Top

Current Urology Reports

Published in:

02-09-2023 | Bariatric Surgery

Embracing the Pros and Cons of the New Weight Loss Medications (Semaglutide, Tirzepatide, Etc.)

Author: Mark A. Moyad

Published in: Current Urology Reports | Issue 11/2023

Abstract

Purpose of Review

The history of multiple weight loss medications has been a concerning paradox based on an increased cardiovascular risk despite significant reductions in adipose tissue and weight. A new class of weight loss medications could change this past narrative based on early preliminary results of cardiovascular risk (not events—still need to be determined) and weight reduction in non-diabetics that acutely competes with results achieved with bariatric surgery. The purpose of this review is to provide a comprehensive summary of the advantages and disadvantages of these newer medications, and how they could impact urology.

Recent Findings

Weight loss of − 15 to − 20% compared to baseline has become plausible in the short-term and preliminary guidance to reduce acute and chronic adverse events are receiving attention. However, the cost, access, conflicts of interest, supply chain, life-long adherence issues, and the long-term diverse implications on mental and physical health when exposed to this class of medications (GLP-1 agonists) are unknown. The profound caloric reductions should also result in baseline or ongoing nutritional deficiency testing, and general and specific dietary recommendations, which could theoretically mimic some bariatric surgery pre- and post-surgical protocols but has yet to be studied. Regardless, the potential impact of these medicines within a variety of medical specialties needs clinical research.

Summary

Current and future lifestyle interventions, dietary patterns, and medicines in the weight loss category need to be held to a paradigm whereby cardiovascular health should improve with significant weight loss without a negative impact on mental health. In urology, the ability to impact cancer risk, ED, FSD, incontinence, infertility, nephrolithiasis, and multiple other endpoints are plausible (based on bariatric surgery data) but need preliminary clinical research. Other medicines with a similar or even larger potential impact are in clinical trials, and thus, a concise overview for clinicians and researchers was needed for objective guidance. Currently, comprehensive lifestyle changes utilized with and without these medications continue to garner positive mental, physical, and legacy effects, which suggest that they are as necessary as ever in the treatment of the numerous conditions impacted by unhealthy weight gain.

Przegalinski E, Witek K, Wydra K, Kotlinska JH, Filip M. 5-HT_2c receptor stimulation in obesity treatment: orthosteric agonists vs. allosteric modulators. Nutrients. 2023;15(6):1449. https://doi.org/10.3390/nu15061449.

Food & Drug Administration. FDA requests the withdrawal of the weight-loss drug Belviq, Belviq XR (lorcaserin) from the market: potential risk of cancer outweighs the benefits. Accessed 1 Jul 2023. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requests-withdrawal-weight-loss-drug-belviq-belviq-xr-lorcaserin-market.

DiNicolantonio JJ, Chatterjee S, O’Keefe JH, Meier P. Lorcaserin for the treatment of obesity? A closer look at its side effects. Open Heart. 2014;1(1)e000173. https://doi.org/10.1136/openhrt-2014-000173.

Garcia-Fernandez G, Krotter A, Gonzalez-Roz A, Garcia-Perez A, Secades-Villa R. Effectiveness of including weight management in smoking cessation treatments: a meta-analysis of behavioral interventions. Addict Behav. 2023;140:107606. https://doi.org/10.1016/j.addbeh.2023.107606.

Tian J, Venn A, Otahal P, Gall S. The association between quitting smoking and weight gain: a systemic review and meta-analysis of prospective cohort studies. Obes Rev. 2016;17(10):1014. https://doi.org/10.1111/obr.12448.CrossRefPubMed

Okorare O, Evbayekha EO, Adabale OK, Daniel E, Ubokudum D, Olusiji SA, Antia AU. Smoking cessation and benefits to cardiovascular health: a review of literature. Cureus. 2023;15(3):e35966. https://doi.org/10.7759/cureus.35966.

Moyad MA. Preventing lethal prostate cancer with diet, supplements, and Rx: heart healthy continues to be prostate healthy and “first do no harm” part I. Curr Urol Rep. 2018;19:104. https://doi.org/10.1007/s11934-018-0846-4.CrossRefPubMed

Wiggins T, Guidozzi N, Welbourn R, Ahmed AR, Markar SR. Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: a systematic review and meta-analysis. PLoS Med. 2020;17(7):e1003206. https://doi.org/10.1371/journal.pmed.1003206.

