GLP-1 receptor agonists have gained favor in recent years for treating type 2 diabetes as well as weight loss.
According to recent polls, approximately one in every eight persons in the United States, or 12%, is currently using a GLP-1 medicine such as Wegovy or Zepbound for weight loss or the treatment of a chronic disease.
Previous study indicates that most patients using a GLP-1 medicine can expect to lose 5% to 15% of their starting body weight over a year.
However, up to 20% of persons who use GLP-1s may not respond to the medicine. According to a recent study published in NatureTrusted Source, a person’s genetic makeup may influence how well they respond to GLP-1 therapy.
Another recent article, a review published in the journal Obesity Science and PracticeTrusted Source, suggests that taking both a GLP-1 medicine and a prescription that combines naltrexone and bupropion into one pill, may be beneficial for patients who do not respond to GLP-1s alone.
What is Contrave?
This review examines how gut hormone analogs, such as GLP-1 medicines and Contrave (a fixed-dose, extended-release combination of naltrexone and bupropion), affect eating behavior and the gut-brain axis.
“Contrave is a medication that acts to alter [the] brain signal (dopamine pathway) in the part of the brain (hypothalamus) responsible for controlling how hungry we feel and how much energy we burn, as well as in the part of the brain (mesolimbic system) that controls how much pleasure we feel while eating certain foods and how compulsive we feel in repeatedly seeking the same pleasure,” Muzamil Hussain, PhD, a clinical research fellow diabetes and obesity at Ulster University in the United Kingdom, and co-author of this study, told Medical News Today.
“By modifying these signals in the brain cumulatively, Contrave improves fullness and reduces food cravings, resulting in weight loss,” Hussain claimed.
“For example, some patients may seek fatty or sugary foods because their brain associates them with pleasure,” he explained. “Contrave dampens this brain response, making eating fatty or sugary foods less fulfilling (less enjoyable), and decreasing the urge to ‘comfort eat’ or seek these foods.”
A multifaceted approach to treating obesity
This work makes the case for a combined approach to treating obesity by employing both gut hormone analogs like GLP-1s and NB-ER at the same time.
“The combination of NB-ER and GLP-1 makes mechanical sense because GLP-1 basically makes a person feel full faster and lessens appetite, whilst NB-ER reduces food cravings,” Hussain noted.
“As a result, this combination may benefit individuals who struggle with binge eating, impulsive (hedonic) eating, or food cravings. It can also help those who did not lose at least 5% of their body weight with (a) GLP-1 alone.
Mir Ali, MD, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, discussed the latest review, stating that there is no one-size-fits-all obesity management.
Ali, who was not involved in the study, stated that the review’s conclusion confirms what he has observed in his own practice: patients who receive combination drug therapy tend to achieve greater results.
“Obesity is a chronic, persistent health condition, and there is no single treatment that works for everyone,” he said. “Because of response variability and other considerations, discovering new, more effective therapies is always a worthy undertaking.”
Jennifer Cheng, DO, chief of endocrinology at Hackensack Meridian Jersey Shore University Medical Center in New Jersey, acknowledged that obesity and weight loss are complex, and more research is needed to understand who will succeed and who will not.
“As someone who handles these people on a regular basis, I have directly witnessed the problems that patients face when attempting to reduce weight,” Cheng, who was also not engaged in the evaluation, told MNT.
“There is a great deal of dissatisfaction when people take the effort to give medication yet do not get the outcomes they want. Certain people are poor responders, and it is difficult to forecast who will and will not respond effectively,” she continued.
“It seems sense that adding secondary therapy or a combination of medications could help specific individuals with a more tailored approach to weight loss,” Cheng explained. “People should consult with their doctors to choose the best course of treatment.”
Cheng also stated that it is critical to identify the reasons behind a patient’s poor reaction to a medicine in order to achieve additional weight loss.
“It is also critical to identify these aspects so that people can employ alternative or combined therapies right now,” she noted. “Targeted and individualized medical care should begin sooner to assist patients in achieving success.”