ADA2023: A Golden Age of Obesity Medicine?

“We may be on the cusp of an era of astonishing innovation – the limits of which aren’t even clear yet,” writes David Wallace-Wells in the New York Times. Among other breakthroughs, he cites the transformation in care that semaglutide and tirzepatide are bringing for the most prevalent chronic disease in the world – obesity. Indeed, as Matthias Tschöp accepted the Banting Medal for scientific achievement at ADA2023 yesterday, it was hard to escape the conclusion we are entering a golden age for obesity medicine.

Tschöp eloquently outlined three decades of work in pursuit of a singular and seemingly impossible goal. He and Richard DiMarchi set out to discover a new class of drugs that can safely reduce body weight by up to 30%, overcome obesity, and prevent type 2 diabetes.

Multi-Receptor Hormone Agonists Become Reality

The fruit of this work is on dazzling display at ADA2023. In just three days we have seen no fewer than six major studies of the drugs inspired by this work published in NEJM and Lancet simultaneously as they were presented at the meeting. Tirzepatide is the most advanced example of these drugs in clinical development. But it is surely not the last of them. Tschöp listed a dozen such molecules that are already in clinical trials.

Tirzepatide targets two distinct peptide receptors: the GLP-1 receptor that semaglutide targets, plus GIP receptors. These are just two of the receptors that serve to regulate signals between the brain and gut to control metabolic function, appetite, and ultimately the adiposity and inflammation that lies at the root of obesity. The disrupted physiology of these hormones is what makes obesity a chronic disease and not merely a sign of bad dietary choices.

A Golden Age for Obesity Medicine

So it is not hard to see that a golden age of obesity medicine is within reach. Writing in Nature Metabolism this month, Tschöp says without a trace of hyperbole:

“The discovery and development of so-called gut hormone co-agonists as a new class of drugs for the treatment of diabetes and obesity is considered a transformative breakthrough in the field. Combining action profiles of multiple gastrointestinal hormones within a single molecule, these novel therapeutics achieve synergistic metabolic benefits.”

Unprecedented Advances

We do appear to be entering an age of unprecedented advances in medicine. Biochemist Jennifer Doudna described it for the Times:

“I’ve been running my research lab for almost 30 years. And I can say that throughout that period of time, I’ve just never experienced what we’re seeing over just the last five years.”

Consider that it was a decade ago when she and colleagues first described the science of CRISPR gene editing. It won her a Nobel Prize. That she sees present advances in medicine as even bigger should make us all stop and think.

The revolution in obesity medicine that co-agonists will bring is part of this. Thus we can see that dramatically better obesity care is at hand. This is breathtaking progress.

Click here and here for perspective from Tschöp on the work to bring co-agonists into clinical care. For more from Wallace-Wells on the coming era of astonishing innovation in medicine, click here.

Matthias Tschöp Accepts the Banting Medal for Scientific Achievement, photograph by Ted Kyle / ConscienHealth

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June 26, 2023