Syn NL, Cummings DE, Wang LZ, Lin DJ, Zhao JJ, Loh M, et al. Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174772 participants. Lancet. 2021;397(10287):1830–41. https://doi.org/10.1016/S0140-6736(21)00591-2.CrossRefPubMed

10.

Wilson RB, Lathigara D, Kaushal D. Systematic review and meta-analysis of the impact of bariatric surgery on future cancer risk. Int J Mol Sci. 2023;24(7):6192. https://doi.org/10.3390/ijms24076192.CrossRefPubMedPubMedCentral

11.

Urquhart S, Willis S. Long-acting GLP-1 receptor agonists: findings and implications of cardiovascular outcomes trials. JAAPA. 2020;33(8):19–30. https://doi.org/10.1097/01.JA.0000669452.63883.45.CrossRefPubMed

12.

Xu D, Nair A, Sigston C, Ho C, Li J, Yang D, et al. Potential roles of glucagon-like peptide 1 receptor agonists (GLP-1RAs) in nondiabetic populations. Cardiovasc Ther. 2022;2022:6820377. https://doi.org/10.1155/2022/6820377.CrossRefPubMedPubMedCentral

13.

Cifuentes L, Camilleri M, Acosta A. Gastric sensory and motor functions and energy intake in health and obesity-therapeutic implications. Nutrients. 2021;13(4):1158. https://doi.org/10.3390/nu13041158.CrossRefPubMedPubMedCentral

14.

Panaro BL, Yusta B, Matthews D, Koehler JA, Song Y, Sandoval DA, Drucker DJ. Intestine-selective reduction of Gcg expression reveals the importance of the distal gut for GLP-1 secretion. Mol Metab. 2020;37:100990. https://doi.org/10.1016/j.molmet.2020.100990.

15.

Holst JJ, Orskov C, Hartmann B, Deacon CF. Posttranslational processing of proglucagon and postsecretory fate of proglucagon products. Front Diabetes. 1997;13:24–48. https://doi.org/10.1159/000194728.CrossRef

16.

• Amaro A, Sugimoto D, Wharton S. Efficacy and safety of semaglutide for weight management: evidence from the STEP program. Postgrad Med. 2022;134(supp1):5–17. https://doi.org/10.1080/00325481.2022.2147326. One of the best cumulative objective reviews of the different phase 3 trials results utilizing semaglutide.CrossRefPubMed

17.

Smith EP, Polanco G, Yaqub A, Salehi M. Altered glucose metabolism after bariatric surgery: what’s GLP-1 got to do with it? Metabolism. 2018;83:159–66. https://doi.org/10.1016/j.metabol.2017.10.014.CrossRefPubMed

18.

Tacad DKM, Tovar AP, Richardson CE, Horn WF, Krishnan GP, Keim NL, Krishnan S. Satiety associated with calorie restriction and time-restricted feeding: peripheral hormones. Adv Nutr. 2022;13(3):792–820. https://doi.org/10.1093/advances/nmac014.CrossRefPubMedPubMedCentral

19.

Hu M, Kong Z, Shi Q, Nie J. Acute effect of high-intensity interval training versus moderate-intensity continuous training on appetite-regulating gut hormones in healthy adults: a systematic review and meta-analysis. Heliyon. 2023;9(2):e13129. https://doi.org/10.1016/j.heliyon.2023.e13129.

20.

Deru LS, Chamberlain CJ, Lance GR, Gipson EZ, Bikman BT, Davidson LE, et al. The effects of exercise on appetite-regulating hormone concentrations over a 36-h fast in healthy young adults: a randomized cross-over study. Nutrients. 2023;15(8):1911. https://doi.org/10.3390/nu15081911.CrossRefPubMedPubMedCentral

21.

touchREV Endocrinol. Tirzepatide: a novel, once-weekly dual GIP and GLP-1 receptor agonist for the treatment of type 2 diabetes. 2022;18(1):10–9. https://doi.org/10.17925/EE.2022.18.1.10.

22.

Rubino DM, Greenway FL, Khalid U, O’Neil PM, Rosenstock J, Sorrig R, et al for the STEP 8 Investigators. Effect of weekly subcutaneous semaglutide vs daily liraglutide on body weight in adults with overweight or obesity without diabetes: the STEP 8 Randomized Clinical Trial. JAMA. 2022;327(2):138–50. https://doi.org/10.1001/jama.2021.23619.

