Obesity Treatments Enter a New Era
By Hope Warshaw
Obesity management options include lifestyle changes, medication, and surgery. Here's what you need to know to make informed decisions about what treatments are optimal for you.
With newer medications and growing recognition that obesity is a chronic disease requiring ongoing management, obesity treatment is undergoing a sea change.
“We’re at an inflection point and are entering a new era of obesity and glucose management,” Dr. Richard Pratley, a diabetes expert and physician with AdventHealth, said during a panel on treatment options for weight and diabetes management at the 2023 ADA Scientific Sessions.
Obesity is a chronic disease, not a temporary situation, that increases the risk for many medical conditions (Pratley’s count is 229) including cardiovascular disease, type 2 diabetes, sleep apnea, and non-alcoholic fatty liver disease.
Just as a person with type 2 diabetes requires an evolving array of medications as the disease progresses, obesity care requires ongoing management and tweaks over time. Multiple obesity treatments are often paired to achieve weight loss that can significantly improve one’s health and prevent obesity-related disease.
There are more tools to treat people with diabetes and overweight or obesity than ever before. Given the number of individual options, patients and healthcare professionals should work together to make informed decisions about the best treatment over time.
Current obesity treatment options
People can choose from a variety of approaches to find what works optimally for them over time. For example, one approach may work well for initial weight loss, and another to counteract weight regain and to keep lost pounds off.
Meal pattern changes
Effective lifestyle approaches range from counting nutrients (for example, grams of fat), following a healthy eating plan (like the Mediterranean diet), consuming portioned meals, time-restricted eating, and setting step-by-step goals to change eating habits and food choices over time.
Pratley underscored that making lifestyle changes must continue to be the foundation of all weight management plans, regardless of whether a person chooses to also use weight loss medication or undergo surgical treatment.
Another essential element of weight management for both weight loss and preventing weight regain is regular exercise. This includes aerobic activities and resistance training, as well as reducing sedentary behavior or the amount of time spent sitting.
Obesity and glucose-lowering medications
Since the FDA approval of diabetes and weight loss drugs including GLP-1 agonists like liraglutide (Victoza and Saxenda) and semaglutide (Ozempic, Rybelsus, and Wegovy), more options have hit the market.
Tirzepatide (Mounjaro), for example, is a dual GIP/GLP-1 agonist that was recently approved to lower blood sugar, and the FDA is now considering its use for obesity management. There are even more of these medications in development including retatrutide, a triple agonist featuring three hormones.
The amount of weight loss seen with these medications is approaching the amount of weight loss observed with metabolic and bariatric surgery. Pratley pointed out that there seems to be a bit less weight loss for people with diabetes using these drugs. He also noted that weight loss will slow over time but can stay off as long as people remain on these medications.
Metabolic and bariatric surgery
The ADA’s current Standards of Care recommends metabolic and bariatric surgery (MBS) as an option to treat people with type 2 diabetes who have a high body mass index and do not achieve lasting weight loss and glucose-lowering with nonsurgical methods.
There are four main types of MBS: gastric bypass, gastric band, duodenal switch, and the most popular, sleeve gastrectomy. Each alters the anatomy of the gut, impacting the same hormones addressed in obesity medications. Surgery is shown to be particularly beneficial in people who’ve had type 2 diabetes for less than 7-8 years, in part, because these individuals likely still make sufficient insulin.
There are caveats, however. “You can’t just walk in and get MBS,” said dietitian and MBS expert Laura Andromalos, who described the lengthy screening process for such a surgery, which includes working with a dietitian, behavioral health provider, surgeon, and other experts.
How to work in tandem with your provider
In the past, lifestyle changes (eating habits, food choices, and physical activity) were positioned as a better alternative to glucose-lowering medications or bariatric surgery. Patients can now work with physicians and dietitians to discuss their options and continually assess how their plan is working and what, if anything, they want to change over time.
Dietitian and weight management expert Eileen Stellefson Myers discussed the importance of clinical care that respects and responds to a person’s individual preferences, needs, and values. She emphasized empowering patients to make educated and informed healthcare decisions that are aligned with their wants and needs.
Myers noted some examples of shared decision-making phrases a provider might use:
“Can we talk about some options?”
“Here are some of the choices you can consider for treatment.”
“Can I tell you about the benefits and potential harms of each of these treatments?”
“Would you like to talk to someone who has used this treatment before you make a decision?”
“How else can I help you make your decision?”
Obesity therapy: Top takeaways
Experts agree there is no one right way to manage obesity; every person is different and has varied needs as they go through different phases of life. That’s why it’s so important for patients and providers to explore various obesity treatment options – and accompanying expectations – together