As the President of the Association's Obesity Group, he managed the opening as a moderator and opened the center with one of its founders, Prof. Dr. It was a great honor for me to open with Daniel Drucker. Prof. Drucker is one of the pioneers in the discovery of the GLP-1 hormone, which is the basis of the drugs known today as "slimming injections", and in the development of treatments based on this hormone.
Prof. Dr. Daniel Drucker
The reason for establishing the center is simple... More than one billion people in the world live with obesity and treatment options change every month. Centre; It will bring together innovations, guidance, research and collaborations from around the world. A guiding scientific declaration prepared by leading experts in the field and published in the journal Endocrine Reviews was also announced at the opening. Declaration; It reveals what we know and what we still don't know, from the biology of obesity to treatment targets, from management of side effects to long-term safety.
WE SHOULD LOOK AT THE HEALTH, NOT THE SCALE
The main message of the declaration published by the Obesity Center is this... The goal should be health gain, not weight loss. Success is not just about the number on the scale; It should be measured by waist-to-height ratio, body composition, blood pressure, sugar, cholesterol, physical function, mental health and quality of life. Just like the blood sugar target in diabetes, it is desired to move to targets defined by health outcomes in obesity. The habit of routinely increasing everyone to the highest dose is also being questioned; In fact, in those who lost weight with the active ingredient tirzepatide, approximately two-thirds of the weight lost was maintained when the dose was reduced.
IT ALSO TREATS OBESITY-RELATED DISEASES
These drugs; It has very positive effects on people with prediabetes or diabetes, sleep apnea, arteriosclerosis, heart attack or high risk, kidney failure, fatty liver and fibrosis, asthma, osteoarthritis and many diseases with high inflammation, and it even extends life. In the study included in the statement, the active ingredient semaglutide (Ozempic) reduced the risk of heart attack, stroke and heart-related death in patients with cardiovascular disease by 20 percent and all-cause deaths by 19 percent. The active ingredient tirzepatide (Mounjaro) reduced the transition to diabetes by approximately 94 percent in those with prediabetes.
A significant part of the benefits such as reducing the risk of heart attack and stroke, slowing the loss of kidney function in diabetics, MASH, where fatty liver disease progresses to fibrosis, which was previously untreatable, and obstructive sleep apnea, which can be treated with a drug for the first time in history, are independent of weight and are now FDA-approved indications. It was also determined that these drugs reduced the pain in knee osteoarthritis (calcification) by more than half and increased the regeneration of cartilage by reducing the mechanical load on the joint. Approval studies in asthma are ongoing. Due to its effect on the reward center of the brain, addictions such as alcohol and cigarettes decreased by up to 49 percent.
UNCONSCIOUS USE CONSUMS THE BODY
Unconscious use of GLP-1 is a big problem. Dosage, dose escalation or reduction, and monitoring should be individualized. Everyone who uses the medicine should know why they are using it, the treatment goal, how long and in what dosage they will use it; All should be done under the supervision of a physician. Someone who takes the injection himself and does nothing else exhausts his body:
- THIRST: As the feeling of thirst decreases, the body becomes dehydrated without realizing it. Kidneys are strained and may lead to acute renal failure. Fatigue and electrolyte disturbances occur.
- VITAMIN DEFICIENCY: Due to undereating, vitamins B12, B6, B1, folic acid and D decrease rapidly, malnutrition develops and immunity decreases. Most people do not notice it because it is not checked routinely.
- BLOOD PRESSURE AND SUGAR DECREASE: Blood sugar may decrease in those who are hungry for a long time. While the vaso-relaxing effect of the drug is beneficial for blood pressure patients, it can cause serious low blood pressure in a dehydrated and hungry user.
- MUSCLE LOSS: Needling used without the addition of aerobic and resistance exercise causes muscle loss and makes it difficult to maintain the lost weight. Someone who uses slimming injections should definitely follow the "GLP-1 diet", which consists of olive oil and avocado oil, high protein fiber food, low calories and plenty of fluids. As the dose increases, vitamin, mineral and protein supplements should be added. So the problem is not with the needles, but with unconscious use.
HOW DOES IT LOSE SLIMMING?
I have written about this in this column before. These drugs also have pill forms... When we eat, our intestines secrete hormones such as GLP-1, GIP and amylin; It slows down the stomach, increases the feeling of fullness, balances sugar, and tells the brain's reward center to "stop eating." This response is seriously reduced in obesity and diabetes. GLP-1 drugs are replacement therapies for the postprandial metabolic response, just like thyroid hormone or insulin, that replace this response, which has receptors in dozens of organs.
PROTEIN SUPPLEMENT AGAINST MUSCLE LOSS
Muscle wasting is not specific to GLP-1. When you eat less than you burn, the body uses muscles for energy. This also happens when you lose weight through diet or surgery. Still, muscle loss is the most important complication of improper weight loss. It reduces the metabolic rate, and most of the weight that comes back when the drug is stopped is fat.
Repeating this cycle, the person loses muscle and gains fat each time. For prevention, 1.2 grams of protein per kilogram should be taken. Since it is often not possible to take high doses with food, protein supplements with “clean” content are required. Choice is important as many products on the market may contain heavy metals and microplastics. Resistance exercise should be done along with it.
STOMACH AND INTESTINAL SIDE EFFECTS
- NAUSEA AND VOMITING: It is the most common side effect and can be controlled. Complaints usually occur at the beginning and with rapid dose increase, are mostly mild-moderate and decrease over time. That's why those who quit the drug are around 3-6 percent. Increasing the dose much more slowly than the classic protocol, with microdoses if necessary, significantly reduces nausea. Ginger and vitamin B6 can help with this problem. Heavy fatty meals seriously increase nausea and vomiting. Eat small and frequent meals. As you chew each bite slowly, put down the fork and pick it up again after swallowing. Stop at the first feeling of fullness, use a small plate if necessary. Avoid large meals and fasting for long periods of time. Dehydration increases nausea. Drink plenty of water. If solid food is difficult, you can drink protein shakes or smoothies. High-protein yogurt or soup with unflavored protein powder added to it are also good options. Sour tastes such as lemon juice, pickles and olives and cold foods with little odor are tolerated more easily.
- CONSPOSITION AND REFLUX: Slowing down digestion is actually a metabolic benefit, but it can cause constipation, bloating and gas. Increase water consumption. Increase insoluble fiber (whole grains, vegetables, nuts), which speeds up bowel movement, and use powdered fiber supplements if necessary. Increase movement. If you eat close to bedtime, stomach contents come back and reflux occurs. Cut out heavy meals as much as possible before bedtime.
- DIARRHEA: It is less common than constipation. Increase soluble fiber (oats, bananas, apples), which solidifies the stool. Choose small meals. Stay away from fatty, sugary and spicy foods. It may be necessary to add electrolytes to the water. Especially in cases of gastrointestinal infections due to a poor quality meal, food poisoning, or ingestion of bacteria or toxins, regardless of the medication, diarrhea may last much longer and more severely in someone using slimming injections. In this case, it is vital to replace fluid loss.
- HAIR LOSS: It is not a direct effect of the drug, but a common result of rapid weight loss. Getting enough protein every day, using a daily multivitamin in tablet or capsule form, and having your iron, biotin, vitamin D, B12 and zinc levels checked by your doctor will help hair regrow.
BEWARE OF FAKES
Beware of fake "slimming injections" prepared with uncertain purity and quantity, except by original manufacturers! Numerous complaints and dozens of deaths have been reported regarding these products.
Self-treatment with products purchased from social media, the internet or under the stairs has become a growing serious public health problem in our country.
