Obesity Trends To Watch For in 2023
There is no doubt that we are currently experiencing the dawn of a revolution in our ability to better treat and manage obesity. Under these circumstances, predicting the future of obesity medicine is perhaps even more difficult than when things were plodding along at a steady pace. Nevertheless, here are some of the trends we should watch for in 2023: With my best wishes for a Happy New Year!@DrSharmaBerlin, D
What Obesity Policies Do We Need?
Earlier this week, I presented at a high-level UK Health Policy Workshop on how I would shape policies to deal with the obesity issue. My suggestions can essentially be summarised as follows: All relevant policies need to acknowledge that obesity management requires the same approach as any other chronic disease. The biological nature of the body’s defense against weight loss dictates the need for treatments that address the biology and don’t just rely on education, motivation, and willpower. Managing obesity needs to become first-line treatment for all patients presenting with any obesity related comorbidity. Obesity management can be funded by progressively diverting funds from treating obesity complication and comorbidities to treating obesity itself. Basic competencies in obesity management need to be a mandatory requirement in all medical licensing exams. Whether or not these suggestions find their way into health policies in the UK or elsewehere remains to be seen, but I certainly see no alternative to implementing such policies if we are ever to make a dent in the obesity crisis that is clearly affecting every health care system around the world. @DrSharma, MDBerlin, D
Guest Post: Racial Diversity in Obesity Research and Practice
Today’s guest post comes from my dear colleague Fatima Cody Stanford, MD, Associate Professor of Medicine and Pediatrics, Harvard Medical School. Particularly in the aftermath of the murder of George Floyd here in the United States, there has been greater attention to racial and ethnic diversity in every domain of human life. His brutal murder during the COVID-19 pandemic set the stage for those to consider the prominence of disparities and how they contribute to differences in health, quality of life, morbidity, and mortality- just to name a few. So now, more than any time since the 1960 civil rights movement catalyzed by individuals such as Martin Luther King Jr., we recognize that racial and ethnic diversity matters. But why does racial and ethnic diversity matter in the field of obesity? Why should we care? The answer is quite simple. Disproportionately, individuals from racial and ethnic minority groups bear the brunt of the burden of obesity. As a Black woman obesity medicine physician-scientist, I can definitely say that the disproportionate burden of obesity in the Black community – particularly amongst those that are the descendants of the enslaved like myself here in the United States, brought me to this field. each and every day in this work I realize the importance of the focus on this issue. Yet, my daily focus on racial and ethnic diversity in the field is not genuinely shared by many of my colleagues. Hence as we seek to improve the care for persons with obesity, we fall short of being able to do so. How is this you might ask? Let’s take a pause and look at clinical trials that are performed around the world for anti-obesity pharmacotherapy. You don’t have to do a deep dive to recognize that the subjects included in those trials disproportionately do not reflect the diverse tapestry of individuals who are impacted by the disease of obesity. As we peruse the prominent publications in the top peer reviewed journals throughout the world, you also don’t see many authors that reflect racial and ethnic diversity. So, how are we going to treat a disease when both the patients, physicians, and other healthcare providers that care for these patients don’t reflect the diversity of the population? How can we extrapolate data and presume it will apply broadly to a population that is underrepresented? We can’t. So we continue to fail. Yet, no… Read More »
Guest Post: Obesidades Mexico
Today’s guest post comes from my Mexican friend and colleague, Verónica Vázquez Velázquez, PhD, Co-founder and President of Obesidades. Is obesity a single disease or are they several diseases with common clinical manifestations? Science is trying to answer this, but every one living with obesity has their personal definition. In Mexico, more than 80 million children, teenagers and adults live with overweight or obesity (55% of children from 0 to 11 years, 44% of teenagers and 74% of adults, from a total of 126 million inhabitants). This means that most Mexican people live with abnormal or excessive body fat that may impair their health. For some, obesity is merely living in a large body, but for others, this is a disease that leads to other diseases and has alienated us from our work, social and love lives. For many, this also means living under the critical and biased eye of physicians, relatives, friends or strangers, who think that “this is our fault”. In reality, obesity results from a series of factors, some that can be controlled/treated and others that we have not chosen (such as biology, genetics and the environment). I remember talking with Dr Sharma in July 2020 and can´t forget his words: “What makes you angry about what is happening in Mexico with obesity? What can you do about