Urgent need for clinical guidelines for obesity care in the era of GLP-1 – MedCity News

The anti-obesity and diabetes drug semaglutide, known under the brand names “Ozempic” and “Wegovy,” is taking the medical world by storm. Physicians who regularly issued their go-to prescriptions for diet and exercise now have effective and reliable drugs to help their patients who struggle with chronic weight management.

The problem is, celebrities and clickbait headlines have channeled this potentially game-changing narrative into a fad drug narrative that will help you shed a few pounds in preparation for the beach weather ahead. is to be

But semaglutide isn’t the latest juice cleanse or diet hack. it’s far

As an endocrinologist who has specialized in treating obesity for over a decade, I know that this new class of anti-obesity drugs, also known as GLP-1, has helped countless people struggling to achieve a healthy weight. I can say with almost certainty that I can help. The hype around GLP-1 is exciting to medical professionals like me, who have specialized in treating obesity for decades, but it’s an unhyped-up, “miracle drug.” is misleading and harmful.

Medical leaders need to reach consensus on best practices for treating obesity, including the use of anti-obesity drugs. Establishing clinical guidelines involves developing a series of clinical consensus statements on how physicians should prescribe drugs and discouraging health care providers from prescribing the newest and most expensive drugs as first-line treatment. This includes allowing Failure to establish and monitor appropriate guidelines increases the risk of companies prioritizing profits over effective treatments and patients being treated inappropriately, inappropriately or even recklessly.

Risk of not defining guidelines

The epidemic of GLP-1 drugs is leading patients to request drugs from their physicians without proper diagnosis or addressing lifestyle factors. Outpatient weight loss clinics built around only GLP-1 drugs have already emerged, promising fast-acting solutions but exposing patients to failure. Relying solely on drugs for weight loss can have disastrous consequences.

A holistic therapeutic approach that incorporates lifestyle habits is required to avoid the risk of frightening metabolic adaptations. Metabolic adaptation means that the body adjusts its metabolism to compensate for a decrease in caloric intake, slowing weight loss and regaining weight gain.

Rapid weight loss is not only unhealthy, it is also dangerous as it can lead to muscle loss, loss of bone density and a significant drop in resting metabolic rate. There is even a phenomenon called “sarcopenic obesity” that occurs with this type of rapid weight loss. In this case, even if your BMI is in the normal or low range, you will have very low levels of lean muscle, and only fat and bone will be obese. Tissue that is metabolically active. From a hormonal point of view, this condition looks like obesity. Therefore, it is very important for people taking GLP-1 to participate in strength training and increase lean protein intake in their diet.

Furthermore, in the absence of strong diet, exercise, sleep, and mental health habits, patients gain weight rapidly when they stop taking drugs, but more slowly if lifestyle and behavioral factors are in place. You will see controlled weight gain. Also, given that most health insurance doesn’t cover his GLP-1, interruptions in medication regimens are common.

Although GLP-1 is relatively safe, a minority of people who use these drugs, especially those at high risk of thyroid cancer, are at risk of experiencing side effects such as severe nausea, vomiting, pancreatitis and pancreatitis. I have. Persons considering GLP-1 should undergo a medical history check prior to use.

Obesity medicine is still in its early stages

Obesity medicine is still a relatively new field, especially compared to established fields such as cancer and diabetes. For this reason, even though more than 4 in 10 adults in the United States are obese, most doctors are not trained in obesity treatment, and he is only 1% of doctors who specialize in obesity treatment.

The use of pharmacotherapy to treat obesity dates back to 1959, when the FDA approved phentermine for weight loss. However, it was not until the 1995 discovery of the hormone leptin by Jeffrey Friedman at Rockefeller University that the field gained clinical relevance. This groundbreaking discovery was the first time adipocytes were viewed as endocrine glands, rather than just fat reservoirs.

Another significant turning point came in 2013 when the American Medical Association classified obesity as a disease. The recognition of obesity as a disease has highlighted the hormonal dysregulation that occurs in obese people and has transformed bariatrics into a legitimate and respected medical field.

In 2021, the FDA approved Wegovy, an injectable form of semaglutide, the first approved obesity treatment since 2014. The federal agency suggested that the drug be used for “chronic weight management in adults with at least one form of obesity or weight-related overweight.” Used in addition to a reduced calorie diet and increased physical activity to improve symptoms (such as high blood pressure, type 2 diabetes, and high cholesterol). “

Despite these advances, there are still no established clinical guidelines for obesity care.

What should be the gold standard? Hmm, complicated!

The challenge in treating obesity is that obesity is a highly complex disease that varies from person to person.

Based on my clinical experience, any guideline should treat patients comprehensively, including physical, emotional, and environmental factors, and patients should be trained by a health professional, preferably in bariatrics. Should be supported by professionals. For example, if a patient is diagnosed with breast cancer, she will not continue to be treated by her primary care physician. No, patients are connected to a treatment team led by a doctor who specializes in oncology.

The same should be true for obesity. The care plan should consider medical history, laboratory work, family history, dietary habits, and possibly the patient’s insurance coverage. While medication may be appropriate and even recommended for some patients, supportive communities and health coaching should be used to reinforce positive habits, healthy habits, and lasting behavior change. must be combined with Clinicians also need to consider drug cost, availability, and efficacy.

Patients interested in weight loss drugs may find alternatives (many of which have been prescribed off-label for years) more appropriate than GLP-1. Some of these drugs are more affordable than GLP-1, which is usually not covered by insurance and costs hundreds if not thousands of dollars a month out of pocket. It may cost a dollar.

Obesity is not a moral flaw or a lack of willpower. I can’t stress this enough. It is a treatable and preventable disease and requires a comprehensive approach. Fighting this epidemic requires consideration of individual biology, genetics, sleep, stress and lifestyle as a whole. Defining guidelines is not easy. We need standards to protect patients, justify obesity medicine, and shape the future of the field.

Photo: Peter Daisley, Getty Images

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