Lose belly fat, hurt less (because metabolism)
A new trial of Ozempic-type drugs (semaglutide) for arthritis is an amazing example of the kind of effect on pain that we’d like to see from more studies: substantial and lasting … blazingly obvious on a graph … statistical significance and clear clinical significance? Am I dreaming?
These drugs reduce blood sugar and treat obesity, with a variety of downstream benefits that are still being studied. Add “great for arthritis” to the list. How does that work? Asaf Weisman (in the comments on his post):
Belly fat is active tissue that secretes adipokines and other pro inflammatory agents which contribute to epigenetic changes that accelerate tissue degeneration.
We’ve had many reasons to suspect this for a long time, but this is a good quality placebo-controlled trial of an effective weight loss drug in humans, and so it’s case closed: lose belly fat, hurt less.
I do worry that this evidence could inspire excessive “just lose weight” advice, justify fat-shaming, and result in misplaced blame on loading (wear and tear) instead of metabolism. The “just” part of “just lose weight” is just wrong! There’s nothing “just” about losing weight.
But if this is actually how things work, then we must just forge ahead as best we can: education, education, education! At least this gives us a strong evidence-based direction to go. This study probably deserves another more detailed post in a while.