Pharmacopia

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Dr. Louis Aronne and Dr. Katherine Saunders discuss new pharmacology treatments for obesity with Dr. Caroline Apovian.

Dr. Caroline Apovian recognizes that the medical profession has a long way to go in educating the public about obesity and making treatment more accessible, but she’s encouraged by new advances in the area of obesity pharmacology.

Dr. Apovian is a leader in the field, serving as the co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital, editor of the Endocrine Society’s Guidelines on Medical Treatment of Obesity, and former president of the Obesity Society.

In this episode of Weight Matters, Dr. Louis Aronne and Dr. Katherine Saunders talk with Dr. Apovian about the latest advances in obesity medication, along with the physiological reasons why diet and exercise don’t always lead to weight loss.

Prevention Versus Treatment

Many doctors who focus on obesity get frustrated because they spend much more time treating the disease than preventing it. Dr. Apovian argued that this stems from the fact that nutrition issues start at a young age.

“In order to prevent obesity, you really have to do something about the environment,” she explained. “It’s going to take quite a while, because we have figured out how to feed the billions of people on this planet in a cheap, calorically dense way, and going back is going to be really, really tough.”

In fact, about 42% of all Americans have obesity, Dr. Apovian shared.

“We are inundated with an environment that promotes easy, fast energy intake. And certainly, we have a sedentary lifestyle, but that’s maybe not really the issue so much as the environment that we’re in,” she said. “Many of us or most of us are defending an abnormal body weight in this environment.”

The Limitations of Diet and Exercise

Once someone has obesity or extra body weight, losing it often requires more than just a lower-calorie diet and increased exercise.

This is partly because the feeling of being full, or satiated, comes from signals sent by the hormones in fat cells. When a person starts to lose fat cells, those hormone signals decrease, and hunger cues increase in response. Plus, the body will actually slow down its metabolic rate to hold onto the weight.

“We recognize obesity to be a disease, and it seems to be a disease of the energy-regulation system in the brain,” Dr. Apovian explained. “Only a quarter of people with obesity remain metabolically healthy.”

New Advancements in Obesity Pharmacology

Fortunately, people who have obesity and other comorbidities have more options than ever for treating their disease medically.

For example, the newly approved pharmacology option Wegovy is a promising option for individuals who have a BMI over 30 with no comorbidities, or even individuals with a BMI over 25 who have comorbidities. Wegovy is a naturally occurring hormone that increases satiety in the brain.

“It’s completely different from anything else we’ve had on the market for obesity, because the other drugs… had side effects because they’re not naturally occurring hormones; they’re drugs,” Dr. Apovian explained.

In one study, one-third of people who used Wegovy lost over 20% of their body weight. In the future, Dr. Apovian believes even more effective treatments will replace bariatric surgery altogether, which partly works by adjusting the hormones in the body, so people feel full faster.

“That 20% is about what we can get with a laparoscopic adjustable band, and it’s almost what we can get with the sleeve gastrectomy; that’s bariatric surgery,” she shared. “If we can get 35% of weight loss with one or two of these gut hormones, we don’t need to do bariatric surgery.”

Despite these medical advances, Dr. Apovian recognizes that stigmas around obesity and weight cause many people to resist options like surgery or medication. And even when patients do agree to try a drug like Wegovy, they’re often not covered by health insurance.

“We’ve got a lot of work to do on convincing patients, doctors and payers that obesity is a disease worth treating,” she shared.

Follow Weight Matters wherever you get your podcasts to never miss an episode. To learn more about Dr. Saunders and Dr. Aronne’s work to transform specialized treatments for chronic conditions through the best in medical science and advanced digital technologies, visit www.intellihealth.co/podcast

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