Key Considerations with Newer Anti-obesity Medications

| July 1, 2022

by Harold Bays, MD, FOMA, FTOS, FACC, FACE, FNLA

Dr. Bays is Medical Director, Louisville Metabolic and Atherosclerosis Research Center in Louisville, Kentucky; Chief Science Officer for the Obesity Medicine Association (OMA); and a member of the Board of Trustees of the OMA.

Funding: No funding was provided.

Disclosures: In the past 12 months, Dr. Harold Bays’ research site institution has received research grants from 89Bio, Alon Medtech/Epitomee, Altimmune, Amgen, Boehringer Ingelheim, Eli Lilly, Evidera, Novartis, NovoNordisk, Pfizer, and Vivus. In the past 12 months, Dr. Harold Bays has served as a consultant/advisor for 89Bio and Amgen. 

Bariatric Times. 2022;19(7):18.

While some patients might seek anti-obesity medications to improve their body image, most patients seek treatment of obesity for the purpose of improving their health. New advancements in obesity research provide effective anti-obesity medication options. Obesity affects 40 percent of adults in the United States (US), with 10 percent experiencing severe obesity.1 A recent treatment option backed by a robust clinical trial program signifies that we might be on the cusp of a new age in the medical treatment of obesity.   

Anti-obesity medications designed to improve overall health. Today’s medications are designed to go beyond weight loss and positively impact the patient’s comprehensive health profile. An example of an anti-obesity medication designed to target multiple functions is Wegovy™, a semaglutide injection with a long-acting glucagon-like peptide-1 (GLP-1) receptor agonist. 

Semaglutide works within several organs, including the brain, pancreas, stomach, liver, and adipose tissue, optimizing its effectiveness. As a result, its incretin-like effects can decrease hunger, increase insulin secretion, delay gastric emptying, reduce liver fat, and improve adipose tissue function. By leveraging these functions, semaglutide can reduce body weight and improve metabolic parameters, such as blood glucose, blood pressure, and blood lipids.

Benefits of anti-obesity medications. One of the biggest concerns for patients with obesity is lifelong exposure to the metabolic complications of the adiposopathy-related endocrine, immune, and fat mass complications of increased body fat. Early diagnosis and intervention, which often include medication, can reduce these exposures and contribute to improved health. 

Patients with obesity who also demonstrate early indications of hyperglycemia, high blood pressure, abnormal blood lipids, or weight-related challenges with sleeping, breathing, or mobility often benefit from anti-obesity medical treatments. Anti-obesity medications are also an important clinical consideration for patients with known complications of obesity, such as obesity-related Type 2 diabetes mellitus, hypertension, or dyslipidemia. 

Facilitating weight loss can lead to improved symptoms of obesity-related diseases or complications, offering a multitude of health benefits to the patient.

Safety, effectiveness, and risks of anti-obesity medication. Every anti-obesity medication has a safety and tolerability profile that should be reviewed prior to prescribing. The Obesity Medicine Association (OMA) recently published a comprehensive Clinical Practice Statement on this topic, as well as discussed anti-obesity drugs in development (e.g., tirzepatide).2 In the past, some anti-obesity medications were found to have postmarketing adverse side effects that resulted in their withdrawal from the market. Semaglutide has undergone a robust development program to provide clinical trial evidence of its safety. The US Food and Drug Administration (FDA) approved semaglutide for adults with obesity in July 2021, the first approved drug for chronic weight management in adults with general obesity since 2014.3

As noted by the OMA Clinical Practice Statement,2 prior anti-obesity medications facilitated a mean weight reduction of approximately 5 to 10 percent. However, semaglutide facilitates a 15 percent mean weight loss, with approximately one-third of patients achieving over 20 percent weight loss.4 Not only is body weight improved in patients with obesity, but semaglutide also facilitates improvements in health, such as improvements in metabolic parameters among patients with diabetes mellitus, hypertension, and dyslipidemia. 

When determining the best treatment for the individual patient, clinicians should utilize a patient-centered approach, consider safety and efficacy, evaluate for possible drug interactions, and choose the optimal anti-obesity medication for the specific patient.

Anti-obesity medication used in conjunction with other treatments. The four nonsurgical pillars of obesity management are appropriate nutrition, physical activity, healthy behavior, and anti-obesity medication.1 Just as obesity is a multifactorial disease, a multifactorial approach must be taken regarding treatment. Anti-obesity medications should be used as an adjunct to lifestyle changes for patients to experience maximum health benefits.

Provider resources. Providers interested in learning more about treatment options and obesity management can visit the OMA’s online clinician resources information center. Resources for providers include:

  • Obesity Pillars journal
  • Adult Obesity Algorithm and Pediatric Obesity Algorithm 
  • Self-assessment programs

Healthcare professionals can join the OMA at https://obesitymedicine.org/join/ to access specialized treatment information and tools to advance their practice.

References

  1. National Institute of Diabetes and Digestive and Kidney Diseases. Prescription medications to treat overweight and obesity. Reviewed Jun 2021. https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity. Accessed 3 Jun 2022. 
  2. Bays HE, Fitch A, Christensen S, et al. Anti-obesity medications and investigational agents: an Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. Obesity Pillars. 2022;2:100018. 
  3. United States Food and Drug Administration. FDA approves new drug treatment for chronic weight management, first since 2014. 4 Jun 2021. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014. Accessed 3 Jun 2022.
  4. Wegovy. Weight loss with wegovy. https://www.wegovy.com/about-wegovy/why-wegovy.html. Accessed 2 June 2022.

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Category: Medical Methods in Obesity Treatment, Past Articles

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