ECO2023: An Eye on Future Progress in Obesity

ECO2023 closed today with a clear focus on future progress in obesity. Lee Kaplan offered a view of what that future might look like with a focus on access and delivery of chronic care for obesity.

Kaplan told us the future of obesity care lies in getting beyond merely saying that obesity is a disease. We must move on to actually treating it like any other disease. That means, for example, treating it just like we would treat coronary artery disease. Instead of pretending that lifestyle changes should take care of it. A substitute for actual medical care.

Most of all, he said, we have failed in efforts for obesity prevention simply because the approach to prevention and treatment have been entirely separate:

“Treatment and prevention people barely talk to each other. It’s like Republicans and Democrats.”

Better Medicines

Much of the excitement in this field comes from the fact that we have much better drugs now than we did even just five years ago. Semaglutide helped us leap forward when it was approved for obesity treatment in 2021. Later this year, tirzepatide may be approved and the signs are that it will offer even better efficacy.

When Novo Nordisk told the world in 2017 that they were committed to matching the outcomes of bariatric surgery with advanced obesity medicines, it was a bold aspiration. Today, it seems very likely.

Better Outcomes

This fall, the results of the SELECT study of cardiovascular outcomes will emerge and it may mark a big milestone for obesity therapy. If the results are positive, this will be the first evidence from a randomized controlled trial to show that obesity treatment can extend life and prevent major health events like heart attacks and strokes.

Such outcome studies have been transformative for treating hypertension, high cholesterol, and diabetes. Obesity is different in so many ways, but we expect that outcome studies for obesity can have similar effects. In a modeling study of cardiovascular risk scones, Wissam Ghusn and colleagues found a drop estimates of cardiovascular risk after therapy with semaglutide. These results, presented as a poster at ECO2023 may be a preview of future progress toward better outcomes.

Better Understanding

One of the key needs for progress relates to the misunderstanding of obesity. The public, and perhaps many health professionals simply don’t understand the nature of obesity as a chronic disease. Thus they are shocked that obesity medicines don’t work after a person stops taking them.

Better Prevention

As Kaplan explained, we must do better on obesity prevention. It will require more nuanced strategies. Because obesity is heterogeneous, no single intervention is likely to work across the population. To develop better prevention strategies, treatment and prevention experts cannot continue to work in separate and polarized silos. Ximena Ramos-Salas summarized the workshop she chaired with Euan Woodward, saying:

“We have some agreement that rethinking obesity prevention is necessary. But there is a lack of empowerment to create this change. Empowerment will require more collaborative and community driven conversations and actions.”

The future is indeed bright for progress in obesity. Because we are shedding some old presumptions that never served us well.

Click here, here, here, here, and here for more about the insights we’ve taken from ECO2023.

Future, painting by Giacomo Balla / WikiArt

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May 20, 2023