Helix Welder

Obesity Care Week: New Roles for Old Tools of Care

Obesity Care Week this year comes at a time when we have shiny new tools for treating obesity that are garnering a whole lot of attention. One would have be living under a rock not to have heard all the buzz about semaglutide, tirzepatide, and a host of other medicines coming soon for obesity.

But we would be foolish to think that these breakthrough medicines mean that other tools for obesity care are suddenly obsolete. It is clear that this is not so. What is true, though, is that their roles are shifting. They are becoming essential to a comprehensive approach to medical care for obesity. Such care is slowly but surely entering the mainstream of medical care.

The Durable Benefits of Surgery

Last week in JAMA, we got a reminder of the durable benefits of metabolic surgery. Anita Courcoulas and colleagues published published data for up to 12 years from a randomized controlled trial of gastric bypass, sleeve, or adjustable banding procedures versus medical and lifestyle therapies for persons with type 2 diabetes and obesity. The results showed decisively better outcomes for the patients randomized to surgery. Surgery was superior for providing long-term control of blood sugar and for producing remissions in diabetes. Even after 12 years, 13% of the surgery patients were still in remission. None of the patients in the medical and lifestyle group were.

Tom Wadden, Bob Kushner, and Ariana Chao summed it up in an editorial published with the study:

“The excellent well-controlled study published in this issue of JAMA by Courcoulas and colleagues provides the most robust evidence to date of the long-term efficacy of bariatric surgery for improving control of type 2 diabetes.”

So, no. Metabolic surgery will not cease to be one of the important tools for obesity care anytime soon.

Support for a Healthy Life

Likewise, the folks who see the new generation of obesity medicines as a threat the role for lifestyle therapies in obesity care are mistaken. Recently in Obesity, Kristina Lewis, Justin Moore, and Jamy Ard laid this out with exceptional clarity:

“As a field, obesity medicine must move away from the toxic “lifestyle versus medical therapy” debate. Our patients will benefit most if we can learn to pair lifestyle interventions with pharmacotherapy to both optimize health outcomes and help them maintain lower body weights.”

Things will change. The role of medicines, surgery, and lifestyle therapies will evolve because of the emergence of more effective drugs. But clearly all of these tools have important roles to play.

Click here for the Courcoulas study and here for the editorial that goes with it. For the perspective from Lewis et al, click here.

Helix Welder, painting by Grant Wood / WikiArt

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March 7, 2024