Understanding Obesity as a Chronic Disease
Understanding Obesity as a Chronic Disease
BioPharma Analyst
Evan is a Managing Director and Senior Research Analyst at BMO Capital Markets covering Biotechnology (Large and SMid Cap) and US Major Pharmaceuticals. His respons…
Evan is a Managing Director and Senior Research Analyst at BMO Capital Markets covering Biotechnology (Large and SMid Cap) and US Major Pharmaceuticals. His respons…
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To better understand the advancements in anti-obesity medicine and how treatment and care are adapting to this new opportunity, BMO Capital Markets hosted providers, key opinion leaders, patients, pharmacy benefit managers and biopharma executives at the inaugural BMO Obesity Summit. To kick off the summit, I sat down with Katherine H. Saunders, M.D., Obesity Expert & Co-Founder, Intellihealth. Below is a summary of our conversation.
It wasn’t long ago that many in the medical establishment considered obesity to be a lifestyle problem. A person with obesity was told to eat less and move more, and the weight would simply come off. Of course, if losing weight were as easy as lifestyle modifications, 41.9%1 of American adults likely wouldn’t be living with obesity today. This idea, which dominated obesity treatments for decades, led to patients experiencing all kinds of weight-related bias and stigma as they sought medical care, especially when the person inevitably gained the weight back.
In 2013, however, the American Medical Association voted to classify obesity as a disease,2 the same year the American College of Cardiology, the American Heart Association and the Obesity Society released guidelines3 for comprehensively managing obesity. Since then, there’s been a real evolution in how scientists understand the biological mechanisms behind obesity, leading to a fundamental shift in how care providers think about and treat the disease.
From weight gain to chronic medical condition
To treat obesity as a chronic disease, we must understand what’s happening in the body. As a patient gains more weight, inflammation around one particular part of the brain, the hypothalamus, begins to increase. We sometimes call the hypothalamus the body’s energy regulatory center because it’s responsible for maintaining homeostasis, or keeping the autonomic nervous system (including heart rate, body temperature and hunger) in a stable state.
When a patient gains weight, inflammation around the hypothalamus prevents certain feedback signals (hormones) from getting through – first, those from the gut that indicate how much food someone has eaten and second, those from fat cells that indicate the amount of fat someone is storing. The result is dysregulated hormonal pathways that make it easier to remain hungry and harder to become full.
Unfortunately, this sets many people up for failure when they try to lose weight since it takes more food to feel full at a time when they need to eat less. Walking around in a state of perpetual hunger makes it so much easier to fall off the proverbial wagon while dieting. In addition, each time someone gains back the weight they’ve lost and tries to lose weight again, those dysregulated hormonal pathways get worse, making it even harder to successfully lose weight. So, ironically, weight loss makes it much easier for the body to gain weight.
Treating the disease
Like any other chronic disease, obesity is complex and manifests differently in each patient. The good news is that more and more care providers recognize that a multifactorial disease requires a multifaceted response.
The last decade has seen the emergence of several different types of anti-obesity medications. Early iterations of these drugs (like phentermine/topiramate and bupropion/naltrexone) netted limited results, with patients losing an average of 5-10% of their total body weight. However, the landscape truly changed with the introduction of GLP-1 – short for glucagon-like peptide-1 – agonists.
This class of drugs mimics the hormones our stomachs release when we’re full. Those who take it feel less hungry, feel full faster and stay full for longer. It can be a tremendous relief for anyone who has been fighting against their body’s hunger cues for years, to finally feel satiated.
More recent drugs like tirzepatide and semaglutide show even more promise as alternate pathways to treating obesity.
Misconceptions and the future of obesity treatment
While there are potential side effects to watch for with each type of obesity medication, the stories in the media have largely been overhyped, or lacked context. When a patient takes one of these medications with adequate physician oversight, we’re starting on very low dosing, looking for early warning signs of any side effects and giving medical advice accordingly. For instance, a patient who feels nauseated after eating a certain meal should tell their care provider and a discussion may then happen regarding the foods that the patient should perhaps avoid.
Even more common is the misconception that these drugs are a one-and-done approach that patients will be able to stop using once they’ve achieved their desired outcome. As mentioned earlier, obesity is a multifactorial chronic disease, and it doesn’t end with weight loss. Patients should have a team of care providers offering not just prescriptions, but a wide range of support. Maintaining that goal weight requires vigilance, and sometimes medication and lifestyle adjustments.
Ultimately, the biological underpinnings of obesity have crystallized over the last decade, and while weight bias and discrimination still exist in the medical establishment, this disease has become treatable. We have made enormous steps forward in treatment, and this aspect of medical care is vital for nearly half of the population right now. The hope is that these treatments will become more widely available and prescribed in the coming years, so that this chronic disease can be better controlled.
BMO Obesity Summit
PART 2
Inaugural BMO Obesity Summit Focuses on Therapeutics and Combating a Growing Epidemic
Evan David Seigerman April 10, 2024
The evolving obesity therapeutic landscape and its potential to help people live longer and healthier lives have captured the public’…
