Dr. Clemens opened her session by acknowledging the American Medical Association’s (AMA’s) statement that obesity is a “chronic disease state” that “…should be treated like diabetes, hypertension, and hyperlipidemia.” She noted that even after 11 years since the AMA made this statement, there are still providers who do not recognize obesity as a chronic disease. She stressed that obesity is a “chronic, relapsing condition in which there are multiple factors that can explain or cause an individual to carry that extra weight and have them living with obesity.”
According to an article published in the New England Journal of Medicine in 2019, by the year 2030, there is an estimated obesity prevalence of >50% in over 29 of the 50 states. This includes one in two adults with obesity (defined as a BMI ≥30); one in four adults with severe obesity (defined as a BMI ≥40); and the high-risk populations that include women (27.6%), non-Hispanic black adults (31.8%), and low-income adults (31.7%).
Dr. Clemens explained that the general goals of weight loss are to reduce morbidity, control concomitant risk factors, and reduce the risk of complications. She noted, however, that what is harder than losing the weight is the maintenance of keeping the weight off long term. She added that lifestyle modifications that need to be considered along with pharmacotherapy include nutrition, physical activity, and behavioral therapy.
This talking point led to the introduction of the two most recent weight-loss medications on the market—semaglutide and tirzepatide. She stated that these two medications are “pushing the needle closer to bariatric surgery,” with these medications reporting secondary endpoints of percent of individuals losing up to 20%.
Several antiobesity medications are available for weight loss. These include phentermine, Orlistat, phentermine/topiramate, bupropion/naltrexone, liraglutide, semaglutide, and tirzepatide. Dr. Clemens broke these medications down into five categories utilizing the information provided by each drug’s package insert: safety, tolerability, efficacy, price, and simplicity. The only short-term medication in this list is phentermine—with 12 weeks of therapy—and the rest are considered long-term medications, ranging from 1 to 3 years of use according to recent trials. Additionally, she included challenges and barriers to each medication. These included adverse events (common and rare), availability (e.g., regulatory considerations, drug supply chain issues), cost/copayments (she noted that this is the biggest challenge), therapeutic inertia, and unknown duration of therapy.
The future antiobesity agents currently being investigated are cagrilintide, cotadutide, danuglipron, efpeglenatide, orforglipron, semaglutide (oral), and retatrutide.
In closing, Dr. Clemens emphasized that healthcare professionals should focus on person-centered weight-management plans that are based on each drug’s clinical evidence and that guidelines should be customizable to each patient. Additionally, she hopes that within the next 2 years or so, there will be a change in insurance coverage for the newer weight-loss agents. Finally, she asked for consideration in proactive strategies to overcome challenges and barriers in promoting evidence-based practice and justifying specific therapy for people living with obesity.
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