Dear Friends, I am pleased to share with you this week’s installment of perspectives across metabolic & obesity care, right on the heels of new pediatric guidelines for the management of obesity, and a busy JPM conference.
EVENTS
- Whilst there was certainly hail, flash floods and sideways winds in San Francisco, the 41st J.P. Morgan Health Conference did not fail to draw big crowds. A couple of key takeaways below.
- A great article in STAT News from Owen Tripp of Included Health summarized that narrative I heard on digital front doors – there are too many of them, and then what happens once you are in the foyer? My approach is that consumerism and tech are definite tailwinds in modern healthcare, though require integration with clinical leadership, existing and novel pathways and protocols, the measurement and delivery of robust and clinically significant outcomes, at reasonable cost and at any address. Let’s do more than just the front-end engagement, and deliver end-to-end high quality care for all.
- Further news on how Omada Health partners with Intermountain Health, to identify patients through the Intermountain Medical Group PCP to use Omada’s virtual diabetes prevention program. The article does a nice job of articulating the challenge of point solutions for employers, citing Omada, Livongo, Hinge Health and Hello Heart for chronic conditions, and the desire to consolidate point solutions.
- And a look forward to the annual Davos extravaganza, is an article penned by Camilla Sylvester, EVP at Novo Nordisk. The quote that 1B adults are predicted to live with obesity by 2030 certainly resonates, and even more so that obesity is considered a ‘gateway disease’, and further that not treating obesity is costly – on both health care delivery systems as well as workforce productivity. The focus of the article seems to be on ‘…solid multi-sector public-private partnerships that are rooted in science-led approaches to obesity prevention and care.’ I look forward to learn more.
NEWS
- The main news of the week was the publication of Clinical Practice Guidelines for the Evaluation and Treatment of Children and Adolescents with Obesity, with an associated Executive Summary. The data is startling – there are 14.4M [or almost 20% prevalence in the U.S.] children and adolescents affected by obesity, with multifactorial influences arising from health inequities, racism, obesogenic environments, weight bias and stigma considerations, adverse childhood experiences, and access to care. The review sought to answer two key questions: what are the effective clinically based treatments for pediatric obesity, and what is the risk of co-morbidities among children with obesity. The CPG is quotes that ‘There is no evidence to support either watchful waiting or unnecessary delay of appropriate treatment of children with obesity.’ and ‘…treatment at the highest intensity level that is appropriate and available.’ The KAS [Key Action Statements] support referral of children from age 2y and upwards with obesity for intensive health behavior and lifestyle treatment, adolescents 12y and older with obesity for weight loss pharmacotherapy, and adolescents 13y and older with severe obesity for evaluation for metabolic and bariatric surgery.
- As you can imagine, this is a contentious topic – at time of writing there is a single Comment from the online publication of the CPGs is from Dr. Natarajan who writes that ‘Overweight and Obesity is a pandemic and we are all responsible for the growing pandemic. Obesity is a societal problem. The children are the victims. To punish the children with Drugs and or Bariatric surgery for a societal failure is a travesty of justice.’
- On a personal note, when I worked at University of Pennsylvania Health System almost ten years ago, we engaged with Dr. Joy Colins at the Children’s Hospital of Philadelphia [CHoP] and Dr. Elizabeth Parks at the Healthy Weight Clinic that accepted referrals for children with obesity from age two to twenty-one years. Amidst much groundwork, I was instrumental to successfully initiate the CHoP Adolescent Bariatric Program, and had the privilege to assist in changing the lives of morbidly obese youngsters from physical, psychological and social perspectives.
- Multiple news commentaries are mentioned below, i.e.
- Jennifer Henderson at MedPage Today quotes co-author Dr. Sarah Armstrong from Duke University that ‘The timing is particularly good right now as we’ve seen sort of a wave of approvals of new medications and indications for bariatric surgery and other treatment.’ The article also cites payment barriers to treatment options, weight bias and stigma among the public, and that obesity needs to be treated via the same model as other chronic diseases, accounting for remissions, relapses, monitoring and ongoing care.