23.

Wegovy (semaglutide injection 2.4 mg) Prescribing Information. Accessed 1 Jul 2023 at https://www.novo.pi.com/wegovy.pdf.

24.

Ghusen W, De la Rose A, Sacoto D, Campos A, Feris F, Hurtado MD, Acosta A. Weight loss outcomes associated with semaglutide treatment for patients with overweight or obesity. JAMA Network Open. 2022;5(9):e2231982. https://doi.org/10.1001/jamanetworkopen.2022.31982.

25.

•• Wilding JPH, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553–64. https://doi.org/10.1111/dom.14725. One of the only studies to examine what happens when medication cessation occurs-two thirds of weight lost was regained within the first year of discontinuation.CrossRefPubMedPubMedCentral

26.

Klein SR, Hobai IA. Semaglutide, delayed gastric emptying, and intraoperative pulmonary aspiration: a case report. Can J Anaesth. 2023. https://doi.org/10.1007/s12630-023-02440-3.CrossRefPubMed

27.

Gulak MA, Murphy P. Regurgitation under anesthesia in a fasted patient prescribed semaglutide for weight loss: a case report. Can J Anaesth. 2023. https://doi.org/10.1007/s12630-023-02521-3.CrossRefPubMed

28.

Silveira SQ, da Silva LM, de Campos Vieira Abib A, de Moura DTH, de Moura EGH, Santos LB, et al. Relationship between perioperative semaglutide use and residual gastric content: a retrospective analysis of patients undergoing elective upper endoscopy. J Clin Anesth. 2023;87:111091. https://doi.org/10.1016/j.jclinane.2023.111091.

29.

•• Joshi GP, Abdelmalak BB, Weigel WA, Soriano SG, Harbell MW, Kuo CI, et al. for the American Society of Anesthesiologists (ASA) Task Force on Preoperative Fasting. American Society of Anesthesiologists consensus-based guidance on preoperative management of patients (adults and children) on glucagon-like peptide-1 (GLP-1) receptor agonists. Accessed 1 Jul 2023 at https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative. One of the only current guidelines recommendations for surgical teams dealing with patients on these novel medications.

30.

Hjerpsted JB, Flint A, Brooks A, Axelsen MB, Kvist T, Blundell J. Semaglutide improves postprandial glucose and lipid metabolism, and delays first-hour gastric emptying in subjects with obesity. Diabetes Obes Metab. 2018;20(3):610–9. https://doi.org/10.1111/dom.13120.CrossRefPubMed

31.

•• Gorgojo-Martinez JJ, Mazquita-Raya P, Carretero-Gomez J, Castro A, Cebrian-Cuenca A, de Torres-Sanchez A, et al. Clinical recommendations to manage gastrointestinal adverse events in patients treated with GLP-1 receptor agonists: a multidisciplinary expert consensus. J Clin Med. 2023;12:145. https://doi.org/10.3390/jcm12010145. One of the only comprehensive guides published to date on how to prevent and manage some of the most common side effects of these weight loss medications.CrossRef

32.

Wharton S, Calanna S, Davies M, Dicker D, Goldman B, Lingvay I, et al. Gastrointestinal tolerability of once-weekly semaglutide 2.4 mg in adults with overweight or obesity, and the relationship between gastrointestinal adverse events and weight loss. Diabetes Obes Metab. 2022;24(1):94–105. https://doi.org/10.1111/dom.14551.

33.

Lingvay I, Hansen T, Macura S, Marre M, Nauck MA, de la Rosa R, et al. Superior weight loss with once-weekly semaglutide versus other glucagon-like peptide-1 receptor agonists is independent of gastrointestinal adverse events. BMJ Open Diabetes Res Care. 2020;8(2):e001706. https://doi.org/10.1136/bmjdrc-2020-001706.

34.

Zhou F, Jiang L, Jiamei G, Fan Y, Pan Q, Tianlian L, et al. Degree of obesity and gastrointestinal adverse reactions influence the weight loss effect of liraglutide in overweight or obese patients with type 2 diabetes. Ther Adv Chronic Dis. 2023;14:20406223231161516. https://doi.org/10.1177/20406223231161516.CrossRefPubMedPubMedCentral

35.

