Part C

In this part of the test, there are two texts about different aspects of healthcare. For questions 1-8, choose the
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answer (A, B, C or D) which you think fits best according to the text. B
C
Fill the circle in completely. Example: D

Text 1: Obesity drugs

At a recent conference on obesity, a larger-than-usual audience awaited a presentation on the results of a drug
trial. Semaglutide, already approved in the USA to treat diabetes, had been trialled as an anti-obesity medication on

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teenagers , a group notoriously resistant to weight loss treatment. The results were astonishing: a weekly injection,
along with some lifestyle changes, reduced body weight by at least 20% in more than a third of participants.

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Previous studies had shown similarly impressive results in adults. The presentation concluded like no other, says
obesity specialist Dr Susan Yanovski: sustained applause echoed through the room ‘like you were at a Broadway

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show’.

After decades of work, researchers are finally seeing signs of success: a new generation of anti-obesity

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medications that drastically diminish weight without the adverse reactions that plagued previous efforts. These
drugs are arriving in an era in which obesity is growing exponentially. They work by mimicking incretins, the

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hormones which lower blood sugar and curb appetite. Some have already been approved for treating type 2
diabetes, and they’re starting to win approval for inducing weight loss.

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The ability to melt weight away by tweaking biology gives credence to the categorisation of obesity as a disease. In
the past, many believed that those with obesity simply lacked the willpower to lose weight. But evidence is growing
that most people’s bodies have a natural size that can be hard to change. ‘The body will defend its weight,’ says
chemist Richard DiMarchi. However, some researchers worry that these drugs play into societies’ obsession with
thinness. After all, body size isn’t always a good predictor of health. ‘I’m hesitant to be excited about something I
think is potentially harmful from a weight stigma perspective,’ says psychologist Sarah Nutter.

The seeds of today’s success were sown decades ago, when molecular geneticist Jeffrey Friedman was racing
to figure out which gene mutation was making the mice in his laboratory eat until they became obese. Friedman
discovered that the faulty gene encoded leptin, a hormone which induces a feeling of fullness. Giving leptin
supplements to mice that lacked it reduced their hunger and body weight. ‘That revolutionized our thinking about
the biological basis of obesity and appetite regulation,’ Yanovski says. An explosion of research into obesity’s
underpinnings followed, alongside research into pharmacological treatments.

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 08/16

 Semaglutide mimics a hormone called GLP-1, which affects brain receptors that govern appetite. Another new
drug, tirzepatide, also mimics another hormone known as glucose-dependent insulinotropic polypeptide (GIP).
Trials have indicated that tirzepatide leads to even greater weight loss than semaglutide. It does, however,
have researchers puzzled. It’s clear how GLP-1 helps to spur weight loss, but GIP’s role is a surprise. Mice with
dysfunctional GIP receptors are resistant to obesity. Therefore, to induce weight loss, researchers thought the
receptor should be switched off. But tirzepatide does the opposite. ‘We were the first to come up with this idea,’
says biologist Timo Müller, ‘and we were quite heavily criticized.’ Müller and his colleagues knew that, like GLP-1,
GIP stimulates insulin secretion depending on blood glucose levels, so they developed molecules that mimicked
both hormones. However, medical physiologist Jens Juul Holst feels that tirzepatide is simply a super powerful

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GLP-1 imitator, and while it can also mimic GIP, ‘it doesn’t really matter in patients with diabetes and obesity,

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because the GIP part doesn’t really do anything,’ she says. Early-stage clinical trials are now being carried out with
drugs that target GIP alone to resolve this ongoing debate.

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One question facing researchers now is whether people will need to take these medications for life to maintain their
weight. A subset of clinical-trial participants who ceased taking semaglutide and resumed their previous eating and

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exercise patterns regained about two-thirds of their lost weight after a year. Another unknown is who will respond
to these drugs. It’s too early to tell now, but they seem to be less effective for weight loss in people with type 2

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diabetes. Conditions such as fatty liver disease and visceral body fat might also affect response to different drugs.

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Some scientists worry about the idea that these drugs offer a quick fix. This is a common misconception about
bariatric surgery, says clinical psychologist Leslie Heinberg. ‘Some people who still hold on to those mistaken
beliefs will say,"Oh, now people can just take this pill and that’s the easy way out of obesity," she says.

Although researchers are still chipping away at obesity’s complex combination of causes—including genetics,
environment and behaviour—many support the idea that biology plays a significant role. Eating healthily and
exercising will always be part of treatment, but many think that these drugs are a promising add-on. And some
researchers feel that because the drugs act through biological mechanisms, they will help people to understand
that a person’s body weight is often beyond their control through lifestyle changes alone.

[CANDIDATE NO.] READING QUESTION PAPER PARTS B & C 09/16