Last updated on January 8th, 2024 at 10:06 am
Reported in Medscape psychiatry online Nov. 1, 2023
Review of the case study by Leslie “Les” Ruthven, Ph.D. in clinical psychology
In this case study a 36 year old obese woman on Semaglutide 2.4 mg for six months and life style changes lost about 30 pounds, from 220 to 190 pounds (about a 14% weight loss) for 6 months of therapy.
In my recent book I said that for over 50 years the attempts to find an effective weight loss drug failed and I suggested that healthcare turn from drugs to psychologists teaching overweight and obese patients to change their eating behavior and treat any psychosocial problems giving rise to the eating disorder.
Physicians tend to view overweight and obesity as a disease and are wedded to the idea of finding a biophysical solution such as a drug to treat this major health problems behind several preventable diseases. However, physicians—and the case study being considered—now believe that these Semaglutide drugs are truly lifesaving and also have positive effects on a number of preventable diseases such as Type 2 diabetes.
These advocates do admit to a number of negative effects (some known side effects such as nausea, diarrhea, vomiting and the cost of lifetime therapy to prevent relapse of the “disease”).
The patient in the case study said “Do I stay on this med for the rest of my life”? Good question. The physician responded “If it’s benefiting you keep doing it.” “If you stop the weight will go back up and the health consequences will return”.
I don’t like to be a spoil sport but I, for one, am not very impressed with a little over a 14% weight loss based upon 6 months of treatment and the patient facing lifetime therapy. Even with life time treatment we do not yet know if there will or will not be relapses.
Medscape’s review of the study did not give a description of the lifestyle changes but I am sure it included a diet prescribed by a nutritionist and perhaps some sessions with a nurse.
However, before trying to get 40 to 60% of Americans on Semaglutide why don’t we randomize Semaglutide vs. patient sessions with a Ph.D. clinical psychologist whose specialties include weight loss behavioral therapy; these sessions would include but not limited to teaching the patient principles of normal eating and dealing with the causes of any untreated behavioral health problems, especially those that give rise to anxiety and other symptomatic behavior.
Like depression I am sure psychologists would find that if you see one case of obesity you have seen one case of obesity; since obesity is caused by multiple factors the health professional treating the patient must be a trained behavioral diagnostician as well.
