This story could have been helped by more insightful independent perspective, but, overall, readers got a decent explanation of the study’s design, and on the small scale of the benefits, and on the possible side effects.
A weight loss drug that works wonders and has few side effects has eluded researchers and pharmaceutical companies for decades. As the story points out, “For obese men and women who can’t control their weight through diet and lifestyle changes, nonsurgical options are limited.” This is likely why the U.S. National Institutes of Health funded the research. Everyone wants to find a way to stop the rising obesity epidemic. And just telling people to eat less isn’t working.
Zonisimide’s cost is known. It is already being used as an antiseizure medication. The story could have discussed its cost in that setting. Instead, this is one of the 70% of stories we review that include only claims (“shows promise” in this case) but nothing about what the promise costs.
We weren’t very happy with the headline and lead of this story, because they make the benefits sound more spectacular than they really were. The story goes on to explain, though, that a larger percentage of the study participants who took the highest does of the drug managed to lose 5 percent of their weight. The story says, “Although nearly 55 percent of those on the higher-dose medication shed 5 percent or more of their pre-study weight, that figure was 34 percent among the lower-dose group and 31 percent among the non-medication participants.”
Nice job mentioning side effects in the third sentence, followed by a paragraph later in the story that spells them out: “But patients in both drug groups faced a higher risk for side effects, including diarrhea, headache, fatigue, nausea/vomiting, concentration and memory difficulties, anxiety, and depression-related symptoms.” While we wish the story had quantified how much higher the “higher risk” really was, we’ll give it the benefit of the doubt for the things it did satisfactorily.
The story provided good detail on the study methods. Here’s one example, “Between 2006 and 2011 the study team randomly assigned more than 200 obese men and women to one of three groups. One group took 200 milligrams of zonisamide daily, another got 400 mg of zonisamide daily and one received a dummy pill. The participants’ average age was 43, and their average body-mass index (BMI) was nearly 38. BMI is a calculation of body fat based on height and weight, and a BMI of more than 30 is considered obese. None had diabetes.” We would have liked to have seen some critical analysis about any possible limitations for a study like this. For example, even the researchers explained:
“A notable limitation of this trial is that most patients did not have significant weight-related comorbidities. At baseline, patients had normal blood pressure, lipid levels, and glycemic measures. Reduction in risks associated with obesity is most demonstrable when patients with risk factors are enrolled. This is a consideration for future investigation.”
The story does not engage in disease mongering.
The story is almost entirely reliant on one source, the lead author of the story. It does quote one independent expert, but it’s at the very end of the story and, in effect, is an endorsement of the study’s findings. We are certain that other weight loss experts would have had more insightful or critical comments to make.
The story does mention the other drugs offered to treat obesity, but it does not make a clear comparison. It says, “Just a few prescription medications are approved in the United States for long-term treatment of obesity, including orlistat (brand name Xenical) and lorcaserin hydrochloride (Belviq).” It does, though, explain how the drug stacked up against diet alone, saying, “Patients who took 400 milligrams of the anti-seizure drug zonisamide daily for a year lost nearly 7.5 pounds more on average than those assigned to dietary and lifestyle changes alone, the new study found.”
The story could have discussed costs and compared side effects and weight loss to the other two drugs. It wouldn’t take much time, space, or words to do so.
The story notes that zonisamide is already used as an anti-seizure drug. It did not discuss whether it’s used off-label for weight loss.
From an availability perspective, it also didn’t provide enough detail about this statement:
“All study participants followed their treatment plan for one year. During this time, they all also received monthly individualized nutritional counseling, which Gadde described as “not intensive,” to help them reduce their overall caloric intake.”
What does “not intensive” actually mean? Since this was part of the treatment “package,” how generalizable is this approach? What kind of setting would be capable of delivering it? The vague “not intensive” comment just isn’t helpful at all.
The story does explore the novelty of the drug in question and makes it clear that the current study is building on past work. The story says, “Gadde and colleagues set out to follow up on a 16-week investigation they conducted in 2003 that had indicated that zonisamide (Zonegran) at a dosage of 400 milligrams a day might offer an alternative.”
The story does not appear to rely on a press release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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