The Dawn of Obesity Centric Medical Practice?

Last week at Obesity Week, Ildiko Lingvay (UT Southwestern Medical Center, Dallas) presented a plenary talk in which she discussed weight-centric vs. gluco-centric approaches to managing patients with type 2 diabetes mellitus (T2DM). 

Despite the fact that we have long seen the strong association between body fat and the development of T2DM, the recommendation of weight loss in all T2DM guidelines, and ample data showing that weight loss can markedly reduce the risk for T2DM, improve glucose control, and even lead to diabetes “remission”, Lingvay noted that we have so far lacked the tools to effectively address obesity in our patients. 

Now, with the advances in Nutrient-Stimulated Hormone (NuSH) based therapies, resulting in weight loss paralleled only by surgical interventions, we can foresee a future, where obesity treatments may well prove to be the first-line treatment not just for T2DM, but for a host of other conditions causally related to or significantly aggravated by obesity. 

Thus, we can envision that anti-obesity medications (AOMs) become the primary treatment for patients with sleep apnea, hypertension, MASLD, and a laundry list of other health problems related to excess body fat. 

Obviously, much needs to happen before we get there. 

For one, we will need dedicated studies directly comparing obesity centric approaches to treatment to “usual care” – numerous such studies for various indications are already underway or in late-stages of planning. 

Secondly, access to such medications will need to vastly improve. Currently cost and a global demand that is far outstripping limited supplies are proving to be significant barriers. 

Thirdly, all of us have to get more comfortable with the appropriate and safe use of these medications, which should only be used in the context of patient-centric obesity care. 

Despite these limitations, it will be exciting to watch how increasing evidence will change our treatment approaches for a large proportion of people living with a wide range of non-communicable chronic diseases, for which obesity remains one of the primary drivers world-wide. 

Jeddah, KSA

Disclaimer: I have received honoraria as an independent medical, research and/or educational consultant from various companies including Aidhere, Allurion, Boehringer Ingelheim, Currax, Eli-Lilly, Johnson & Johnson, Medscape, MDBriefcase, Novo Nordisk, Oviva and Xenobiosciences.