Category: Obesity

The battle of weight loss drugs: which is better? Mounjaro versus Ozempic.

Mounjaro is the winner !

The question has been answered by a high quality trial published in the premier medical journal ( New England Journal of Medicine).

Mounjaro is the winner !

Mounjaro is the brand name of the weight loss drug called Tirzepatide.

Mounjaro has come out on the top when it was compared to the other popular weight loss drug called Ozempic.

Ozempic is the brand name of the weight loss drug called semaglutide. Wegovy is another brand name for semaglutide .

A total of 751 participants were invoked in this trial . The trial was conducted very recently between April 2023, and November 2024.

Nearly 20% of those having Mounjaro injections had lost at  least 30% of their weight but only about 7% of people having Ozempic/ Wegovy injections lost that amount of weight.

Remember- the weight loss injections are not a one time silver bullet. Most people put the weight back on when they stop the injections. 

A healthy diet remains a very important part of weight loss.

References

  1. NEJM Tirzepatide as Compared with Semaglutide for the Treatment of Obesity. L.J. Aronne and Others. DOI: 10.1056/NEJMoa2416394 | May 11, 2025.
  2. Guardian. People who stop weight loss drugs return to original weight within year, analysis finds (Research raises questions about long-term treatment of and support for people using weight loss drugs). Anna Bawden Health and social affairs correspondent in Málaga. Wed 14 May 2025 20.00 BST

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information research only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options, which are relevant and specific to you. The views expressed in this blog are NOT, in any way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Should NHS bribe people to adopt a healthy life style?

A recent study conducted in U.K. later looked at the problem of smoking in pregnant women.

The study gave money to pregnant women if women stopped smoking.

The study found that giving money up to 400 pounds made some women stop smoking but sadly, the women stopped smoking only for a short period. After six months, there was NO significant difference between women given money and women given only usual advice about smoking.

The first issue with this study is the principle of “inducing / bribing” people with money to give up unhealthy habits. Shouldn’t the healthcare staff educate women rather than giving money for bad behaviour?

The second issue is no one knows whether the money was used wisely. Pregnant women who smoke are likely to have other vices such as unhealthy diet, physical inactivity, alcohol misuse, use of recreational drugs etc. Unhealthy behaviours cluster.

Giving money may have encouraged the women to stop smoking temporarily but the money could have used by women to replace smoking with other unhealthy behaviours. Unfortunately, the study doesn’t seem to looked at this problem.

In the study, two thirds of adverse events occurred in women given money vouchers. The authors have naively dismissed them as unrelated. The increase in adverse events suggests that women, who were given money, may have used the money unwisely. Perversely this well intentioned attempt to encourage good behaviour seem to have caused harm !

First, do no harm should be motto of healthcare staff .

Finally, most women who smoke during pregnancy are likely to be from lower socioeconomic group. Poverty is the underlying reason for most of their problems in life including unhealthy habits.

The Healthcare staff in UK are dealing with multiple crisis at present. It is beyond the ability of NHS staff to deal with poverty. The government through social services and public-health team should deal with poverty.

Read my reply at BMJ rapid response and contribute your thoughts through BMJ rapid response

References

Sundar S. Clustering of unhealthy behaviours and medicalisation of unhealthy lifestyles.

Effect of financial voucher incentives provided with UK stop smoking services on the cessation of smoking in pregnant women (CPIT III): pragmatic, multicentre, single blinded, phase 3, randomised controlled trial. BMJ 2022; 379 doi: https://doi.org/10.1136/bmj-2022-071522 (Published 19 October 2022)

Jefferies D. The steady crisis across the NHS. BMJ 2022;377:o1566. doi:10.1136/bmj.o1566

Sokol D K. “First do no harm” revisited BMJ 2013; 347 :f6426

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in any way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Wearable Technology: are Physical activity and Fitness monitors useful ?

Once we come out of this COVID pandemic, everyone’s attention needs to be focused on the obesity pandemic.

During the COVID pandemic, lot of people started to focus on their physical fitness. People invested in Home Exercise equipment and in wearable technology such as Fitness monitors.

Even before this pandemic, lot of people have started using Fitness monitors.

Are they any good?

A recent study published in British Medical Journal (BMJ) looked the effectiveness of physical activity monitors.

The study authors looked at more than 120 trials involving more than 16 700 participants.

Most of studies they looked at were either European (31%) or North American (40%). Most of these studies included healthy participants (47%), although some included overweight participants (17%).

They found Fitness monitors are generally safe and help to increase physical activity.

Whether the Fitness monitors will help overweight people to lose weight permanently over long term needs further investigation.

References:

Effectiveness of physical activity monitors in adults: systematic review and meta-analysis. BMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2021-068047 (Published 26 January 2022)Cite this as: BMJ 2022;376:e068047

Gov.UK. Physical activity: applying All Our Health
Office for Health Improvement & Disparities
Guidance. Physical activity: applying All Our Health. Updated 16 October 2019

Bravata DM, Smith-Spangler C, Sundaram V, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007;298:2296-304. doi:10.1001/jama.298.19.2296 pmid:18029834.

Activity monitors for increasing physical activity in adult stroke survivors
Elizabeth A Lynch et al. Cochrane Database Syst Rev. 2018.

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in any way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Do statins cause muscle aches and pain ?

Yes, Statins can cause muscle aches and pains.

But the number of people getting it is very small and in vast majority of people, the symptoms are not serious.

Most importantly, the benefits of statins outweighs the risk of side effects.

That is the conclusion of a study published in BMJ medical journal.

References

BMJ. Associations between statins and adverse events in primary prevention of cardiovascular disease: systematic review with pairwise, network, and dose-response meta-analyses
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1537 (Published 15 July 2021)
Cite this as: BMJ 2021;374:n1537

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s personal views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is NOT previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice.

