Hello everyone,
I hope you are enjoying this weekend, one where — at least in much of the US Northeast — the weather is feeling like the first crisp glimpses of autumn [though I note that, if you were exposed to Hurricane Lee, it may be wet and windy, and with the inconvenience of power outages in certain regions].
Good materials this week in our newsletter, with an excellent analysis around what the advent of effective medications means on our approach to treating obesity; long-term reductions in hematological cancers following bariatric surgery; and the rising public health challenge (emergency?) of obesity in children. Also, a good primer around bariatric surgery and what doctors wish their patients knew about it; and the food lobby sponsoring dieticians who are also social media influencers.
Kind regards, Raj
AT A GLANCE
- The American Medical Association released an article on ‘What doctors wish patients knew about bariatric surgery…’
- The Washington Post declares ‘…Registered dietitians are being paid to post videos that promote diet soda, sugar and supplements on Instagram and TikTok.’
- ZS, a global management consulting and professional services firm, in reference to the golden age of medicine recounts ‘…for the first time in history, we have highly effective and safe pharmacological tools to deploy against obesity.’
- A group of physicians writing in Pediatrics found that ‘Obesity affects 20% of U.S. youth, with severe obesity… at record high prevalence…’, and propose to declare it as a public health emergency.
- The Lancet Healthy Longevity reports from Sweden a reduced incidence of 40% of hematological cancers following bariatric surgery, more specifically in women.
NEWS
- The American Medical Association released an article on ‘What doctors wish patients knew about bariatric surgery…’ in partnership with Ethan Lazarus, MD, a family and obesity medicine physician, and Samer Mattar, MD, a bariatric surgeon. Specifically, they write about the following facts (with additional discussion under each bullet in the linked article):
- Bariatric surgery reduces hunger
- The two most common procedures are gastric sleeve and gastric bypass
- In each case, there should be a sober-minded review of the benefits versus the risks of surgery
- Weight loss prior to surgery helps
- A psychiatric evaluation is important
- The procedure is performed laparoscopically through keyhole or minimally invasive surgery
- Weight loss happens quickly
- Anti-obesity medications and surgery can go together, in a multimodal approach to care
- Upon outcomes, chronic conditions improve, quality of life gets better, and most people are going to continue to need to eat healthy, and to keep on moving (exercise)
- More broadly, patients need to control their environment, get the whole family involved, take vitamins and supplements, and need to take advantage of lifetime support
- Finally, surgery is not the easy way out; says Dr. Mattar, ‘…It’s just a tool that helps patients make changes that are more long lasting and more effective than were they to do them without the surgery.’
- The Washington Post declares ‘…Registered dietitians are being paid to post videos that promote diet soda, sugar and supplements on Instagram and TikTok.’ Dieticians Steph Grasso, Cara Harbstreet and Mary Ellen Phipps who posted on Instagram and TikTok to reassure followers to continue to take artificial sweeteners ‘…were paid to post the videos by American Beverage, a trade and lobbying group representing Coca-Cola, PepsiCo and other companies.’ The ‘…coordinated campaign by American Beverage…’ comprised ‘…at least 35 posts from a dozen health professionals.’ In response, William Dermody, an American Beverage spokesman, stated: ‘…The registered dietitians and nutritionists we relied on shared their own informed opinions when communicating the facts to their audiences, and were up front about being paid.’
OPINION
- Terms including ‘blazing success’ and ‘electrified pursuit’ are used by Elain Chen and colleagues at STAT to note the ‘…dozens of companies … jumping into the race…’ — unleashed by the major pharma companies producing GLP-1 agonists — to ‘…bring to market medications that are oral, longer-lasting, avoid side effects, or provide additional benefits besides weight loss.’
- In a market leading approach to information sharing, STAT has compiled ‘…a new database to track the significant obesity drugs that are on the market and in development…’ [though updates each quarter are likely to infrequent to be meaningful in the hottest pharma market play for many years].
- A total of 74 drugs are classified by phase [preclinical through to approved], category, company, mechanism, route and regimen.
- The related STAT article kicks off with the ‘exploding popularity’ of weight loss drugs, and references Reut Shema, managing director of VC firm aMoon, ‘…if you want to compete, and you’re not Lilly or Novo, you need to make an acquisition.’ In addition, Shipra Patel, medical director at contract research organization Parexel, states ‘…Wegovy and Mounjaro [have] made it possible to enroll participants in clinical trials very quickly.’
- ZS, a global management consulting and professional services firm, in reference to the golden age of medicine, recounts ‘…for the first time in history, we have highly effective and safe pharmacological tools to deploy against obesity: glucagon-like peptide-1 receptor agonists (GLP-1s).’
