Difficult to escape severe obesity with exercise and diet

In Korea, bariatric metabolic surgery has been covered by national health insurance since January 2019, making it accessible to severely obese patients. There are two main types of bariatric metabolic surgery, one of which is sleeve gastrectomy. This surgery involves significantly reducing and excising the part of the stomach that can store food.

He explained that the reason obesity persists is not simply because the stomach is large, but because of the body's efficiency, which has evolved to survive on less food. Such a body maintains itself with remarkable efficiency even in an environment where it can eat very little. A real case involved a patient who lost over 20kg in 3 months and successfully lost a total of 26kg by the 6-month mark.

However, even after bariatric metabolic surgery, the body exhibits a strong endocrine system regulation phenomenon that tries to return to its original weight. Professor Jang Hyung-woo revealed that about 4 years after surgery, he had regained 12kg, bringing his weight to 102kg. This phenomenon shows that while surgery can be a temporary solution, it is difficult to change the body's inherent long-term tendency to maintain obesity.

Serious health problems also occurred as weight increased again. Professor Jang Hyung-woo mentioned that as his weight increased again, a more dangerous type of arrhythmia, ventricular arrhythmia, appeared, different from before. This suggests the possibility of it being a precursor to coronary artery disease, warning that obesity-related complications can threaten life beyond mere discomfort.

Professor Jang Hyung-woo emphasized that coronary artery disease has an irreversible characteristic: once damaged, it only progresses and cannot be reversed. Therefore, he explained that even if one loses weight, the already damaged coronary arteries do not return to their original state, making prevention and early management very important.

Wegovy began to be prescribed in Korea on October 17, 2024. Professor Jang Hyung-woo personally experienced weight loss independent of diet and without special effort after being prescribed and taking Wegovy. He pointed out that while countless pieces of advice on exercise and diet abound, in reality, many problems can be solved at once through medication.

Professor Jang Hyung-woo said he felt regret over the reality that severely obese patients desperately needing obesity treatment hesitate to get a prescription. He revealed that seeing patients who hesitated, saying they would 'try it alone' or 'think about it,' led him, as a doctor, to write a book to convey correct information about obesity treatment and improve awareness.

Professor Jang Hyung-woo confessed that he suffered from obesity since childhood. He revealed that he was among the heaviest in his class from second to third grade and already weighed over 100kg in his second year of high school. This long personal struggle with obesity has provided him with a deep understanding and empathy for obesity treatment.

Professor Jang Hyung-woo stated that after using obesity medication, his severe fatty liver diagnosis and liver enzyme levels, which were more than double the normal, all returned to normal. This means that obesity treatments like Wegovy and Mounjaro are effective not only for weight loss but also for treating fatty liver, and are actually listed in clinical recommendations for fatty liver treatment. Blood pressure reduction and improved HbA1c levels were also confirmed, explaining that obesity treatments have a positive impact on various metabolic diseases.

Professor Jang Hyung-woo pointed out that the 'piecemeal' approach of individually treating numerous complications arising from obesity, such as muscle pain, joint pain, depression, diabetes, and hyperlipidemia, is inefficient. He emphasized that instead of taking medication for joint pain, depression medication for depression, and diabetes medication for diabetes, simply losing weight can naturally eliminate 90% of these conditions. This suggests that weight loss is a fundamental solution to obesity-related diseases.

Professor Jang Hyung-woo emphasized that it is very difficult to escape severe obesity with exercise and diet alone, citing the results of the Wegovy clinical trial. In the 68-week trial, there was a significant difference in weight loss between the control group, which combined exercise and diet, and the treatment group, which was given Wegovy. For the control group, despite intense efforts that were difficult to maintain lifelong, the extent of weight loss was limited.

He argued that through these clinical results, severely obese patients must realize that achieving or maintaining desired weight loss goals with exercise and diet alone is virtually impossible.

Nevertheless, he pointed out that many people still adhere to conventional perceptions about exercise and diet.

Professor Jang Hyung-woo refuted that a few exceptional cases of successful weight loss through diet and exercise alone cannot represent medical universality. He emphasized that such atypical cases do not apply to most people, and medical judgments should be based on statistical significance derived from treating hundreds of patients. He explained that a single success story alone cannot be given medical value.

In the case of the obesity drug Mounjaro, about 10% of patients show minimal effectiveness. Professor Jang Hyung-woo explained that these cases are mainly due to genetic mutations, where the 'key' between the hormone receptor and the drug does not match. However, he pointed out that most reported cases of ineffectiveness are often due to insufficient dosage, not taking it for a sufficiently long period, or irregular administration of the drug.

Professor Jang Hyung-woo expressed skepticism about the term 'natural Wegovy'. He pointed out that such expressions are essentially just a type of low-carb, high-fat diet, and are likely marketing ploys by 'keyword marketers'. He re-emphasized that diet alone cannot be a fundamental solution to overcoming obesity, stressing the importance of medication.

Wegovy and Mounjaro are both medications used for obesity treatment, but with slight differences. Professor Jang Hyung-woo explained that when he used Wegovy, he experienced mild nausea in the morning, but this symptom disappeared when he switched to Mounjaro. Both drugs can commonly cause mild constipation, and Mounjaro is known to result in greater weight loss at maximum doses.

Oral Wegovy has already been launched in the United States, and its effectiveness proven. Professor Jang Hyung-woo stated that he would gladly switch to an oral medication if it were as effective as injectables and cheaper. Currently, various next-generation obesity treatments like 'Pounday' are under development, and the key to these new drugs lies in how well they can maintain current weight loss effects.

Professor Jang Hyung-woo expressed regret that many severely obese patients desperately need obesity treatment but cannot receive prescriptions due to economic reasons. He predicted that patient accessibility would increase if generic versions become available and prices drop due to patent expiration. He emphasized that for patients with serious health risks such as cardiovascular disease, obesity treatment is essential and directly linked to life. He stressed the urgent need for government policy support for severely obese patients for disease treatment purposes, not cosmetic.

Professor Jang Hyung-woo emphasized that there is a group of people who should absolutely not be given obesity drugs like Wegovy or Mounjaro. This is due to insufficient data to guarantee safety, and prescriptions are particularly not allowed for those with a history of chronic pancreatitis or medullary thyroid cancer. Additionally, prescriptions are restricted for those planning or currently pregnant, and those who are breastfeeding. Special caution is needed for specific cases where safety has not been confirmed in animal studies or similar situations.