OW2024: Is Obesity Becoming The New Hypertension?

With the opening of ObesityWeek 2024, it’s worth stopping to consider the radically different situation for obesity medicine today in comparison to a few years ago. Obesity is becoming the new hypertension, says Lou Aronne. He called for it in 2017 and now it’s coming true.

Aronne is a past president of the Obesity Society and will be giving a key lecture Monday on therapeutic goals for obesity treatment – in addition to presenting with four others on three-year health outcomes with tirzepatide in the SURMOUNT-1 study.

Aronne has been a pioneer in obesity medicine research for decades now. But he recently reflected on how great the progress has been in the last few years:

“I love telling people that I’ve done more than 60 trials of drugs for obesity treatment in 35 years. It’s only been in the last 2 years that have really moved the needle. An idea I presented as far back as 19 years ago is that losing weight produces health benefit. Cardiologists have always been skeptical of this. Cardiologists think that being a little bit overweight in their studies shows there’s better survival from various cardiac maladies.”

Treating Obesity First

Just a few years ago, treating obesity was a mere footnote. Physicians might dispense boilerplate – and largely useless – advice to lose weight. But their focus has long been on controlling the diseases that result from obesity, not obesity itself.

As data from cardiometabolic outcomes studies emerges with drugs like semaglutide and tirzepatide accumulates, it is becoming obvious that this has been a missed opportunity. Aronne explains:

“The point is that if you are overweight, you’re more likely to have those problems. We now have, if you will, a dose response of weight loss vs. improvement in obesity comorbidities. And the beauty of treating obesity is that you get all of them.

“For example, if you try to reduce cardiovascular mortality by using a statin, you’re not improving type 2 diabetes. In fact, there’s some areas that may be worse – maybe increasing glucose. If you use a statin, you’re not improving heart failure. But if you get someone to lose weight, you could get all three of those. If you can get 15% or greater weight loss, there’s evidence you could throw type 2 diabetes into remission. You can reduce cardiovascular mortality and improve heart failure, and the list goes on.”

Will Obesity Become the New Hypertension?

With every new piece of outcome data for highly effective obesity treatment, it seems more likely that obesity will indeed become the new hypertension. One block of that data will be the three-year data we see on Monday at ObesityWeek.

There is a big missing piece, though. Translating this opportunity into reality will require a shift in pricing and access to obesity medicines. Right now, as first-movers are skimming profits from the market with high prices, access is limited. The life-changing benefits of these medicines are going only to a few people with wealth and privilege.

This will change. Because obesity will genuinely become the new hypertension only when everyone who needs care can get it. The only question is how that change will come. Will current market leaders bring it? Will new competitors? Or will other forces reshape the marketplace? We have some interesting years of great change ahead.

Click here and here for more on ObesityWeek and here for more on Aronne’s thinking.

Frost-Covered Lifebuoy, photograph by Radomianin, licensed under CC BY-SA 4.0

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November 3, 2024