FDA approves once-weekly Wegovy^® injection for the treatment of obesity in teens aged 12 and older. Accessed 1 Jul 2024 at https://www.novonordisk-us.com/media/news-archive/news-details.html?id=151389.

36.

Weghuber D, Barrett T, Barrientos-Perez M, Gies I, Hesse D, Jeppesen OK, et al. for the STEP TEENS Investigators. Once-weekly semaglutide in adolescents with obesity. N Engl J Med. 2022. 387(24):2245–57. https://doi.org/10.1056/NEJMoa2208601.

37.

FDA approves new drug treatment for chronic weight management, first since 2014. Accessed 1 Jul 2023 at https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014.

38.

• Kanerva N, Larrson I, Peltonen M, Lindroos A-K, Carlsson LM. Changes in total energy intake and macronutrient composition after bariatric surgery predict long-term weight outcome: findings from the Swedish Obese Subjects Study. Am J Clin Nutr. 2017;106(1):136–45. https://doi.org/10.3945/ajcn.116.149112. The main manuscript and supplementary index provide a rare glimpse into the quantity and quality of caloric intakes, which impact short and long-term weight loss after bariatric surgery.CrossRefPubMedPubMedCentral

39.

Giusti V, Theytaz F, Di Vetta V, Clarisse M, Sutter M, Tappy L. Energy and macronutrient intake after gastric bypass for morbid obesity: a 3-y observational study focused on protein consumption. Am J Clin Nutr. 2016;103(1):18–24. https://doi.org/10.3945/ajcn.115.111732.CrossRefPubMed

40.

Reichmann MTF, Duarte A, Ivano F, Campos ACL. Evolution of the basal metabolic rate after Roux-en-Y gastric bypass: a systematic review and meta-analysis. Updates Surg. 2023. https://doi.org/10.1007/s13304-023-01523-6.CrossRefPubMed

41.

Moehlecke M, Blume CA, Rheinheimer J, Trindade MRM, Crispim D, Leitao CB. Early reduction in energy expenditure and successful weight loss after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2017;13(2):204–9. https://doi.org/10.1016/j.soard.2016.08.027.CrossRefPubMed

42.

Monnier L, Schlienger J-L, Colette C, Bonnet F. The obesity treatment dilemma: why dieting is both the answer and the problem? A mechanistic overview. Diabetes Metab. 2021;47(3):101192. https://doi.org/10.1016/j.diabet.2020.002.

43.

Heise T, DeVries JH, Urva S, Li J, Pratt EJ, Thomas MK, et al. Tirzepatide reduces appetite, energy intake, and fat mass in people with type 2 diabetes. Diabetes Care. 2023;46(5):1–7. https://doi.org/10.2337/dc22-1710.CrossRef

44.

Blundell J, Finlayson G, Axelsen M, et al. Effects of once-weekly semaglutide on appetite, energy intake, control of eating, food preference and body weight in subjects with obesity. Diabes Obes Metab. 2017;19(9):1242–51. https://doi.org/10.1111/dom.12932.CrossRef

45.

Friedrichsen M, Breitschaft A, Tadayon S, Wizert A, Skovgaard D. The effect of semaglutide 2.4 mg once weekly on energy intake, appetite, control of eating, and gastric emptying in adults with obesity. Diabetes Obes Metab. 2021;23(3):754–62. https://doi.org/10.1111/dom.14280.

46.

Gibbons C, Blundell J, Tetens Hoff S, Dahl K, Bauer R, Baekdal T. Effects of oral semaglutide on energy intake, food preference, appetite, control of eating and body weight in subjects with type 2 diabetes. Diabetes Obes Metab. 2021;23(2):581–8. https://doi.org/10.1111/dom.14255.CrossRefPubMed

47.

Aldawsari M, Almadani FA, Almuhammadi N, Algabsani S, Alamro Y, Aldhwayan M. The efficacy of GLP-1 analogues on appetite parameters, gastric emptying, food preference and taste among adults with obesity: systematic review of randomized controlled trials. Diabetes Metab Syndr Obes. 2023;16:575–95. https://doi.org/10.2147/DMSO.S387116.CrossRefPubMedPubMedCentral

48.

Wharton S, Batterham RL, Bhatta M, Buscemi S, Christensen LN, Frias JP, et al. Obesity (Silver Spring). Two-year effect of semaglutide 2.4 mg on control of eating in adults with overweight/obesity: STEP 5. 2023;31(3):703–15. https://doi.org/10.1002/oby.23673.

