New weight-loss drugs

You may have heard about a relatively recent weight loss and diabetes drug, Semaglutide. This drug, from Novo Nordisk, is marketed as Wegovy for weight loss and at a lower dose as Ozempic to treat Type-2 diabetes. Both are administered as a once-weekly injectable. Semaglutide works by mimicking the GLP-1 (glucagon-like peptide-1) satiety hormone in our bodies. When we eat, GLP-1 is released from our intestines and sends signals to our brain centers that control appetite. This is having remarkable weight loss results in patients taking the drug.

However, much like the speed-based weight loss drugs of the past, when patients stop taking the medicine, they start to feel hungrier and regain the weight. This is concerning because insurance coverage for semaglutide is spotty. Medicare does not cover weight loss drugs and many insurers follow Medicare's lead. The lowest price among all retailers is $1,304 per month for people paying out of pocket, which is out of reach for most people.

Another concern is long-term effects, especially if these drugs have to be taken indefinitely. There's ongoing research to evaluate the drug's effect on the cardiovascular system, and it has caused thyroid tumors in rodents. It is also important to remember that Wegovy is only recommended for people with a BMI of 30 or higher, or people with a BMI of at least 27 with weight related conditions.

Of course, exercise and diet modification are still the first strategies to try. But given that about 70% of Americans are overweight or obese, nearly half of adults in the U.S. have hypertension and more than 1 in 3 have pre-diabetes, doctors' groups cite an urgent need to layer on more interventions.

I think these medications can be used to help people who qualify for whom diet and exercise alone hasn't helped. Semaglutide can work together with exercise and diet modifications to help those with obesity and diabetes. I do wonder whether the drugs will have staying power or if they'll fall out of favor, like their predecessors, either from side effects or decreased effectiveness.

Have you had any experience with medications for weight loss? Do you think they can be part of combating the obesity epidemic, or do you think a "magic pill" is too good to be true?

Can compression devices enhance recovery?

Some of you may have heard of compression devices designed to enhance recovery from exercise. NormaTec is an intermittent pneumatic compression device that features chambers that sequentially inflate, starting with the ankle, working their way up the leg, and then deflate. You may have seen these devices in a hospital setting, where they are used to reduce blood pooling and prevent the onset of deep vein thrombosis in the lower extremities of patients who must spend long stretches of time in bed. The idea is that by facilitating venous return we may increase the speed of the clearance of lactic acid and thereby speed recovery.

The study recruited 15 healthy male college-age students and after baseline testing had them perform 3 bouts of High-Intensity Interval training. After each training, the participants recovered through Passive recovery (reclining with the legs elevated), Active recovery (cycling at a low intensity), and NormaTec recovery (reclining with the feet elevated while wearing the NormaTec Pulse 2.0 Recovery System at the maximal setting) for 30 minutes.

Blood lactate clearance for both the NormaTec and active recovery conditions was significantly faster than passive recovery. The study participants also completed some performance tests to measure if the recovery methods would impact athletic performance. There was no significant difference in performance after 24 hours of either of the 3 recovery methods.
The results indicate that the NormaTec or active recovery may be most beneficial to people training twice or more per day. For the typical gym goer, who takes a 24 hour recovery between workouts, recovery mode did not impact performance. However, anecdotal statements by the study participants emphasize how good NormaTec feels. The massage-like experience provided relaxation and a potential stress-relief or mental-health benefit.

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