Obesity Medicine Wasn’t Born Yesterday, Ya Know
Much of the world is having a revelation. Stat News call is a revolution. So does Oprah. They are waking up to a very basic fact that we’ve been working with for decades now. Obesity is a chronic, treatable disease. Obesity medicine wasn’t born yesterday.
But it has, at times, been lonely. Arthur Frank, a distinguished obesity medicine physician, once wrote in JAMA about his experience taking up a calling to work in this field back in the 1970s:
“Twenty years ago, I changed course in my internal medicine practice and decided, rather deliberately, to work on the problem of obesity. My friends, my colleagues, and my family thought I was crazy. The warnings were clear. ‘Don’t risk your credibility and your career…Don’t venture into a part of medicine that no one takes seriously…Don’t move into the world of quacks and charlatans.’”
No, obesity medicine wasn’t born yesterday. For people living with severe obesity, the need for medical care was always great. But for a very long time the most common response was stigma, blame, and shame. Not support and care. Obesity medicine physicians like Frank were rare gems.
Pharmaco-Amnesia
Writing in the Atlantic, Daniel Engber describes what he calls “pharmaco-amnesia.” Many doctors and patients have forgotten, if they ever knew, that other medicines for obesity have been around for a long time, he says:
“Indeed, the best of these latter treatments might produce, on average, one-half the benefit you’d get from using GLP-1s in terms of weight loss, at less than one-30th the price.”
He also points out something we’ve known for a very long time – individual results may vary:
“The average weight-loss effects reported in the literature can’t tell you how each specific patient will respond to treatment. When people take Wegovy or Zepbound, more than half of them are strong responders, according to the published research, with weight loss that amounts to more than 15 percent. At the same time, roughly one in seven people gets no clear benefit at all. The older drugs also have a diversity of outcomes. Qsymia doesn’t seem to work for about one-third of those who take it, but another third finds Ozempesque success, losing at least 15 percent of body weight.”
GLP-1 or Bust
Sarah Ro is an obesity medicine physician in Hillsborough, NC. She cares for people with obesity in a primary care setting – people who have not had great access to GLP-1 agonists. Yet she finds ways to get good clinical results with older tools and with good clinical judgment. To illustrate, she describes a patient who has lost 70 pounds and resolved their sleep apnea, pre-diabetes, gastric reflux, and MASLD without taking a GLP-1. Two generic drugs – metformin and topiramate – produced those results.
She told Engber (and she has told us) that she rejects the mentality of “GLP-1 or bust.” Rather she celebrates the great breadth of options available:
“Compared to just a few years ago, I am amazed and hopeful with all the resources we now have for ALL patients suffering from obesity!”
The resources for obesity medicine have been developing for a very long time. The challenge that remains is to improve awareness and access, while continuing to improve the tools.
We highly recommend you read Engber’s new article, available here.
Birth, painting by Marc Chagall / WikiArt
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March 27, 2024
