Cityscape with Bridge

OW2021: Building a Bridge to the Future of Obesity Care

Monday was quite an opening day for ObesityWeek 2021. Starting with the lived experience, the meeting then moved quickly into some serious science, clinical care, and policy discussions. But one of the most impressive sessions of the day gave us a “tour de force” of future options under development for obesity care. Our friend Mike Albert described it well in a thread we commend to you.

A Bridge to Better Care in the Future?

Tirissa Reid chaired this impressive session. It led us through the status of a wide range of new options for obesity care in various stages of development. At one extreme, we heard about Plenity – a super-absorbent hydrogel with exceptional safety and modest effectiveness. It’s just now being introduced into clinical care as a medical device, because it acts locally in the gut.

At the other extreme comes cagrilinotide – a new analogue of amylin that went only by its code name AM833 until recently. That’s how new it is. Along with that newness comes excitement from tantalizing early clinical data. That’s because those data suggest it might work in combination with semaglutide to yield even higher effectiveness than semaglutide alone. Of course, these are early clinical results – mere hints of promising efficacy.

Then there was more. Setmelanotide is already approved for clinical use in very specific indications, but clinical research is ongoing to explore other uses. Bimagrumab is a fascinating anti-obesity medicine that may have beneficial effects on not just weight, but also body composition.

It’s a lot that’s on the way and there’s more besides just this sampling.

But What About the Systems for Care?

New options are good, but can’t have much impact in a world where healthcare really means delayed disease care for the complications of untreated obesity. Because this is our present reality.

A new paper in Mayo Clinic Proceedings tells us that anti-obesity medicines are still (as of 2016) barely used at all in the care of people living with obesity. Between 2011 and 2016, when several new meds gained approval, there was no more than a slight increase in use. Senior author Fatima Cody Stanford tells us, “This is sad. Physicians have tools for obesity care that they are just not presently using for most patients.”

Ard et al: Pharmacotherapy Use in Obesity CareFurther insight into this situation comes from research that Jamy Ard and colleagues are presenting at ObesityWeek. People living with obesity have very negative perceptions about this condition, but they are open to treatment. However, most healthcare providers aren’t familiar with obesity care guidelines and thus prioritize treating other conditions. They see the complications of untreated obesity – diabetes, hypertension, dyslipidemia, etc. – as being easier to treat.

So it’s no surprise that we don’t have a healthcare system that attends to the problem of obesity. Instead, we have a system that waits for the complications of obesity and spends huge sums of money on treating those complications. It is a perfect case study in irrational healthcare.

We have good new options coming for a future of better obesity care. But they will be have little impact if the systems for delivering that care remain so deficient.

Click here for Albert’s thread on the pipeline of antiobesity meds and here for Stanford’s new paper. For more details on Ard’s research, download his poster here.

Cityscape with Bridge, painting in the style of futurism by Bela Kadar / WikiArt

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November 2, 2021