How close are we to developing a metabolic weight loss pill?

Written by: Dr Alexander Miras
Edited by: Jay Staniland

Over the years, bariatric surgery has evolved from a focus on weight loss to a treatment for health gain. Discoveries made using surgery to reduce hunger and increase fullness, have led to a shift in focus onto using surgery to make changes to the metabolism. With these discoveries are we moving toward the development of a multipurpose metabolic pill capable of causing weight loss?



The evolution of metabolic surgery


Over 30 years ago, bariatric surgery was seen as potentially risky, but with the introduction of a laparoscopic (keyhole surgery) approach it has become one of the safest types of surgery available.

With the realisation that bariatric surgery was superior to lifestyle changes in creating a widespread improvement in not only weight loss, but also the general health of the patient, the focus moved ever more in the direction of metabolic surgery.

Metabolic surgery is the term given to surgery that changes the metabolism of the patient. In recent times, there has been the discovery that procedures such as the gastric bypass, and sleeve gastrectomy have seen fascinating effects on type 2 diabetes. Within 48 hours of leaving the hospital after having a gastric bypass operation, patients see normal glucose levels without the need for medication whatsoever, leading the procedure to be hailed as a cure for type 2 diabetes. Not only did the procedure bring a solution to diabetes, but also had significant weight loss benefits.

This type of surgery doesn’t only have to be for obese patients, as metabolic surgery as a cure for metabolic dysregulation can even be used in patients with a BMI less than 35.

Metabolic surgery has also seen improvements in cardiovascular problems, retinopathy, neuropathy and even cancer death rates.


Why do we need a magic pill?


Although there are many benefits seen from metabolic surgery, there are some complications associated with it. These include the usual risks associated with surgery, such as bleeding and infection, possible medical complications such as malnutrition and nutritional deficiencies, and the unwillingness of some patients to have surgery.

The development of a multipurpose pill that can change the metabolism of the patient would be greatly beneficial, but is it possible?

In terms of weight loss, there is no medication that could have the degree of success seen from surgery. Mechanical restriction and calorie malabsorption cannot be achieved with a pill. However, the benefits seen on glucose control and organ damage could possibly be achieved, as nutritional interventions, pharmacotherapy have developed at a rapid rate and the mechanisms and effects on physiology discovered and understood through metabolic surgery could lead to the development of a metabolic pill.

Developments have been made on the possible ingredients of the metabolic pill, and have been seen to reverse non-alcoholic fatty liver disease (steatohepatitis), improve diabetic nephropathy, and reduce death rates from cardiovascular events.

These ingredients have very few side-effects, and will work together well. Other possible ingredients to consider could be macronutrients and monounsaturated and polyunsaturated fatty acids, the healthy fats found in a Mediterranean diet that have shown an improvement in glucose control.


The future of metabolic surgery


Metabolic surgery has opened the door to understanding how surgery helps to improve health as well as cause weight loss. With these developments, pharmacological developments could lead to a multi-purpose pill that greatly improves metabolism, and though the benefits of surgery may not be matched by medication, there is promise to use a pill in conjunction with surgery to see even better results for the patient.

If you are concerned about obesity or diabetes, make an appointment with a specialist.

Dr Alexander Miras

By Dr Alexander Miras
Endocrinology, diabetes & metabolism

Dr Alexander Miras is a leading London-based consultant endocrinologist, and a clinical senior lecturer in metabolic medicine at Imperial College London. He specialises in obesity and type 2 diabetes, and was awarded a clinical research training PhD fellowship, investigating the effects of bariatric surgery on food reward, studying neuroimaging and behaviour in both humans and rodents. He also has interest in the mechanisms through which lifestyle interventions, pharmacotherapy, bariatric surgery and medical devices improve weight, metabolic control, and diabetes complications, and has published numerous peer-reviewed articles on these topics. Dr Miras has also received a number of awards, including the Nutritional Society Cuthbertson Medal, and is a SCOPE national fellow at the World Obesity Federation. 

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