49.

Chuong V, Farokhnia M, Khom S, Pince CL, Elvig SK, Vlkolinsky R, et al. The glucagon-like peptide-1 (GLP-1) analogue semaglutide reduces alcohol drinking and modulates central GABA neurotransmission. JCI Insight. 2023. https://doi.org/10.1172/jci.insight.170671.CrossRefPubMedPubMedCentral

50.

• Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, et al. for the STEP 1 Study Group. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989–1002. https://doi.org/10.1056/NEJMoa2032183. Supplementary table 5 provides a unique look at the impact of this medication on fat and lean muscle mass compared to placebo.

51.

Cava E, Yeat NC, Mittendorfer B. Preserving healthy muscle during weight loss. Adv Nutr. 2017;8(3):511–9. https://doi.org/10.3945/an.116.014506.CrossRefPubMedPubMedCentral

52.

de Souza Vilela DL, da Silva A, Pinto SL, Bressan J. Relationship between dietary macronutrient composition with weight loss after bariatric surgery: a systematic review. Obes Rev. 2023;24(6):e13559. https://doi.org/10.1111/obr.13559.

53.

Reid RER, Oparina E, Plourde H, Andersen RE. Energy intake and food habits between weight maintainers and regainers, five years after Roux-en-Y gastric bypass. Can J Diet Pract Res. 2016;77(4):195–8. https://doi.org/10.3148/cjdpr-2016-013.CrossRefPubMed

54.

Moslehi N, Kamali Z, Golzarand M, Sakak FR, Mirmiran P. Association between energy and macronutrient intakes and weight change after bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2023;33(3):938–49. https://doi.org/10.1007/s11695-022-06443-9.CrossRefPubMed

55.

Bray GA, Beyond BMI. Nutrients. 2023;15(10):2254. https://doi.org/10.3390/nu15102254.CrossRefPubMedPubMedCentral

56.

American Medical Association (AMA) Press Release. AMA adopts new policy clarifying role of BMI as a measure in medicine. Accessed 1 Jul 2023 at https://www.ama-assn.org/press-center/press-releases/ama-adopts-new-policy-clarifying-role-bmi-measure-medicine.

57.

Mathus-Vliegen EMH. Obesity and the elderly. J Clin Gastroenterol. 2012;46(7):533–44. https://doi.org/10.1097/MCG.0b013e31825692ce.CrossRefPubMed

58.

Gao X, Hua X, Wang X, Xu W, Zhang Y, Shi C, Gu M. Efficacy and safety of semaglutide on weight loss in obese or overweight patients without diabetes: a systematic review and meta-analysis of randomized controlled trials. Front Pharmacol. 2022;13:935823. https://doi.org/10.3389/fphar.2022.935823.

59.

Kennedy C, Hayes P, Salama S, Hennessy M, Fogacci F. The effect of semaglutide on blood pressure in patients without diabetes: a systematic review and meta-analysis. J Clin Med. 2023;12(3):772. https://doi.org/10.3390/jcm12030772.CrossRefPubMedPubMedCentral

60.

Adams TD, Meeks H, Fraser A, Davidson LE, Holmen J, Newman M, et al. Long-term all-cause and cause-specific mortality for four bariatric surgery procedures. Obesity (Silver Spring). 2023;31(2):574–85. https://doi.org/10.1002/oby.23646.CrossRefPubMed

61.

Klein EA, Thompson IA Jr, Tangen CM, Crowley JJ, Lucia MS, Goodman PJ, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2011;306(14):1549–56. https://doi.org/10.1001/jama.2011.1437.CrossRefPubMedPubMedCentral

62.

Lingvay I, Brown-Frandsen K, Colhoun HM, Deanfield J, Emerson SS, Esbjerg S, et al. for the SELECT Study Group. Semaglutide for cardiovascular event reduction in people with overweight or obesity: SELECT study baseline characteristics. Obesity (Silver Spring). 2023;31(1):111–22. https://doi.org/10.1002/oby.23621.

63.

• Jeon E, Lee KY, Kim K-K. Approved anti-obesity medications in 2022 KSSO Guidelines and the promise of phase 3 clinical trials: anti-obesity drugs in the sky and on the horizon. J Obes Metab Syndr. 2023;32(2):106–20. https://doi.org/10.7570/jomes23032. One of the best summaries of the weight loss medication pipeline, which is replete with potential future options if efficacy and safety can be sustained.CrossRefPubMedPubMedCentral

64.

