Top Ten Thoughts to Take Home from OW2022

It’s been quite a week in San Diego and we hope that everyone is safely home or on their way. So with the wrap-up of OW2022 yesterday, here are a few thoughts we’ll take home with us from this remarkable week.

1. Pediatric Obesity Care Is Set to Leap Forward

It’s hard to miss this week. Obesity care for young persons has been lagging for years as these kids suffer with meaningful help available to only a small fraction of those who need it. The outstanding results with semaglutide in teens reported this week remind us that better care with meds and surgery can make a big difference. The American Academy of Pediatrics is poised to issue new clinical practice guidelines that will likely nudge the profession toward providing better care.

2. Obesity Meds Are Catching Up with Surgery

The breadth and depth of research on new obesity meds presented at this meeting is truly breathtaking. Ania Jastreboff did a fine job of laying it out for us at the opening of the meeting and new insights kept coming through the week.

3. Healthcare Is Making People with Obesity Sick

Our systems (if you can call them that) for delivering healthcare are failing people with obesity. Regardless of health insurance, most people still pay out of pocket for this care. Worse, pervasive bias and stigma in healthcare adds to the suffering.

4. People Gotta Get Over Nature-vs-Nurture Thinking for Obesity

Ismaa Sadaf Farooqi gave us an excellent overview of the genetic basis for obesity and appetite on Thursday. Copious research presented this week makes it clear that obesity is a highly heritable condition of physiology that isn’t working well to regulate our fat storage. Genes set the table and the environment serves it up. But for the public and even many health professionals, it’s tough to escape the implicit assumption that this is merely a behavioral problem the food industry drives.

It’s time to move on to problem solving.

5. BMI and Weight Loss Have Issues

Our friend Scott Kahan brought the message home in a key lecture. But this thinking was pervasive through the week. BMI as the sole measure of obesity and weight loss as the main measure for treatment outcomes requires rethinking.

6. Lived Experience Gaining Traction

We were delighted to see Patty Nece receive a presidential medal for her work – bringing the voice of lived experiences with obesity into a prominent place. Liz Paul and others made this a visible feature of the meeting.

7. Models of Obesity Care Changing Fast

The future of obesity care will not be confined to obesity medicine specialists delivering face-to-face care. Many models are competing to offer better ways to deliver this important care.

8. What About Prevention?

It’s plain to see that decades of talk about prevention has not yielded any change in the upward trend in obesity prevalence. So we need better strategies with a demonstrable effect for bending the curve. Neglecting this important dimension of the response to obesity would be a tragic mistake.

9. The Economics of Obesity Need Work

John Cawley made us think hard about the economics of obesity. The current approach, with everyone paying out of pocket, is quite costly but hard to change. Costs of untreated obesity pile up.

10. Precision Medicine Has Promise Yet Unfulfilled

Obesity clearly is a very heterogeneous condition. One-size-fits-all diagnosis and treatment yields mediocre results. But differential diagnosis and care is not yet here for us. Lee Kaplan told us a bit about the promise and the gaps, as did Christopher Gardner.

It’s been quite a week. We’ll be processing these insights for quite a while.

Homework, painting by Nikolay Bogdanov-Belsky / WikiArt

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November 5, 2022