Dear Friends, an interesting meteorological week, when there was snow in Southern California and temperatures close to freezing point in Dallas, TX. A busy week in all things metabolic and obesity care too!
AT A GLANCE…
- World Obesity Day is next week – please take a look and would love your review.
- Supply chain issues are apparently over for GLP-1s, though this might not be for all that need it.
- Durability of weight loss and resolution of co-morbidities after stopping GLP-1 medication, in relation to weight set-points.
- Person-first language and condition-first language terms for diabetes and obesity – there is a remarkable difference.
EVENTS
- World Obesity Day is next week – Saturday March 4. It is ‘a unified day of action that calls for a cohesive, cross-sector response to the obesity crisis’ convened by the World Obesity Federation. The mission is four-fold, i.e. to increase awareness, encourage advocacy, improve policies and share experiences. I very much like the conversation cards, which are available for download too.
NEWS
- The Science Editor at The Times, a UK newspaper describes a new pill that ‘…acts like a sieve to slow digestion and halt obesity.’ My first thought is that halting obesity is a wild claim; more detailed reading leads to the concept of a ‘molecular sieve’ that captures stomach enzymes and makes digestion less efficient. The company, Sigrid Therapeutics, has undertaken experiments in obese mice, leading to a one-third reduction in food efficiency, driving weight loss in the mice as a precursor to human trials this year. This drug/device pertains to a mechanical effect, which reminds me of earlier versions of drugs to slow/modify digestion, that led to stomach cramps and offensive, voluminous diarrhea in their users. And I am not sure what to make of the quote from the CEO of Sigrid, Sana Alajmovic in terms of market opportunity beyond humans, that ’There are millions of obese cats out there.’
- Dan Skovronsky, the chief scientific and medical officer of Eli Lilly and Company, was referred to in Healthcare Brew that oral medications will likely play a large role in treating the rising number of obesity cases across the globe. Clinical trials are underway at Eli Lilly for the oral version of its GLP-1 agonist, orforglipron; Pfizer is undertaking a clinical trial expected to complete in January 2024, for its oral GLP-1 drug, catchily named PF-07081532.
- Bloomberg reports on Eli Lilly, that all doses of its GLP-1 diabetes drug Mounjaro are now available, after the social media and celebrity hype led to a two-month shortage.
- Similarly, Peter Loftus at The Wall Street Journal writes on Ozempic’s short supply for diabetes patients, referring to the chief science and medical officer at the American Diabetes Association in that ‘Doctors should give priority to Ozempic’s use among people with diabetes.’ The article also refers to a write up in the WSJ my newsletter last weeks on ‘… digital health startups [are] cashing in on demand for the drugs, sometimes advertising or prescribing them to people who aren’t overweight.’
OPINION
- Good Morning America has a spot on fruit and vegetable intake for kids in the US; nearly 1 in 5 are not eating a daily vegetable, and nearly one-third are not eating a daily fruit. More on this in the DATA section below.
- Jillian Michaels, a personal trainer and previously engaged as a coach on the reality series The Biggest Loser, was featured in PEOPLE magazine to set ’the record straight about why she’s not a fan of Ozempic.’ Ms. Michaels was quoted ‘I have taken at least eight family friends’ parents off of this drug…’ noting side effects from heart palpitations and nausea. More relevant in my opinion is her narrative on stopping the medication, and on taking the medication without focused behavioral change, i.e. ‘Once they get off of the drug, it does the rebound effect… So you’re not gaining anything. You get off the drug in a year and go all the way back. You’ve not learned anything. You’ve not built any physical strength or endurance. You haven’t learned how to eat healthy.’
- An article from Australian outlet nine.com reports on long term weight loss studies, in that ‘…more than half of the weight lost by participants was regained within two years, and more than 80 per cent of lost weight was regained within five years.’ I do love the sentence that follows: ‘When we regain weight, we tend to blame it on a lack of willpower.’ The article continues to describe the weight set point, in that ‘Our genes play a role in programming our weight set point. Just as DNA prescribes whether we’re shorter or taller than others, we’re born with a tendency to be slim or overweight.’ And ‘We are biologically wired to protect our weight set point’. My take home is that weight loss needs to be undertaken in a stepwise manner, with as much focus [if not more] upon maintenance of weight and avoidance of weight regain, before the next step of weight loss is even contemplated.
