'Marijuana paradox for obesity': How THC and CBD affect weight

Marijuana has implications for weight and metabolism — but perhaps not in the ways one might expect, according to a speaker at the 2022 Overcoming Obesity conference.

During the presentation, Jeff Sicat, MD, FACE, FOMA, a physician with the Virginia Weight and Wellness who specializes in medical weight loss, discussed how marijuana and cannabidiol (CBD) affect weight and metabolism.

Although there are some positive factors of cannabis, like euphoria, a sense of relaxation, heightened sensory perception, increased appetite and more, Sicat said there are some negative factors, including “the munchies,” acute weight gain, anxiety, distrust, panic, paranoia and more.

In the Controlled Substance Act of 1970, the U.S. government categorized marijuana as a schedule I substance, “meaning it was considered to have no acceptable medicinal use and was among the class of drugs having the highest potential for abuse.”

Today, medical marijuana is legal in 38 states, four territories and Washington, D.C., and recreational marijuana is legal in 19 states, two territories and Washington, D.C. Usage rates are up, too: NIH data from 2021 recorded historic highs in marijuana use among adults aged 19 to 30 years — 43% of people in this group reported use in the last year.

“This is happening,” Sicat said. “It's interesting that this is not something that I regularly have asked my patients in the past, but this really opens my eyes of how many people are actually using cannabis nowadays.”

Marijuana being classified as a schedule I drug, he explained, “really precludes a lot of studies from happening.” With the available data, though, Sicat said he noticed an interesting trend, one that he coined the “marijuana paradox for obesity”: small, short-term studies showed increases in body weight, but long-term studies revealed that chronic marijuana use was actually associated with weight loss.

In fact, he said, “the higher the dose of marijuana over the years is associated with a lower body weight.”

“When you look at prospective studies where they look at over 30,000 people across the country and follow them for the course of 3 years, you see that those who smoke the most cannabis or use the most cannabis actually have the lowest body weight in a dose-dependent manner,” he said. “The more frequent that someone is actually using cannabis, they'll lower their body mass index.”

Additionally, he said that data have shown women using cannabis heavily were about 50% less likely to be diagnosed with type 2 diabetes than non-cannabis users.

A report from the National Academies of Sciences, Engineering and Medicine showed substantial or conclusive evidence that cannabis is effective in adults for chronic pain as well as chemotherapy-induced nausea and vomiting, and can improve muscle spasticity syndromes in MS.

Cannabis plants have at least 100 plant-derived phytocannabinoids, including tetrahydrocannabinol (THC), delta 8 THC, CBD and more. CBD — the most common phytocannabinoid — is, by volume, the biggest part of the cannabis plant.

“What’s nice about it is that it does not have any psychotropic effects; it actually has a very wide range of potential pharmacological effects through different mechanisms,” Sicat said.

For example, there is an FDA-approved CBD product for pediatric intractable epileptic seizures.

“It turns out that CBD in high doses has actually been shown to actually reduce seizures by almost 50% in this very refractory population,” he said.

Despite the fact that trials did not fully investigate weight loss, data from these studies indicated greater weight loss from people who took CBD compared with those who took placebo, though he cautioned that only 20% of participants were adults.

Although CBD has shown to be “helpful for a lot of different things ... from a diabetes perspective, we are uncertain.”

Sicat referenced a 2016 study published in Diabetes Care that assessed the impact of CBD and THC on people with type 2 diabetes.

“When you look at the data, what they found is that it actually had benefit in terms of several different hormones. There's actually a hormone called resistin that's made in the body fat, and resistin causes resistance to insulin. And when they gave CBD at these doses, it actually reduced resistin,” he said.

Sicat concluded that “further studies are needed to better evaluate the benefits of CBD and other phytocannabinoids on metabolic features.”

“In conclusion, I would just say, personally, I have found that putting this presentation together has sort of opened my eyes because I really never thought about the impact of how many of my patients are actually taking all these different phytocannabinoids, how many of them might be taking medical marijuana, different things like this. [It] just has not been something that I've really asked about a lot, but it makes me really think about inquiring much more commonly about that.”

References:

• Jadoon KA, et al. Diabetes Care. 2016;doi:10.2337/dc16-0650.
• Sicat, J. CBD for obesity? Our patients are asking! Presented at: Overcoming Obesity 2022; Nov. 2-5; (hybrid meeting).