What I Took Away From EASD 2023

Last week at EASD 2023 in Hamburg, the greatest buzz was clearly around incretin-based weight loss treatments and their potential metabolic benefits. 

In the many sessions on incretin mimetics, data were presented with the promise of weight loss of 25% and beyond, results that are only rivalled by surgical treatments. 

There were also several sessions that focussed on the increasingly complex biology of adipose tissue and the various obesity phenotypes that may be defined according to metabolic parameters. 

Does this mean that diabetes is now poised to take over the fast evolving field of obesity medicine? 

Not quite! 

Although clearly, weight-centric (rather than gluco-centric) management of type 2 diabetes is gaining in acceptance and importance, there is more to obesity medicine than lowering body weight or optimising glycemic control. 

For one, most people with obesity do not have diabetes and even if they do, normalising their HbA1c is often the least of their problems. 

Rather, their issues often revolve around chronic pain, osteoarthritis, sleep apnea, reflux disease, incontinence, fertility, and a host of other problems including the social and psychological burden of living with excess weight, all of which markedly impair their quality of life.

As one may guess, none of these topics featured anywhere in the EASD plenaries – in fact I did not note a single presentation on the topic of weight bias and discrimination – probably the single most import issue to be aware of and be able to deal with when working in obesity medicine. 

Also, given that obesity is largely driven by ingestive behaviour and the principal mode of action of incretin-based weight-loss treatments is to markedly alter eating behaviour through its central actions on the brain, it may be surprising that short of the excellent presentation by  Timo Müller on the role of GIP and GLP-1 on energy homeostasis (58th Minkowski Lecture – which unfortunately ran parallel to the the SURMOUNT-4 session), there was rather little focus on the central modulation of eating behaviour, the real reason why these treatments work to reduce weight. 

So, while I was happy to see the excitement at EASD around incretin-based treatments for weight management and appreciated the many excellent presentations on adipocyte biology, this is still a far cry from fully embracing the complexity and diversity of obesity medicine. 

Clearly, I expect that the presentations this week at Obesity Week in Dallas will paint a very different picture of obesity care than I witnessed at EASD.

@DrSharma
Berlin, D

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.