The First Flowers

Ready to Treat Obesity First? It Only Took 35 Years

We asked professor Caroline Apovian about the origin of treat obesity first as a principle of care for patients suffering with many complications of the disease. She was blunt. “I was teaching this concept 35 years ago in the Blackburn Course on Obesity Medicine. Suddenly people think they’ve stumbled onto something new.”

New or not, people are getting a clue that obesity medicine physicians like Apovian and her peers have had for a long time. We’ve known it at ConscienHealth from the beginning. When obesity goes untreated, medical complications pile up. With effective treatment, those complications can resolve.

Gina Kolata reported on this epiphany in the New York Times yesterday. She also pointed to factors that get in the way, even today.

New Therapies Make It Real

If this insight is something obesity specialist have long known, why is it suddenly so obvious to so many people. Yale’s Ania Jastreboff explains that having new and better treatments is opening many eyes:

“The new obesity medications are highly effective, and they’re transforming the way that we can care for our patients. By treating obesity, we are mitigating, treating, and preventing obesity-related conditions such as cardiovascular disease, diabetes, hyperlipidemia, and hypertension.”

Most especially, a flow of outcomes studies brings powerful data to support the experiences that clinicians routinely see. It started with the SELECT study, making it clear that obesity treatment prevents heart attacks, strokes, and death in people with cardiovascular disease. Studies on sleep apnea, renal, liver, and other metabolic outcomes will keep adding to the evidence.

Meanwhile, patients like Lesa Walton (whom Kolata interviews) find relief from inflammatory conditions when their doctors treat their obesity. Inflammation is a prominent feature in the pathophysiology of obesity.

Held Back by a Fraught History

So why do people hesitate to treat obesity first? In part, this is an expression of a normal adoption curve for innovation. Medical innovation is no different.

But it is also important to remember the fraught history of efforts to “tackle” obesity. All too often they were more about blame and shame than medical care for a chronic disease. Doctors would simply “instruct the patient to lose weight” and leave it at that.

Mindful of that history, primary care doctor Scott Hagan tells the Times that he fears patients will be put off if he wants to address obesity first and foremost. “My priority is establishing trust in a relationship,” he says.

These concerns will not simply evaporate. But they are fading. Both good data and good patient experiences are pushing that unfortunate history into the past.

Click here for Kolata’s report in the New York Times and here for guidance from the Endocrine Society that offers perspective on prioritizing obesity in drug therapy.

The First Flowers, painting by Paul Gauguin / WikiArt

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June 19, 2024