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 ever more safe and effective anti-obesity medications becoming available (assuming the supply issues can keep up with the demand), patients, desperate for treatment, will be running down their doctors’ doors demanding prescriptions. At the same time, doctors, seeing the success that their patients are having, will begin feeling far more positive and optimistic about obesity management than at any time in the past.
- While the benefits for patients with clear indications for anti-obesity treatment will become more and more obvious, so will the magnitude of misuse and abuse of these medications by folks who clearly do not have a medical need to lose weight. As the misuse of these medications will largely happen without the supervision of health professionals, we should expect increased occurrence of adverse effects and complications that could well be avoided when these medications are used as intended. This development will prompt increasing critical attention by the media with warnings about these medications and calls to restrict access even for people who meet the indications and stand to benefit from these treatments.
- As medical treatments are now approaching a level of effectiveness previously only seen with bariatric surgery, one may suspect that surgery rates will decline. The opposite is likely to be true. In fact, we will probably see pre- and post-surgical use of these medications substantially enhance the safety and long-term success of surgical procedures. Thus, for many (if not most) patients with severe obesity, the question will no longer be surgery or medication – in most cases it may well be both.
- As medical treatments become more effective and available, many treatment plans that have so far relied solely on behavioural interventions (including the use of devices and formula diets), will adapt to support and embrace medical options if they hope to stay in business. The same will apply to the many behavioural apps that are now crowding the eHealth space – these will need to incorporate some form of support for patients on anti-obesity medications – and this feature may well turn out to be their most valuable function yet.
- As with other chronic diseases, the greatest challenge will be to actually get patients to use these medications as prescribed and to persist with treatment in the long-term. Thus, the issue of proper adherence (without which there will be little long-term benefit, potential harm, and a substantial economic waste) will gain increasing attention.
With my best wishes for a Happy New Year!
@DrSharma
Berlin, D
No One Should Be Surprised That There Are Skinny Genes
Anyone who has ever seriously looked at the genetics of obesity should be well aware that body weight and size is a highly heritable trait.
As one may expect, this heritability extends across the entire spectrum of body size. Thus, if there are genes that explain obesity, then perhaps certain variations of these very same genes may do the exact opposite – i.e. promote “skinniness”.
In fact, we all know these people, who appear to be highly weight-gain “resistant”, in that they can apparently eat all day without gaining a gram of body fat or simply find it very difficult to “overeat” even when surrounded by highly-palatable food.
Now, a study by Fernando Riveros-McKay and colleagues, published in PLOS Genetics, compares the genetics of thinness with that of severe obesity.
Using genome-wide association studies, the researchers not only show that the heritability of thinness was comparable to that of severe obesity but they also confirmed the existence of 10 genetic loci that had been previously associated with obesity (as well as an addition obesity and BMI-associated locus (PKHD1).
As there may well be non-genetic reasons for people to fall into the “thin” end of the size spectrum, the researchers were careful to only include individuals who appeared in good health and especially excluded individuals with anorexia.
Overall, these finding are consistent with animal studies that have also identified loci/genes associated with thinness/decreased body weight due to reduced food intake/increased energy expenditure/resistance to high fat diet-induced obesity, mechanisms that the authors hypothesise may also contribute to human thinness.
Clearly, further genetic and phenotypic studies focused on persistently thin individuals may provide new insights into the mechanisms regulating human energy balance and may uncover potential anti-obesity drug targets.
@DrSharma
Edmonton, AB
Why Obesity Is A Chronic Disease
While I am currently teaching at a Harvard Medical School course on obesity for obesity educators here in Las Vegas, I thought it may be appropriate to post a link to my recent Obesity Canada webinar (about 60 mins) on why obesity is a chronic disease.
The full video can be accessed by clicking here
@DrSharma
Las Vegas, NV
Experimenting And Reevaluating
If there is one thing for sure, when it comes to managing obesity, one size does not fit all. In the same manner as there are hundreds of paths that lead to obesity, predicting the treatment that works best for any given patient is almost impossible – what works for one, may do nothing for another (treatments fail patients, patients never fail treatments).
Thus, in our analysis of interviews with patients and providers, published in Clinical Obesity, the eighth theme that emerged, was the importance of experimenting and reevaluating.
“Participants experimented with different actions, arranged appointments with interdisciplinary providers, or tried out community resources. Some changed their action plan and implemented different behaviours inspired through the consultation. During follow-up interviews, people reflected on what worked, what did not and what needed adjusting. Participants found that having someone ask how things are going was helpful for accountability and motivation. These conversations also helped them develop solutions for barriers.
It became glaringly obvious that, as with any other chronic disease, obesity care needs creating a supportive long-term relationship in order to respond to emerging barriers, shifting experiences, illness and treatment burden – what works great at one point may stop working when situations change. Things that seem impossible at first may well become possible over time.
If there is one thing that I have learnt in my dealing with patients, it is modesty in professing to have the solution for every problem.
As I have said, people who think there is a simple answer to every question, generally don’t even understand the question.
@DrSharma
Madrid, ES
Fostering Reflection
As should be clear by now, obesity management often involves reframing the story, changing misconceptions about obesity, managing expectations, reorienting from weight to health goals.
All of this requires reflection both on part of the patient and the provider.
Thus, fostering reflection was one of the key themes that emerged from out interviews with patients and providers published in Clinical Obesity.
“For many participants, the insights and shifts in beliefs about self and health required time to reflect and integrate.People processed new understandings in different ways and internalized them to different degrees.”
While some patients went though this process of reflection in conversations with family, friends or their clinician, many reported that keeping a journal of their progress was a key instrument:
I routinely tell my patients to write down key events, emotional issues, stressors, milestones, challenges, and successes in their journals (not just their food intake and physical activity). Many have told me how helpful they find this and how much they have discovered about themselves through this exercise.
@DrSharma
Copenhagen, DK