it? Whatever it is, make it important and manageable. First, get together friends who think alike and understand obesity. Then, little by little, you will add people to spread knowledge and advocate for change. If you feel passionate about it, just do it. It does not have be perfect, it just has to be good”. This is why we founded Obesidades (Spanish plural for obesity), to give voice to those interested in understanding and addressing obesity. We are a non-profit organization incorporated in Mexico in 2020 by a psychologist/patient in treatment, a bariatric surgeon and a physician/patient in treatment. Our goal is to create a community that includes people living with obesity, health professionals, organizations and authorities, all joined together for changing the narrative around obesity and its treatment. Primary prevention is important, but clearly many of us will, at some point, require access to health services offering an individualized biopsychosocial approach, incorporating early diagnosis and evidence-based treatments that includes strategies to sustain the treatment in the long term. All of this may seem complicated. Nonetheless, we can start… Read More »
Guest Post: Family Doctors and Obesity Management
Today’s Guest Post comes from my colleague Michael Crotty, MD, a family doctor in Dublin, Ireland. I believe we are on the cusp of a new dawn where the vast majority of bariatric care will be provided in primary care with family physicians taking a leading role. Obesity is a chronic, progressive disease that impacts every organ and system in the human body. It requires an individualised, bio-psycho-social approach which incorporates screening, early diagnosis and evidence based treatment. We must shift away from solely focusing on primary prevention to also provide treatment and support to those living with overweight and obesity. This is in addition to the ongoing management of the potential medical complications and co-morbidities. There is, undoubtably, work to be done to change the narrative around obesity in society. We must continue to reduce the weight bias and stigma that persists in healthcare and primary care is no different. As family doctors, we are perfectly positioned to support patients who live with obesity. If we are adequately resourced, we have the capacity to see the large volumes of patients for whom excess weight may affect health. Primary care is not only a more convenient setting for our patients but it also offers significant savings from a healthcare economics perspective when compared to hospital based care. In many countries, primary care clinicians have invested heavily in healthcare informatics/IT and have been at the forefront of adopting hybrid models of care. These advancements have been realised on a day to day basis during the COVID19 pandemic. There is an opportunity to offer a blend of traditional, in-person and virtual consultations to patients living with obesity. The advantages offered are immense and can potentially remove some of the barriers to care that have existed in the past. As GPs, we know our patients in the context of their family and their community. We treat them across their lifespan. This provides an opportunity to screen those at higher risk ( with knowledge of family history, medical history and medications etc) and to facilitate early intervention. We are skilled in managing chronic diseases and offer the continuity of care and frequent review that is needed to manage a long term, progressive medical issue like obesity. We are innovators and can be at the forefront of adopting new treatments as they become available. We are experts in communication, behavioural support and brief intervention –… Read More »
Guest Post: My Journey With Obesity Medicine in Clinical Practice, Academia and Industry
Today’s guest post comes from my friend and colleague Abd Tahrani MD, PhD, International Medical Vice President in Global Obesity Drug Development at Novo Nordisk. My interest in obesity was sparked as a medical student. I remember being fascinated by three diseases: obstructive sleep apnoea, non-alcoholic fatty liver disease (NAFLD) and polycystic ovaries syndrome (PCOS). Clearly, obesity and disturbances in weight regulation (as well as abnormalities in autonomic function but that’s a separate story) play an important role in these diseases. But, at the time, there was no training in obesity in my medical school, which sadly is still uncommon globally today. My interest in obesity was reignited when I started my specialist training in diabetes and endocrinology. It was clear to me that there was a huge unmet need in the field of obesity. The burden of the disease was huge, access to health care for patients with obesity was challenging, treatment options were limited, stigma, prejudice and myths were quite common in the wider society as well as amongst health care professionals, payers and policy makers, and relatively low interest amongst my fellow trainees to specialise in obesity. Many of my colleagues felt that I was “mad” to choose obesity. Their negative impressions were driven by the perception that obesity was a “hard” speciality where achieving a successful treatment outcome is challenging and that the “customers” are unlikely to be happy with the results. For me, the challenge to improve health care delivery, treatment outcomes and patients satisfaction was a major driver. Also, my colleagues often cited the