- Away from the hype of 15% to 25% total weight loss, and rightly so, from a population perspective: ‘…the traditional healthcare infrastructure and obesity treatment paradigm are ill-equipped to supply the hundreds of millions who could benefit from a better model.’
- Indeed, to ‘…do what is right and make population health our priority’, the ‘… one-size-fits-all approach to patients who are overweight or obese…’ through a ‘…prescription: to eat better and exercise more…’ is outdated. Cancer is ‘…caused by a complex mix of genetic, behavioral and environmental factors…’ and the large-scale shift in social attitudes, with investments of billions of dollars are ‘…because we’ve collectively agreed that cancer’s financial, health and social costs are too high to ignore.’
- Obesity is a chronic disease that is set to affect over 50% of the U.S. adult population by 2030, and 4 billion humans by 2035, and I agree that ‘…Arresting and reversing the rise of global obesity will take a similar, arguably much more intensive effort.’ Further, the cancer care model, through multimodal interventions comprising surgery, medication in the form of chemotherapy, radiotherapy, and additional supportive therapies to manage side effects is perfectly designed to treat patients with obesity and related metabolic diseases.
- Think of a baseline of nutrition, behavioral and exercise therapy, delivered on an always-on technology platform, supported by health coaches who really get to know the patient, with additional medication in the form of GLP-1 drugs, and/or surgical intervention as determined.
- The article suggests a new business model for weight-management drugs:
- first to ‘…Redefine the journey from weight loss to weight management…’, to incorporate ‘…millions of individual patient journeys and therefore no single solution.’
- Second to ‘…Pursue innovative population health-based models…’ through capitated, or value-based care models, with advice that ‘…direct-to-consumer risks leaving out the most vulnerable patients.’
- And third to ‘…Improve manufacturing capacity and supply chain.’
- In closing, on a highly worthwhile article: ‘…Tackling obesity is a marathon, not a sprint…’ so ‘…Let’s not squander the opportunity.’ Really terrific, on point, and highly relevant. Thank you.
- ‘Obesity affects 20% of U.S. youth, with severe obesity… at record high prevalence…’ and propose to declare it as a public health emergency, per Dr. Eric Bomberg, Theodore Kyle and Dr. Fatima C. Stanford, writing in Pediatrics. The authors ‘…discuss pediatric obesity in the United States, needs for further effective interventions, previous public health strategies for mitigation, public health emergencies, and arguments favoring and opposing a pediatric obesity declaration.’
- Dr. Melynda Barnes, Chief Medical Officer at Ro, direct-to-patient healthcare company, writes in MedCityNews that ‘…Investment in both prevention and treatment are essential for public and individual health…’ in reference to obesity which today affects over 100 million Americans. Indeed, ‘…we should focus on the tools that best solve the needs of people where they are – just as we would for cancer or diabetes…’ and make ‘…the most effective treatments possible available.’
- I could not agree more that ‘…Diet and exercise should be part of a comprehensive approach to obesity treatment, inclusive of provider-led care and, when appropriate, prescription medication.’
- A comprehensive approach to care ‘…should weigh the value of treating obesity for its ability to improve someone’s quality and quantity of life…’ and move on from focusing upon costs of care, toward the value created in terms of better health.
- Dr. Jody Dushay, an endocrinologist at the Beth Israel Deaconess Medical Center writes in STAT that ‘There is just not enough Wegovy.’ Indeed she goes on, ‘…even if Novo Nordisk were to manufacture an enormous surplus of Wegovy, millions more will never get it…’ through denial of coverage by insurance companies.
- Through insights into her daily practice, Dr. Dushay comments ‘…for now, with limited supply, inequitable insurance coverage, and the complication option of prescribing Ozempic off-label, patients and doctors are in a marathon that nobody signed up for.’
- She hopes her ‘…patients understand that I am navigating the course with everyone’s best interests in mind.’
DATA
- In a 14 year longitudinal study, the Lancet Healthy Longevity reports from Sweden on over four thousand individuals, half of whom underwent bariatric surgery between 1987 and 2001. Hematological, or blood, cancers were diagnosed in ‘…34 participants in the surgery group and 51 participants in the usual care control group…’ after over two decades of follow-up. The data denote a reduced incidence of 40% of hematological cancers in the surgery group, more specifically in women. There was also a 55% reduced incidence of lymphoma in the surgery group. The authors suggest ‘…bariatric surgery a primary prevention resource for people with obesity…’ in the field of cancer care.
Kind regards, Raj