Novo Nordisk spent $11 million on Ozempic promotion. Accessed on 1 Jul 2023 at: https://finance.yahoo.com/video/novo-nordisk-spent-11-million-155418308.html.

65.

Food and Drug Administration. Medications containing semaglutide marketed for type 2 diabetes or weight loss. Accessed on 1 Jul 2023 at https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/medications-containing-semaglutide-marketed-type-2-diabetes-or-weight-loss.

66.

Jung HN, Jung CH. The upcoming weekly tides (semaglutide versus tirzepatide) against obesity: STEP or SURPASS. J Obes Metab Syndr. 2022;31(1):28–36. https://doi.org/10.7570/jomes22012.CrossRefPubMedPubMedCentral

67.

le Roux CW, Hankosky ER, Wang D, Malik R, Yu M, Hickey A, et al. Tirzepatide 10 and 15 mg compared with semaglutide 2.4 mg for the treatment of obesity: an indirect treatment comparison. Diabetes Obes Metab. 2023. https://doi.org/10.1111/dom.15148.

68.

Azuri J, Hammerman A, Aboalhasen E, Sluckis B, Arbel R. Liraglutide versus semaglutide for weight reduction-a cost needed to treat analysis. Obesity (Silver Spring). 2023;31(6):1510–3. https://doi.org/10.1002/oby.23752.CrossRefPubMed

69.

Clinicaltrials.gov. A study of tirzepatide (LY3298176) in participants with obesity or overweight with weight related comorbidities (SURMOUNT-5). Accessed on 1 Jul 2023 at: https://classic.clinicaltrials.gov/ct2/show/NCT05822830?term=NCT05822830&draw=2&rank=1.

70.

Block J. Eli Lilly to use priority review voucher for Mounjaro weight loss indication. https://seekingalpha.com/news/3961462-eli-lilly-priority-review-voucher-mounjaro-weight-loss-indication.

71.

Sarpatwari A, Kesselheim AS. Efficacy of the priority review voucher program. JAMA. 2016;315(15):1660–1. https://doi.org/10.1001/jama.2016.0386.CrossRefPubMed

72.

Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the surgical weight loss patient 2016 update: micronutrients. Surg Obes Relat Dis. 2017;13(5):727–41. https://doi.org/10.1016/j.soard.2016.12.018.CrossRefPubMed

73.

O’Kane M, Parretti HM, Pinkney J, Welbourn R, Hughes CA, Mok J, et al. British Obesity and Metabolic Surgery Guidelines for perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery—2020 update. Obes Rev. 2020;21(11):e13087. https://doi.org/10.1111/obr.13087.

74.

Blum D. An extreme risk in taking Ozempic: malnutrition: the diabetes medication has gained attention for its dramatic weight loss effects-but doctors worry that it can go too far. Accessed on 1 Jul 2023 at: https://www.nytimes.com/2023/04/21/well/eat/ozempic-side-effects-malnutrition.html.

75.

Desai D, Singhal S, Koka J. Evaluating the correlation of bariatric surgery and the prevalence of cancers in obese patients: a study of the National Inpatient Sample Database. Cureus. 2022. 14(4):e23976. https://doi.org/10.7759/cureus.23976.

76.

Aminian A, Wilson R, Al-Kurd A, Tu C, Milinovich A, Kroh M, et al. Association of bariatric surgery with cancer risk and mortality in adults with obesity. JAMA. 2022;327(24):2423–33. https://doi.org/10.1001/jama.2022.9009.CrossRefPubMedPubMedCentral

77.

Nomiyama T, Kawanami T, Irie S, Hamaguchi Y, Terawaki Y, Murase K, et al. Exendin-4, a GLP-1 receptor agonist, attenuates prostate cancer growth. Diabetes. 2014;63(11):3891–905. https://doi.org/10.2337/db13-1169.CrossRefPubMed

78.

Malczak P, Wysocki M, Pisarska-Adamczyk M, Strojek J, Rodak H, Lastovetskyi I, et al. Influence of bariatric surgery on erectile dysfunction-a systematic review and meta-analysis. Obes Surg. 2023;33(6):1652–8. https://doi.org/10.1007/s11695-023-06572-9.CrossRefPubMedPubMedCentral

79.