lack of effective pharmacotherapy as a reason to avoid specialising in obesity. After deciding that obesity medicine was a career for me, I faced the reality that there was no clear training path to become an obesity specialist in the UK. Hence, I had to build my own clinical training program alongside my academic research training. This enthused me to work with the appropriate societies and organisations in the UK to improve obesity training and to establish the first dedicated course to train diabetes and endocrinology trainees in obesity medicine in the UK. However, obesity medicine can be practiced by a wide range of health care professionals beyond diabetes and endocrinology. Hence, it is important to establish the appropriate education resources across multiple disciplines, especially primary care. In my years of practicing obesity medicine, I found working with patients in… Read More »
Canadian Obesity Guidelines Double CMAJ’s Impact Factor
There can be little doubt in anyone’s minds that the 2020 release of the Canadian Clinical Practice Guidelines on Adult Obesity, a summary of which was published in CMAJ, represents both a landmark and a watershed in obesity medicine. Within 48 hours of its release, it received over 80 miillion media impressions around the world and the CMAJ summary was the #1 downloaded article on the CMAJ website in 2020. Just how large the impact of these guidelines were, is perhaps best reflected by the recent “thank you” note to the authors from Kirsten Patrick, Editor-in-Chief of the CMAJ, which notes: “I’m writing to thank you for contributing to CMAJ’s doubling its Impact Factor (IF) in this year’s report! CMAJ’s 2021 IF is 16.859. The highly-influential Guideline that you and your colleagues published in CMAJ in 2020 contributed to this big jump. Thanks for choosing CMAJ for your publication. I hope you’ll choose us again.” In fact, according to Google Scholar, the guidelines have already been cited in over 150 articles and downloads of the PDF from the CMAJ website continues at a steady clip of over 2000 a month. This rather spectacular attention to these clinical practice guidelines (generally a rather mundane event that rarely catches the attention of lay media), is testament to the tremendous efforts and forward-thinking approach taken by the over 60 authors, who in 19 chapters layout our current thinking and evidence for addressing obesity as a chronic disease in clinical practice. While I congratulate CMAJ on this spectacular jump in its impact factor, I can only hope that this attention is reflected in the implementation of the over 80 recommendations by payers and health authorities as well as any health practitioners involved in obesity care. As our knowledge continues to advance, I look forward to the continuing updates of these guidelines to ensure that these advances continue to improve the lives of the people living with obesity. @DrSharmaBerlin, D
European Withdrawal of Amfepramone – End of an Era!
On Jun 10, 2020, the European Medicines Agency (EMA) recommended the withdrawal of amfepramone from the European market. This agent, belonging to the group of amphetamine-like stimulants, was authorised in Denmark, Germany, and Romania under the trade names Amfepramone Hormosan, Regenon, and Tenuate for weight reduction. Due to an increased risk of significant side effects including cardiovascular disease, pulmonary arterial hypertension, dependency and psychiatric disorders, as well as harmful effects if used during pregnancy, use of amfepramone was limited to no longer than three months. However, as the EMA review of amfepramone use revealed, “…amfepramone medicines continue to be used outside the current risk minimisation measures included in the product information.” As the EMA could not see any further measures that would be sufficiently effective to minimise the risk of side effects, it concluded that the benefits of amfepramone medicines do not outweigh their risks and recommended that the medicines be removed from the market in the EU. Notably, EMA also stated that other treatment options for obesity are available and that health professionals should inform patients about these options. Thus, it appears that at least in Europe, the era of amphetamine-like sympathomimetic medications for weight loss is finally coming to an end. No doubt, many health care professionals and patients, who may have relied on amfepramone in the past, will state that, despite possible risks, this medication at least was affordable to the many patient desperate for obesity treatment. Indeed, the vast majority of patients seeking anti-obesity medications, who may have swallowed the rather low cost of amfepramone (pun intended), may well baulk at the cost of the newer class of GLP-1 analogues (liraglutide, semaglutide), despite being deemed safer and more effective. This issue will need to be addressed by fair pricing policies and the hope that the daily cost of liragutide will drop considerably once the more effective once-weekly semaglutide enters the market, thus providing an affordable alternative to patients, who have previously relied on amfepramone. Ultimately, I see no alternative than to include reimbursement for safe and effective anti-obesity medications in health plans, thus making these treatments available to more than just the upper 1% who can afford to pay out-of-pocket. @DrSharmaBerlin, D
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