- POLITICO publishes an opinion piece titled ‘The most stigmatized disease in the world’, referring to a quote from Dr. Ryder, a scientist with expertise in pediatric obesity at Lurie Children’s Hospital of Chicago, who further states that ‘In America, we view obesity as a personal behavior problem and not as a disease.’ For example, utilizing the term anti-obesity medication aligns more appropriately with drugs for other chronic diseases such as anti-hypertensive and anti-diabetic drugs, rather than use of the term weight-loss drugs. The rest of the article focuses upon the cost of medication for severe obesity, rather than additional tangible information or efforts on how to impact the stigma, fear and bias that impacts metabolic and obesity care.
- The New York Times has an article on an interesting side effect of Ozempic to decrease a desire to drink alcohol. There is minimal scientific evidence on the role of GLP-1 agonists to even be contemplated as a treatment for substance-use disorder, but this does remind me of the necessity for me to advise my past patients who had undergone bariatric surgery to avoid alcohol not only in terms of the modified response to a glass of wine or cocktail, but even further that alcoholic beverages are liquid calories too.
- The shortages for people with diabetes and obesity of GLP-1 drugs are recounted in abcNEWS, such that the reimbursement and supply-chain issues are poised to lead to ‘…a wider disparity around the country between those who can afford and get easier access to the medications and those who can’t.’
DATA
- The CDC published its National Survey of Children’s Health this week, of more than 18,000 children such that in a preceding week, one third did not eat a daily fruit, nearly one half did not eat a daily vegetable, and more than one half drank a sugar-sweetened beverage at least once. There was also geographical variance, such that two-thirds of children in Vermont ate a daily vegetable, compared with only one-third of those in Louisiana; similarly, the ‘…percentage of children drinking sugar-sweetened beverages at least once during the preceding week ranged from 38.6% in Maine to 79.3% in Mississippi.’ There was in addition to racial disparity, such that ‘Drinking a sugar-sweetened beverage at least once during the preceding week ranged from 47.5% among multiracial non-Hispanic children to 71.7% among Black children.’ These are highly concerning data, though not new too; the complexity of the issue with regard to economic, racial and geographic status necessitates clinical, political and societal might to reduce the rate of increase, even before we think to reverse the trend.
- An interesting review was published in Diabetic Medicine, on the use of person-first language and condition-first language terms for diabetes and obesity. Among diabetes articles [or should we say articles researching patients with diabetes], 43% employed person-first language contrasted with 40% using condition-first language; among the same for obesity articles, less than 1% used person-first language, and 99% utilized condition-first language. Encouragingly, there was an increasing rate in the use of person-first language from articles researching patients with obesity.
- Dr. Courcoulas, a well known academic bariatric surgeon in Pittsburgh, penned an article in The Lancet Diabetes and Endocrinology on the ‘…welcome and timely review…’ of the 2022 Joint Statement from the American Society for Metabolic and Bariatric Surgery [ASMBS] and the International Federation for the Surgery of Obesity and Metabolic Disorders [IFSO] that is ‘…thorough and presented from the surgical perspective.’ She importantly mentions the ‘…update was not from a consensus development conference, a specific programme in which an independent panel, meeting specific criteria, generates evidence-based consensus statements, as was the US National Institutes of Health (NIH) report from 1991…’ and rather is ‘…a summary of and statement about the currently available scientific information, focusing mainly on the indications for surgery.’ A worthwhile review of the opportunities and challenges to operationalize a modern approach to surgical care for patients with obesity and metabolic disease.
- In the same Journal, Dr. Reinehr, a pediatric physician in Germany, comments upon the new clinical practice guidelines from the American Association of Pediatrics published earlier this year, with a focus upon the physical and psychological co-morbidities associated with obesity in childhood and adolescence, which can result in premature death; together with stigmatization and the concomitant socioeconomic impact, aligned with the very low uptake of effective treatment strategies for pediatric obesity.
Kind regards, Raj
