The New England Journal of Medicine reports a 24% reduction in kidney disease events, or death from kidney-related or cardiovascular causes for those on semaglutide – the hotly awaited FLOW trial.
The Lancet on bariatric surgery in women with obesity, polycystic ovarian syndrome and infertility, led to ‘…a significantly higher rate of spontaneous ovulatory events, approximately 2·5 times greater than that of the medical group over the 52-week follow-up period.’
A The Lancet Diabetes & Endocrinology review of 246 randomized clinical trials of 12 medications for obesity, involving 139 566 participants, finds older participants, those with class 3 [≥40kg/m2] obesity, non-White participants, and male participants were heavily under-recruited.
Discontinuation of GLP-1 meds in 37% at 12 months, rising to 50% in those with obesity from JAMA Network Open.
Alice Park at TIME notes ‘…not everyone responds to them in the same way…’, applicable to any health care intervention.
At Digestive Disease Week in Washington D.C., Dr. Andres Acosta of Mayo Clinic ‘…reported that a genetic test he developed can identify which people are most likely to respond to semaglutide (Wegovy) and which are not.’
Two dozen genes linked to obesity, and more than 6,000 variants of these genes, categorized patients into four categories: hungry brain, hungry gut, emotional hungry, and slow burn.
Acosta says the test ‘…predicts with 75% accuracy who will respond to semaglutide…’ and ‘…could change the way we manage obesity.’
80 patients took a saliva test and were on the GLP-1 drug for one year; those classified as hungry gut lost almost 20% in weight.
The results are preliminary for sure, though I certainly subscribe to the personalized medicine approach to care, not just for weight loss drugs, but across the continuum of nutrition, behavioral, exercise, medication and surgical interventions for people with obesity.
An American Heart Association scientific statement ‘…highlights the barriers to treatment and improvements needed in translating the science of obesity to patient care.’
The focus is on a comprehensive approach to obesity care to ‘…include evidence-based patient care strategies, innovative technology solutions, improved public policy, increased collaboration and education for health care professionals and more data about the cost-effectiveness of obesity prevention and treatment.’
Deepika Laddu, Ph.D., FAHA, chair of the statement writing committee noted ‘…Despite advancements in understanding the complexities of obesity and newer treatment options, major gaps remain between obesity research and real-world implementation in clinical practice.’
Laddu adds ‘…Health care professionals and health care systems need to find better ways to put what we know about obesity into action…’ with adoption of new technologies and telemedicine.
In addition, the scientific statement ‘…highlights implications for health research policy and future research to improve patient care models and optimize the delivery and sustainability of equitable obesity-related care.’
I am all for the expertise and outputs of this six thousand word report, though I have also been involved in too many of these efforts that lead to nowhere; how can we make these words come to life, to drive true impact to those who need it the most?
Daniel Gilbert at The Washington Post reports Taylor Huber who is paid to promote weight-loss medications on TikTok, had been banned for violating its Integrity and Authenticity policy.
A new policy is in place to ‘…prohibit users from marketing weight-loss products…’ to block body-shaming imagery and related harmful messages.
There is big money to made here for stay-at -home mother Taylor; Amble Health, a telehealth platform registered last year, has told prospective TikTok influencers that some of its partners have made $30,000 in a month by promoting GLP-1 medications.
Jennah Siwak, a doctor specializing in obesity medicine posts on TikTok as @weightdoc, and is credited by Rachael Gullette for changing her life.
Gullette was scrolling TikTok when she came across a video by Siwak, and says ‘…If there was no TikTok, I would not be down 172 pounds right now, I would not be pregnant. I would be blaming myself.’
We as clinicians need to be cognizant of the potential influence of social media on weight management, and its relation to medication usage.
OPINION AND EVENTS
Digital Health New York, or DHNY, led by Bunny Ellerin, hosted an Obesity + Health summit at NYU Langone, supported by LifeMD, Ilant Health, Intellihealth, Virta and Novo Nordisk.
In addition, they launched the Obesity Management Framework ‘…to enable employers to consider how comprehensive obesity care, including anti-obesity medications (AOMs), impacts their business.’
From 3,533 participants with type 2 diabetes and chronic kidney disease, at three years those on semaglutide had a 24% reduction in kidney disease events, or death from kidney-related or cardiovascular causes.