Loh HH, Shahar MA, Loh HS, Yee A. Female sexual dysfunction after bariatric surgery in women with obesity: a systematic review and meta-analysis. Scand J Surg. 2022;111(1):14574969211072396. https://doi.org/10.1177/14574969211072395.CrossRefPubMed

80.

King WC, Hinerman AS, Subak LL. Seven-year durability of improvements in urinary incontinence after Roux-en-Y gastric bypass and sleeve gastrectomy. JAMA Netw Open. 2022. 5(12):e2246057. https://doi.org/10.1001/jamanetworkopen.2022.46057.

81.

Lee Y, Yu J, Tikkinen KAO, Pedziwiatr M, Major P, Aditya I, et al. The impact of bariatric surgery on urinary incontinence: a systematic review and meta-analysis. BJU Int. 2019;124(6):917–34. https://doi.org/10.1111/bju.14829.CrossRefPubMed

82.

Muller RL, Gerber L, Moreira DM, Andriole Jr G, Hamilton RJ, Fleshner N, et al. Obesity is associated with increased prostate growth and attenuated prostate volume reduction by dutasteride. Eur Urol. 2013;63(6):111es 5–1121. https://doi.org/10.1016/j.eururo.2013.02.038.

83.

Nosrati F, Nikoobakht MR, Oskouie IM, Rahimdoost N, Inanloo H, Abolhassani M, et al. Does significant weight loss after bariatric surgery affect sexual function and urinary symptoms? An Iranian Study Obes Surg. 2023. https://doi.org/10.1007/s11695-023-06717-w.CrossRefPubMed

84.

Stefanova I, Currie AC, Newton RC, Albon L, Slater G, Birnie A, et al. Systematic review and meta-analysis of the impact of bariatric surgery on lower urinary tract symptoms in males. Obes Surg. 2021;31(7):3151–8. https://doi.org/10.1007/s11695-021-05403-z.CrossRefPubMed

85.

Lee Y, Dang JT, Switzer N, Yu J, Tian C, Birch DW, Karmali S. Impact of bariatric surgery on male sex hormones and sperm quality: a systematic review and meta-analysis. Obes Surg. 2019;29(1):334–46. https://doi.org/10.1007/s11695-018-3557-5.CrossRefPubMed

86.

Gao Z, Liang Y, Yang S, Zhang T, Gong Z, Li M, Yang J. Bariatric surgery does not improve semen quality: evidence from a meta-analysis. Obes Surg. 2022;32(4):1341–50. https://doi.org/10.1007/s11695-022-05901-8.CrossRefPubMed

87.

Moxthe LC, Sauls R, Ruiz M, Stern M, Gonzalvo J, Gray HL. Effects of bariatric surgeries on male and female fertility: a systematic review. J Reprod Infertil. 2020;21(2):71–86. https://pubmed.ncbi.nlm.nih.gov/32500010/.

88.

Alibhai KM, Churchill IF, Vause T, Lochnan HA. The impact of bariatric surgery on assisted reproductive technology outcomes: a systematic review. J Obstet Gynaecol Can. 2022;44(8):915–23. https://doi.org/10.1016/j.jogc.2022.04.010.CrossRefPubMed

89.

Laurenius A, Sundbom M, Ottosson J, Naslund E, Stenberg E. Incidence of kidney stones after metabolic and bariatric surgery—data from the Scandinavian Obesity Surgery Registry. Obes Surg. 2023;33(5):1564–70. https://doi.org/10.1007/s11695-023-06561-y.CrossRefPubMedPubMedCentral

90.

Thongprayoon C, Cheungpasitporn W, Vijayvargiya P, Anthanont P, Erikson SB. Ren Fail. The risk of kidney stones following bariatric surgery: a systematic review and meta-analysis. 2016;38(3):424–30. https://doi.org/10.3109/0886022X.2015.1137186.CrossRef

91.

Helmen ZM, Helm MC, Helm JH, Nielsen A, Kindel T, Higgins R, et al. Predictors of postoperative urinary tract infection after bariatric surgery. Obes Surg. 2018;28(7):1950–4. https://doi.org/10.1007/s11695-017-3095-6.CrossRefPubMed

92.

Arafat M, Norain A, Burjonrappa S. Characterizing bariatric surgery utilization and complication rates in the adolescent population. J Pediatr Surg. 2019;54(2):288–92. https://doi.org/10.1016/j.pedsurg.2018.10.089.CrossRefPubMed

93.

