Obesity is a problem for half of citizens

A new, popular anti-obesity drug, a powerful weapon in the hands of doctors, will soon be available in Montenegro, but experts warn that this medication can only be taken on the basis of a doctor's prescription, and never on its own.

Almost half of the population in Montenegro is overweight or obese, as are more than a third of children. These figures represent a huge problem or challenge, which is why doctors, above all, remind about healthy lifestyle habits and nutrition in order to reduce the health and socio-economic consequences for patients and the healthcare system.

The drug 'ozempic' in strengths of 0,25 mg, 0,5 mg and 1 mg was registered, i.e. received a marketing authorization in Montenegro in January 2022, for the treatment of type 2 diabetes and with an approved prescription regimen. Abuse of this drug, for the purpose of weight loss, has been recorded both in Montenegro and around the world, including among celebrities.

At the end of March this year, the Montenegrin Institute for Medicines and Medical Devices registered "wegovy" with the same active substance for the long-term treatment of obesity, which will be approved for patients in Montenegro exclusively with a doctor's prescription.

Obesity and diabetes are a major problem and challenge

Internist endocrinologist Đorđije Krnjević, medical director of the Clinical Center and president of the Montenegrin Association for the Study of Obesity MASO, tells "Vijesti" that according to estimates, around 50.000 citizens in Montenegro have diabetes, of which around 30.000 are included in the registry.

"The national prevalence of diabetes is around 11 percent. In other words, every tenth adult citizen of Montenegro has diabetes, and every third person with diabetes has not been diagnosed. This unfortunately places us high among European countries," he points out.

At the same time, claims Krnjević, almost 50 percent of our adult population is overweight or obese, while that percentage among children is around 35 percent.

These data, he warns, tell us that diabetes and obesity are highly prevalent among our population and as such represent a major health and socio-economic problem and challenge.

All these patients, explains Krnjević, are at high risk of developing cardiovascular diseases, neurological diseases, diseases of the locomotor system, weakened lung function, kidney disease, cognitive function disorders, sterility, etc.

"Changing lifestyle habits, adequate nutrition, physical activity, quitting smoking, avoiding stressful situations, spending time in nature, adequate hydration and quality sleep are what we need to prevent and reduce the prevalence of diabetes and obesity among our population. Education from an early age, respecting the postulates of healthy lifestyle habits, regular check-ups, consultations and accepting advice from professional and competent people are the best way to prevent the development of these chronic diseases," emphasizes Krnjević.

What are Ozempic and Wegovy used for?

Asked who the drugs Ozempic and Wegovy are intended for and under what conditions they are prescribed to patients, Krnjević explains that they belong to a group called GLP1 receptor agonists and are intended for the treatment of type 2 diabetes and obesity.

"Both of these drugs contain the same active substance, semaglutide. The difference between them is not only administrative, but also manifests itself in the different goal of therapy, patient profile, accompanying comorbidities and patient needs. So although the molecule, or active substance, is the same, their purpose, dosage, goals of therapy and patients to whom they are prescribed are not the same," the doctor points out.

He explains that Ozempic is primarily intended for the treatment of type 2 diabetes and is registered in Montenegro exclusively for that indication. Its main task, he claims, is to help regulate blood sugar.

"This drug primarily has an effect on the pancreas, improving beta cell function, thereby reducing hyperglycemia. The reasons for using this drug off-label lie in the side effects of the drug. Namely, it reduces appetite and food cravings, which is why we eat less food. On the other hand, it also slows down stomach emptying, which is why we feel fuller longer after a meal. Due to the combination of these two effects, many consumers of this drug lose a significant amount of weight. This fact has been confirmed through numerous clinical studies in which a favorable cardio and renoprotective effect has been confirmed, i.e. a positive effect on the heart and kidneys, as well as a favorable effect on non-alcoholic fatty liver. Due to all these benefits, the drug is highly positioned in all relevant guides to good clinical practice in the treatment of diabetes," Krnjević points out.

On the other hand, he says that Wegovy was developed and registered as a drug for the long-term treatment of obesity.

He states that the primary therapeutic goal for him is to reduce body weight and maintain the achieved weight loss over time.

"The drug Wegovy is therefore used in higher doses of semaglutide than Ozempic, so that the effect on the hunger and satiety centers is more pronounced. It will be available in Montenegro in the third quarter of this year and will represent a powerful weapon in the hands of doctors for the treatment of obesity," says Krnjević.

Therapy only with a doctor's decision and prescription

The doctor emphasizes that these medications cannot be used arbitrarily, nor can they be interchanged without a doctor's decision and on the recommendation of the lay and non-professional public.

"Each of them has a clearly defined indication, dosage and treatment plan. They have an extremely favorable safety profile and, as two innovative drugs, they underwent extensive and long-term trials to assess efficacy and safety before becoming available to patients," he explains.

Krnjević claims that, however, these drugs can also cause certain side effects such as allergic manifestations, nausea, vomiting, diarrhea, bloating. They are also contraindicated in patients with acute pancreatic disease, pregnant women, children, and patients with type 1 diabetes.

"If these drugs are combined with other antidiabetic drugs, especially insulin, hypoglycemia, or a sudden drop in blood sugar, can occur. It is also important to note that some patients purchased counterfeit Ozempic outside of Montenegro, most often in neighboring countries, and such cases were reported to the manufacturer. In this way, individuals were endangering their health and the consequences could have been truly serious," he says.

Krnjević warns that, due to all of the above, it is clear that these can only be taken based on the recommendations of professionals - doctors, in institutions that are registered and intended for the adequate distribution and sale of medicines and medicinal products, and with an appropriate doctor's prescription.