In addition, risk of major cardiovascular events was 18% lower, death from cardiovascular causes was 29% lower, and the risk of death from any cause 20% lower, in the GLP-1 group.
You may recollect that back in October 2023, Novo Nordisk made a statement that it had stopped a major study of semaglutide on kidney disease – the FLOW trial.
Sadly though, Black people made up only 4.5% of participants; in America, Black people are three times more likely to have kidney failure than white people.
We still have much more work to do.
Dr. Ted Kyle at ConscienHealth reports on ‘Two updated analyses from the Global Burden of Disease (GBD) Study…’ in The Lancet encompassing data across 204 countries and territories, from 1990 to 2021, for 88 risk factors.
The authors state ‘…Troubling increases in high fasting glucose, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions.’
BMI and dietary behavior are framed as both the problem and the solution, influenced by lifestyle factors and an ageing population, focused upon dietary behaviors.
From The Lancet, bariatric surgery in women with obesity, polycystic ovarian syndrome and infertility, led to ‘…a significantly higher rate of spontaneous ovulatory events, approximately 2·5 times greater than that of the medical group over the 52-week follow-up period.’
The medical group was treated with age-old drugs metformin and orlistat; the surgery group had a 30% total weight loss, compared to minimal weight change for the medication group.
The study was performed prior to the widespread availability of GLP-1 weight loss drugs.
Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age, affecting an estimate 8-13% with 70% remaining undiagnosed.
As I recollect with a patient of mine back at Imperial College over 15 years ago, notably where some of the surgeries were performed in this trial by my past colleagues Drs. Sanjay Purkayastha, Ahmed Ahmed and Sherif Hakky, she had had seven cycles of IVF therapy to no avail.; just eighteen months after gastric bypass surgery, she became pregnant naturally, and went on to have a healthy baby.
This publication also includes my past physician colleagues, Carel le Roux and Alex Miras, as well as Dr. Harpal Randeva at the University of Warwick – Harpal taught me in London as a fourth-year medical student.
Wow – it feels so great to have a trip back down memory lane.
In summary… bariatric surgery could enhance the prospects of spontaneous fertility in this group of women.
We knew this, and now we know it!
In a systematic review of 246 randomized clinical trials of 12 medications for obesity, involving 139 566 participants, the studies over-recruited White, female participants aged 40 years or older with obesity, at BMIs of between 30-40 kg/m2.
The Lancet Diabetes & Endocrinology paper continues, older participants, those with class 3 [≥40kg/m2] obesity, non-White participants, and male participants were under-recruited.
Indeed, researchers and funding bodies need to ensure recruitment of ‘…traditionally under-represented populations to allow for accurate measures of efficacy of medications for obesity, enabling more informed decisions by clinicians.’
In JAMA, University of Michigan and Yale University researchers assessed GLP-1 dispensing to adolescents (aged 12-17 years) and young adults (aged 18-25 years), from the IQVIA Longitudinal Prescription Database.
There was an increase of number of individuals dispensed a GLP-1 drug by almost 600%, from 8,722 in 2020 to 60,567 in 2023, per month.
For young adults, the users were three-quarters female, and almost half residing in the South.
JAMA Network Open reviewed almost 200,000 individuals with type 2 diabetes or obesity, on a GLP-1 medication.
There was discontinuation of 37% at 12 months, rising to 50% in those with obesity alone.
In addition, Black or Hispanic, male, and Medicare or Medicaid enrollees, were associated with discontinuation.
The key take home here is that discontinuation could have policy and medication coverage implications, especially if the weight reduction is not sustained after medications are discontinued.
ADDITIONAL TOPICS
Rachel Cohrs Zhang at STAT on Bernie Sanders may have reached the limits of his pharma pressure campaign.
The Lancet Diabetes & Endocrinology publishes Setmelanotide for the treatment of acquired hypothalamic obesity: a phase 2, open-label, multicentre trial.
Reuters on Australia to ban knock-offs of popular weight-loss drugs Ozempic, Mounjaro.
Mario Aguilar at STAT notes Eyeing GLP-1 opportunity, Click buys assets of Better Therapeutics.
STAT reports Biotechs turn to gene silencing for obesity drugs that can last longer than Wegovy.
Eli Lilly Increases Manufacturing Investment to $9 Billion at Newest Indiana Site to Boost API Production for Tirzepatide and Pipeline Medicines.
