Dr. Amir Ghaferi and colleagues from Wisconsin review Metabolic Surgery for Diabetes Management in JAMA Surgery.
Adam Feuerstein at STAT News writes Skye Bioscience ‘…is developing a treatment for obesity that was discovered through research into marijuana.’
The New England Journal of Medicine publishes a randomized study from France on participants with early Parkinson’s disease and GLP-1 therapy.
NEWS
USA Today reports ‘…Costco and its low-cost health care partner are expanding into weight-loss management…’ through Sesame, a health care marketplace.
David Goldhill, Sesame‘s co-founder and CEO said the ‘…No. 1 search term of Costco members seeking primary care on Sesame was around weight loss.’
The service will cost $179 every three months, and include clinical consultations, a nutritional guide, and an individualized treatment program, but not weight loss medication which will be at additional cost.
Reuters notes a biosimilar version of Novo Nordisk’s popular diabetes drug Ozempic has been developed in China, and the drug maker has applied for approval to sell it there.
Hangzhou Jiuyuan Gene Engineering said on Wednesday in a post on its official social media account that it was seeking approval to sell the drug, which it calls Jiyoutai.
Notably, patents in China on Ozempic and related drug Wegovy are set to expire in 2026.
OPINION
The Economist projects GLP-1 medications to increase in market size ‘…by 26% per year in the next five years, compared with 16% per year for oncology drugs and 4% per year for immunology medicines.’
Liraglutide and semaglutide, developed by Novo, and tirzepatide from Eli Lilly are likely to be usurped by over 100 drugs in pipeline that ‘…are easier to take, cause fewer side-effects or result in more effective weight loss.’
Daniel Drucker, at Mount Sinai Hospital in Toronto, found that in mice suffering from extensive inflammation throughout the body, GLP-1 drugs reduced the condition; these drugs might be useful for treating Alzheimer’s disease and Parkinson’s disease, brain disorders that are characterized by inflammation.
In addition, GLP-1 drugs may curb cravings, such as alcohol-use disorder, and other ‘…other addictive substances such as tobacco or marijuana.’
Wide variation in weight loss, with up to 1 in 6 patients being ‘non-responders’ defined as losing lass than 5% total body weight, might be due to genetic differences.
Dr. Eduardo Grunvald, an obesity-medicine physician at UC San Diego Health rightly says ‘…There’s going to be extreme variability in how people respond…’ which is true of all therapies – the tumor response to chemotherapy varies across patients, and do drugs for the resolution of inflammatory bowel disease.
Dr. Steven Heymsfield at Louisiana State University’s Pennington Biomedical Research Center notes ‘…People who have had obesity their whole lives might have genetic mutations preventing them from responding strongly…’ in terms of tolerance to the drug, or drug-drug interactions – say for people that are on antipsychotic medications.
Dr. Grunwald adds that patients who do not respond should be counseled by their physician to consider bariatric surgery.
Importantly, Dr. Jaime Almandoz, medical director of the Weight Wellness Program at UT Southwestern in Dallas, adds ‘…Considering ‘response’ solely in terms of weight loss, and not broader outcomes for health and quality of life, overlooks many of the benefits seen with treating obesity beyond weight loss.’
I fully agree – weight loss is a process measure, but we want to resolve chronic diseases associated with obesity, such as hypertension, diabetes, and sleep apnea.
Dr. Myra Ahmad, chief executive of Mochi, a telehealth obesity clinic is also quoted that for patients struggling with weight for years ‘…another option not working can feel very demoralizing.’
Dr. Amir Ghaferi and colleagues from Wisconsin review Metabolic Surgery for Diabetes Management in JAMA Surgery.
Dr. Walter Pories, a visionary leader in the field of bariatric and metabolic surgery, asked over 30 years ago ‘Is Type II Diabetes Mellitus A Surgical Disease?’
Since then, numerous trials have ‘…clearly delineated the superior effectiveness of metabolic surgery for glycemic outcomes in patients with type 2 diabetes and overweight or obesity.’
The authors continue to state ‘…The total annual cost of diabetes care in the US in 2022 was $412.9 billion, with $106.3 billion attributed to lost productivity at work, unemployment from chronic disability, and premature mortality.’
Metabolic surgery drives a reduction in the likelihood of all-cause mortality by 39% at 8 years and is cost-effective.
In addition, there are several randomized clinical trials evaluating the effectiveness of metabolic surgery for patients with class 1 obesity, namely the STAMPEDE, TRIABETES, SLIMM-T2D, AND CROSSROADS trials.
Despite such robust data, metabolic surgery is woefully underused.
Barriers to metabolic surgery are insurance coverage, and patient and provider knowledge about the risks of obesity and the health benefits of metabolic surgery.
The authors close that ‘…Patients deserve access to life-extending metabolic surgery now. Let’s make it happen.’
Adam Feuerstein at STAT News writes Skye Bioscience ‘…is developing a treatment for obesity that was discovered through research into marijuana.’
The drug nimacimab, is a second-generation antibody that blocks cannabinoid receptor CB-1, that works in peripheral tissues, designed to maintain the ability to reset the body’s metabolism.
Past efforts at CB-1 blocker drugs such as rimonabant led to psychiatric problems and an increased risk of suicide.
Skye CEO Punit Dhillon notes ‘…Nimacimab and other newer iterations of anti-CB-1 antibodies don’t cross the blood-brain barrier…’ and thus are without the psychiatric safety risk.
In addition, Novo Nordisk acquired start-up Inversago last year, also developing an anti-CB-1 antibody for obesity, for $1 billion.
DATA
The New England Journal of Medicine publishes a randomized study from France on participants with early Parkinson’s disease and GLP-1 therapy.
The drug lixisenatide produced by Sanofi, resulted in less progression of motor disability than placebo at 12 months, across over 150 subjects.
Sadly though, side effects of nausea and vomiting were common in the treatment group.
The working hypothesis on mode of action is that GLP-1 drugs may help by reducing inflammation and protecting neurons from dying, a hallmark of Parkinson’s disease.
ADDITIONAL TOPICS
CBS News on the “Oatzempic” craze: Should you try the oat drink for weight loss? Experts weigh in.
The Washington Post notes As obesity rises, Big Food and dietitians push ‘anti-diet’ advice.
