Harold Bays, MD, on the Benefits of Obesity Pharmacotherapy
Obesity is highly prevalent in the United States, affecting more than 93 million American adults between 2015 and 2016, according to the Centers for Disease Control and Prevention.1
Until somewhat recently, obesity was not considered a disease. However, in 2013, the American Medical Association formally and officially recognized obesity as a disease that requires careful management using various modes of treatment.
Pharmacotherapy is one treatment option that can aid in managing obesity, said Harold Bays, MD, medical director and president of the Louisville Metabolic and Atherosclerosis Research Center in Kentucky. He discussed this topic in depth on September 16 at the 2018 Cardiometabolic Risk Summit (CRS) in San Antonio, Texas, where he presented “Current and Future of Obesity Drug Therapies: Echoes of Today’s Metabolic Treatments.”2
Consultant360 recently spoke with Dr Bays, who shared his insights on the most common myths associated with obesity and its management, the role of pharmacotherapy in an obesity treatment plan, and exciting new pharmacologic agents on the horizon.
Consultant360: Why is it important to approach and treat obesity as a disease? What is the biggest misconception about obesity in primary care?
Harold Bays: The biggest misconception about management of obesity as a disease is that adipose tissue is often considered an inert organ that simply stores energy. This helps explain why so many—including many opinion leaders—describe diabetes mellitus, hypertension, dyslipidemia, and cardiovascular disease as “co-morbidities,” suggesting these common metabolic diseases just happen to be found among patients with obesity.
The fact is, adipose tissue is an active endocrine and immune organ, with no less potential for disease than any other organ. This is the justification for the term “adiposopathy,” which reflects the pathogenic potential of adipose tissue—not unlike cardiomyopathy, retinopathy, ophthalmopathy, enteropathy, nephropathy, neuropathy, and dermopathy.
With this frame of reference, diabetes mellitus, hypertension, dyslipidemia, and cardiovascular disease are not simply “co-morbidities.” Instead, these metabolic abnormalities are both direct and indirect adverse consequences of increased body fat, and the adiposopathic dysfunction of adipose tissue.
Consultant360: Which patients should be considered for obesity pharmacotherapy?
HB: Most guidelines, recommendations, and indicated uses support consideration of anti-obesity pharmacotherapy for patients having the adverse metabolic consequences of obesity, and a body mass index (BMI) of at least 27 kg/m2.
Consultant360: How might clinicians go about selecting the right medication for each candidate for obesity pharmacotherapy? What are the most important factors to consider?
HB: A typical patient who is most likely to benefit from anti-obesity pharmacotherapy is one who has committed to change, and in addition to appropriate nutrition and physical activity, requires additional help in treating the disease of obesity. This is especially the case if the patient has adverse “fat mass disease” or “sick fat disease” (adiposopathy) contributing to ill health.
C360: What are some of the most exciting pharmacological agents that are on the horizon?
HB: Perhaps the two most promising anti-obesity agents in development would be novel glucagon-like peptide-1 agonists and oxyntomodulin acting agents.
C360: What is the most common question that people ask you after a presentation like the one you just gave at CRS 2018, and how do you typically respond?
HB: Many people wonder if the benefits of anti-obesity pharmacotherapy are solely due to weight loss or other effects as well. To address this issue requires an understanding of how an increase in body fat causes high blood sugar, high blood pressure, dyslipidemia, and cardiovascular disease. It requires an understanding of the mechanism of action of specific anti-obesity drugs.
Unfortunately, time restraints after presentations do not typically allow for a satisfying answer to this question. Perhaps future topics presented at the Cardiometabolic Risk Summit might address this very topic. I think it would beneficial to have a future symposia or session on the mechanisms as to how an increase in body fat causes high blood sugar and heart disease (for example), and how anti-obesity agents improve blood sugars and potentially reduce cardiovascular disease. I believe clinicians are more accepting of solutions when they understand how solutions work.
Harold E. Bays, MD, is the Medical Director and President of the Louisville Metabolic and Atherosclerosis Research Center, Inc., in Louisville, Kentucky.
—Christina Vogt
References:
1. Overweight and obesity: Adult obesity facts. Centers for Disease Control and Prevention. Page last updated on August 13, 2018. https://www.cdc.gov/obesity/data/adult.html Accessed on September 6, 2018.
2. Bays HE. Current and future of obesity drug therapies: Echoes of today’s metabolic treatments. Presented at: Cardiometabolic Risk Summit 2018; September 14-16, 2018; San Antonio, TX. https://www.primarycarecardiometabolic.com/program
3. Bays HE, Seger, J, Primack C, Long J, Shah NN, Clark TW, McCarthy W. Obesity Algorithm, presented by the Obesity Medicine Association. 2017-2018. www.obesityalgorithm.org. Accessed on September 12, 2018.