- Jonel Aleccia titles an AP article on ‘New guidance: Use drugs, surgery early for obesity in kids.’ and quotes co-author Dr. Ihuoma Eneli for Nationwide Children’s Hospital in Columbus, OH that ‘Waiting doesn’t work.’ Additional commentary from Dr. Stephanie Byrne at Cedars-Sinai states ‘I definitely think this is a realization that diet and exercise is not going to do it for a number of teens who are struggling with this – maybe the majority.’
- ABC News additionally weighs in with an interview from Dr. Sarah Hampl at Children’s Mercy of Kansas City that ‘Our kids need the medical support, understanding and resources we can provide within a treatment plan that involves the whole family.’
- NBC News contributor Kaitlin Sullivan writes that ‘Since the 1980s, obesity rates have tripled in children and quadrupled in adolescents.’ Dr. Joan Han from Mount Sinai Kravis Children’s Hospital quotes a startling CDC report ‘that the rate of weight gain nearly doubled in 2020, compared with prepandemic years.’
- Ted Kyle of ConscientHealth was interviewed by BBC News this week. He commented that if diet and exercise were successful, then the large amounts of money spent on these interventions would have already led to a reduced prevalence in obesity rates. He also referred to the World Health Organization statement that obesity is defined by physiology – the accumulation of abnormal or excess fatty tissue that impairs a person’s health; it requires more than just stepping on a scale; it requires thoughtful evaluation by a clinician.
OPINION
- This week celebrity personal trainer Jillian Michaels advised readers of a Business Insider article against weight loss drugs like semaglutide, in favor of ‘common-sense’ habits. She said the drugs are dangerous, with short-terms side effects like nausea and uncertain long-term safety. She said fitness wearables can be a helpful tool, with mention of her partnership at a wearable tracker company.
- Laura Ingraham at FOX News talks openly of glamorizing and normalizing obesity, with a recommendation upon nutrition, exercise and behavior change rather than medication and surgery. And to focus upon personal accountability.
- The Canyon Ranch guide to intermittent fasting from Dr. Stephen Brewer, Medical Director at Canyon Ranch Tucson AZ. The article promotes a new book on a scientific approach to weight loss; make of this what you will.
DATA
- A study from France was published in JAMA Surgery this week of 300K patients having undergone bariatric surgery, matched with 600K patients with severe obesity who did not undergo bariatric surgery. The authors report a 24% decrease in incidence of esophageal and gastric cancer, at a mean of six years after bariatric surgery. This is intriguing research that I have been following since the seminal 2009 publication in Lancet Oncology from Sweden of a 42% reduction in cancer at 10-year follow-up in obese women having undergone bariatric surgery, though perhaps surprisingly no such reduction in obese men having undergone bariatric surgery. Associated data was published from the Cleveland Clinic in Jun 2022, in JAMA, from 30K patients [of whom 5K underwent bariatric surgery] resulting in a 32% risk reduction in development of obesity-related cancers [i.e. breast, esophageal, renal, multiple myeloma, stomach, colon, rectum, liver gallbladder, pancreas, ovary, uterus and thyroid] at 10 year follow-up. Whilst the follow-up periods are long, these impressive results should be further evaluated and underpinned with an economic analysis.
- A systematic review of nine studies, from researchers in Australia on the concept of chrononutrition [timing of meals and distribution of total energy intake across the day] reports that earlier eating patterns are beneficial for weight loss, though the average difference was modest at 1.2kg between groups. The research was picked up by The Washington Post with the subtitle that ‘The timing of your meals can have striking effects on your weight, appetite and chronic disease risk.’ Recommendations are provided for an ‘early-eating schedule.’ with a focus to eat breakfast.
Thank you and have a great week. Kind regards, Raj.
