my professional opinion, I really think that it actually really highlights the danger of anti-obesity promotion on social media. And then, of course, its downstream negative effects we can assume on teen mental health. They looked at the engagements, likes and sharing of tweets displaying anti-obesity drug advertisements or content. And what they found was that there was actually a really prominent engagement with these tweets, pretty much confirming interest in such drugs or rising interest in anti-obesity drugs, we can say, amongst teens and young adults due to Twitter's younger population of users. Couldn't that interest potentially be seen as a good thing because of the obesity crisis? Yes, that is one way of seeing it. But what I want to highlight is that this direct-to-consumer sort of marketing approach can have really detrimental effects on mental health. Because although the tweets were posted by reputable pharmaceutical companies themselves, they actually found, and I'm going to quote the article directly here, that they focused directly on efficacy and rarely mentioned side effects or discussed issues related to the personal adherence of treatment regarding anti-obesity drug therapy. And I just feel it does not account for the majority of impressionable young adolescents that do not have the knowledge that would provide them with the ability to know that most drugs, despite their benefits, actually do have significant side effects. Take what happened in the EU, for example. The so-called anti-obesity drug, which is actually a diabetes medication, is empty. They actually recently launched an investigation into this drug, along with another drug I believe is called Sexender, after societal thoughts were reported during their use. So it is very clear to me that there still may be gaps in research that allow certain negative effects to be swept under the rug. All of this, pretty much, just brings me back to the Twitter research article, really, and brings up the question in my mind, are we monitoring the access of these anti-obesity medication advertisements on social media and their access to adolescents? The problem is that there isn't enough research on mental health effects of anti-obesity, and that is the point that I want to emphasise as well. Thank you for that, Dr Roberts. I think that the research article you mentioned is really interesting, and along with the recent development in the EU, it really does bring into the question the mental health effects of these drugs long-term. And with that, I would like to thank all our guests for taking the time to join us on today's episode about the use of anti-obesity drugs in teens, to educate us about some of the risks and benefits that many of us may not even consider. I hope you all found this discussion informative and thought-provoking. Remember, we all want the best for our teens, and keeping these mentioned arguments in mind can help to keep them safe and healthy. At the end, it all comes back to opinion on choosing whether the positive benefits outweigh the negative drawbacks, or vice versa. Join us next time as we continue to explore more topics on the Mindful Health Podcast.