What Does a New Era of Obesity Care Look Like?
For decades now, Lee Kaplan and Caroline Apovian have led what was known as the Blackburn Course in Obesity Medicine every year at Harvard in June. This year, the name of the course has changed to Obesity Treatment 2022. It has moved to the Dartmouth Geisel School of Medicine, where Richard Rothstein has joined Kaplan and Apovian as a course director. Though the Blackburn Foundation is supporting this course in its new form, Harvard seems to be hanging onto the Blackburn name for a future offering. But one thing has not changed. The course began yesterday with a compelling overview by Kaplan of the new era in obesity care that is emerging with more and better options for care in this chronic disease.
Three observations from Kaplan help to paint the picture.
Embracing the Science
Kaplan began with an exceptionally clear view of what obesity is and what it isn’t. The science of obesity and metabolism tells us that it is a problem of physiology – irrespective of whatever triggers it. The body has highly evolved systems for regulating fat mass and protecting it for our very survival. This is why it’s a chronic disease. It develops when that physiology isn’t working well and harms our health all by itself. When it goes untreated, obesity also causes other diseases.
But the whole world has been acting as if obesity is a problem external to the body. Most people regard it as a manifestation of a bad environment and bad behaviors. Correct the environment or the behaviors and the disease will disappear.
We now know that this is not so. When obesity develops – whatever the triggers – it doesn’t disappear through behavior and environmental changes. Effective obesity care requires embracing the science that tells us it requires treatment to fix the broken physiology driving a higher fat mass that is driving this disease.
With better options – both drugs and surgery – to fix that broken physiology, the world is waking up to embrace the science of obesity as a problem of physiology. Not bad behavior.
Better Options
Over the last month, news about tirzepatide made it real. A new generation of truly effective anti-obesity medicines is emerging. We are entering a new era for obesity care. These new drugs are bringing us a level of effectiveness that may eventually match or exceed bariatric surgery.
Semaglutide was not a fluke, Tirzepatide will not be the last word. Cagrlinitide is entering phase 3 trials this year. More options, like AMG 133 and danuglipron are progressing too. Competition is attracting innovation and that will bring even more options because the need for options that work well is great.
Better Access
But the final piece of the puzzle is better access to care. Kaplan explained that embracing the science of obesity will be essential for overcoming the bias that obesity is not really a disease. It’s that bias that gets in the way of access to the care that people need to overcome this disease. It may help if prices come down as price competition heats up.
The biggest factor, though, will be the stubborn and persistent facts of obesity science. Without adequate care for this disease, many other diseases develop and become costly to our health and our economy. Only by facing the facts of this relentless disease can we interrupt that cycle. As we do so, access to obesity care will open up.
Click here for the slides from Kaplan’s sweeping view of the future for obesity care with our thanks for his permission to share them.
Architectural Form of Future Ideal Landscape, painting by Enrico Prampolini / WikiArt
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June 25, 2022