Vaccine for the obesity pandemic !

As the world battles the COVID-19 pandemic , there is another pandemic that been going on for decades without any end in sight.

The other pandemic is obesity !

Obesity has caused far more deaths than the COVID-19 pandemic.

The Vaccines promise to end the COVID-19 pandemic.

Wouldn’t it be wonderful if a vaccine can sort the obesity pandemic ? It does not need to be rhetorical question or wishful thinking.

An article in Science magazine reports an association between obesity and a type of body immune cell called macrophages. This raises the possibility of using immunotherapy for obesity.

There is also another tantalising possibility. Behaviours, emotions and eating wrong type of food are often blamed for obesity. What if the entire scientific thinking about obesity is wrong?

In the past, another widespread condition used to be blamed on wrong food and stress. Stomach ulcers used to be very common and very distressing. Modern stressful life, emotions and wrong type of food were universally blamed for stomach ulcers. Then an Australian team proved stomach ulcers were due to an infection. Now stomach ulcers are routinely treated by antibiotics!

Obesity is common among the disadvantaged people in society. All types of infections are common in disadvantaged people. So it is not beyond the realms of plausiblity to hypothesise (suggest) that obesity could be caused by an infectious agent that affects food intake in some way, by possibly affecting sense of taste or smell of smell or feeling of fullness after eating (satiety).

If an infectious agent (e.g bacteria, virus or prion) is indeed found to be responsible for development of obesity, then the vaccines would provide a very easy way to prevent obesity.

Please note: The science magazine article on immunotherapy is based on excellent, high quality scientific work. But the possibility of an infection being responsible for obesity is merely a scientific hypothesis or scientific suggestion. It is based on a personal hunch. It is NOT based on any direct high quality scientific data at this stage !

References

Science Magazine. An anti-obesity immunotherapy? https://science.sciencemag.org/content/373/6550/24

BBC. Over a million hospital admissions for obesity
By Sophie Hutchinson
BBC News

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s personal views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is NOT previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice.

What has ‘Public health’ ever done for us ?

An apple a day might not keep the doctor away. But a good public health team can keep the doctors away for many people!

Public health is about prevention and promotion of health in the society.

Public health is largely responsible for the significant improvements in life expectancy over the last 150 years.

Providing people with clean drinking water, removal of rubbish from houses and streets, good sewage system, and vaccination has saved many millions of lives over the years.

The recent smoking ban in work-places, public places and indoor venues is a modern example of public health activity.

The one area where public health has not been hugely successful is obesity. It may be because of the reliance on nudging the individual to change rather than dealing with underlying structural problems.

Read my letter in BMJ and make your views known at the BMJ rapid response section.

Sundar S. Public health needs to go back to basics, not rely on nudge theory.

Toll-free link:
http://bmj.com/cgi/content/full/bmj.n1153?ijkey=CUQNozGH9yJeK57&keytype=ref

References:

BMJ. Lifestyle and socioeconomic group on health
Public health needs to go back to basics, not rely on nudge theory
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1153 (Published 06 May 2021)
Cite this as: BMJ 2021;373:n1153

BMJ. Short term impact of smoke-free legislation in England: retrospective analysis of hospital admissions for myocardial infarction
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2161 (Published 08 June 2010)
Cite this as: BMJ 2010;340:c2161

BMJ. Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n604 (Published 14 April 2021)
Cite this as: BMJ 2021;373:n604

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation the author is associated with. The views expressed in this blog are not in way intended to be a substitute for professional advice.

Low Carb diet for Diabetes: what is the scientific evidence?

Low Carb diet is often used for weight loss.

A recent “Study of Studies” published in BMJ shows that Low-Carb-diet is beneficial for diabetes control and remission.

The beneficial effects seem quite remarkable in the first six months but there is uncertainty about the long term effect.

Before you consider the Low-Carb-diet option, do discuss it with your doctor.

What replaces the Low-Carb-Diet is also important. Long term Low-Carb-Diet with animal protein seems to be bad for health.

Do consider plant based proteins instead .

References: Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data.
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.m4743 (Published 13 January 2021)
Cite this as: BMJ 2021;372:m4743

Seidelmann SB, Claggett B, Cheng S, et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health2018;3:e419-28. doi:10.1016/S2468-2667(18)30135-X pmid:30122560

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and the authors views are NOT in way intended to be a substitute for professional advice.

Obesity kills but is losing weight in old age also risky ?

Losing weight is a New year resolution for many people. There is no doubt that having a normal weight is healthy overall.

But there is always some degree of uncertainty with any health advice and this BMJ paper certainly gives “food for thought”.

Before you read further , you have understand that there are varying degrees of being overweight. BMI ( Body mass index) is the scientific way of looking at body weight issues and it is calculated using height and weight.

Based on BMI, people are usually classified into three groups:

(a) underweight and normal weight (BMI<25)

b) overweight (BMI 25.0-29.9)

(c) obese (BMI ≥30.0)

There is no doubt that obesity is bad for health. The BMJ paper not supringly found obesity in adulthood increased the risk death.

But, intriguingly, just being overweight only without being obese does NOT seem to have MAJOR impact on risk of death in adults.

Paradoxically, the study found that “weight loss from middle to late adulthood was associated with increased risk of death”

It is large well designed study but nevertheless results of observational studies need to be interpreted with caution.

The message from this study is “do not gain excessive weight during early adulthood“. Losing the excessive weight later on might not undo the damage already done to the body.

References:

(1) Weight change across adulthood in relation to all cause and cause specific mortality: prospective cohort study.

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l5584 (Published 16 October 2019) Cite this as: BMJ 2019;367:l5584

(2) Free NHS calculator for BMI ( Body mass index calculation) and advice regarding Body mass index.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.