Semaglutide for the treatment of antipsychotic-associated weight gain in patients not responding to metformin—a case series. Ther Adv Psychopharmacol. 2023. https://doi.org/10.1177/20451253231165169.

94.

Wharton S, Blevins T, Connery L, Rosenstock J, Raha S, Liu R, et al. for the GZGI Investigators. Daily oral GLP-1 receptor agonist orforglipron for adults with obesity. N Engl J Med. 2023. https://doi.org/10.1056/NEJMoa2302392.

95.

Jastreboff AM, Kaplan LM, Frias JP, Wu Q, Du Y, Gurbuz S, et al. for the Retatrutide Phase 2 Obesity Trial Investigators. Triple-hormone-receptor agonist retatrutide for obesity—a phase 2 trial. N Engl J Med. 2023. https://doi.org/10.1056/NEJMoa2301972.

96.

Knop FK, Aroda V, do Vale RD, Holst-Hansen T, Laursen PN, Rosenstock J, et al. Oral semaglutide 50 mg taken once per day in adults with overweight or obesity (OASIS 1): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2023. https://doi.org/10.1016/S0140-6736(23)01185-6.

97.

Terhune C for Reuters. Exclusive: most patients using weight loss drugs like Wegovy stop within a year, data show. Accessed on 11 Jul at: https://www.reuters.com/business/healthcare-pharmaceuticals/most-patients-using-weight-loss-drugs-like-wegovy-stop-within-year-data-show-2023-07-11/.

98.

Reuters and NBC News. EU investigates Ozempic and weight-loss drug Saxenda after reports of suicidal thoughts. Accessed 11 Jul 2023 at: https://www.nbcnews.com/news/world/eu-investigates-ozempic-saxenda-suicidal-thoughts-reported-rcna93552.

99.

Hartmann-Boyce J, Theodoulou A, Oke JL, Butler AR, Bastounis A, Dunnigan A, et al. Long-term effect of weight regain following behavioral weight management programs on cardiometabolic disease incidence and risk: systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2023;16(4):e009348. https://doi.org/10.1161/CIRCOUTCOMES.122.009348.

100.

Theodoulou A, Hartmann-Boyce J, Gorenberg J, Oke JL, Butler AR, Bastounis A, et al. Weight regain and mental health outcomes following behavioural weight management programmes: a systematic review and meta-analyses. Clin Obes. 2023. 13(3):e12575. https://doi.org/10.1111/cob.12575.

101.

Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss in the diabetes prevention program outcomes study. Lancet. 374(9702):1677–86. https://doi.org/10.1016/S0140-6736(09)61457-4.

102.

Vinas Esmel E, Naval Alvarez J, Sacanella ME. The legacy effect in the prevention of cardiovascular disease. Nutrients. 2020;12(11):3227. https://doi.org/10.3390/nu12113227.CrossRefPubMedPubMedCentral

103.

Johnson JL, Slentz CA, Ross LM, Huffman KM, Kraus WE. Ten-year legacy effects of three eight-month exercise training programs on cardiometabolic health parameters. Front Physiol. 2019;10:452. https://doi.org/10.3389/fphys.2019.00452.CrossRefPubMedPubMedCentral

Title: Embracing the Pros and Cons of the New Weight Loss Medications (Semaglutide, Tirzepatide, Etc.)
Author: Mark A. Moyad
Publication date: 02-09-2023
Publisher: Springer US
Keywords: Bariatric Surgery
Bariatric Surgery
Semaglutide
Tirzepatide
Published in: Current Urology Reports / Issue 11/2023
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI: https://doi.org/10.1007/s11934-023-01180-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Embracing the Pros and Cons of the New Weight Loss Medications (Semaglutide, Tirzepatide, Etc.)

Abstract

Purpose of Review

Recent Findings

Summary

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 11/2023

The Potential Role of Persister Cells in Urinary Tract Infections

Pathophysiologic Insights into the Transition from Asymptomatic Bacteriuria to Urinary Tract Infection

Recent Advances in Surgical Simulation For Resident Education

The State of Urotrauma Education Among Residency Programs in the United States: A Systematic Review and Meta-Analysis

Guiding Clinical Decision Making for Surgical Incontinence Treatment After Prostatectomy: A Review of the Literature