Paradigm Shift - Why Treating Obesity is Important

Jun 3

Obesity is a complex, chronic, relapsing, multifactorial medical condition that requires ongoing therapy. It is NOT the result of a lack of willpower.

Yet, it has taken decades for the medical community to finally, across disciplines, recognize that obesity is as much a chronic medical condition as type 2 diabetes, hypertension, and high cholesterol, to name a few. Over the past decades a lot of important time and money has been spent on clinical trials and the development of therapies, both pharmacologic and lifestyle-based, to treat the latter 3 chronic conditions listed.

In type 2 diabetes, we can use medications like metformin, GLP-1 receptor agonists like semaglutide and liraglutide, GIP/GLP-1 agonists like tirzepatide, SGLT2 inhibitors like empagliflozin and dapagliflozin, and oral insulin secretagogues (although used much less frequently nowadays) glipizide, glimepiride, and repaglinide. Insulin also can be used in type 2 diabetes as treatment, it is not just a type 1 diabetes medication. All of these medicines can help bring down high blood sugars and target goal blood sugar levels. Some of these medicines have been shown to have additional benefits outside of blood sugars, as in heart and kidney protection.

For high blood pressure, similarly, there are several drug classes, such as diuretics, like hydrochlorothiazide, triamterene, ACE-inhibitors like lisinopril and captopril, ARBs such as losartan and irbesartan, calcium channel blockers such as amlodipine, nifedipine, verapamil, and beta-blockers, such as metoprolol and bisoprolol, to name a few. There are certainly more blood pressure lowering drug classes and medications. These medicines have shown to be effective in helping lower high blood pressure and some of them have been shown to also reduce repeat adverse heart events.

If we last focus on high cholesterol, we have several different drug classes: statins such as atorvastatin, pravastatin, rosuvastatin, PCSK-9 inhibitors such as alirocumab and evolocumab, fibrates such a fenofibrate and gemfibrozil, ezetimibe, bempedoic acid, and niacin as potential medications we can use to reduce cholesterol and in various populations, some of these medicines have even been shown to help prevent heart disease, or reduce repeat heart disease.

When treating type 2 diabetes, high blood pressure, and high cholesterol, individuals sometimes need more than one type of drug class for that specific condition, and so it is not uncommon that someone who has all three of these medical conditions need to take 4-6 medicines a day to keep these medical conditions in check. This is, of course, in addition to following appropriate nutrition and exercise recommendations.

Well, guess what other chronic medical condition frequently coexists with these three diseases and if we treated that FIRST with as little as one or two medicines, that person could potentially avoid the 4-6 other medicines? I’m sure you guessed what this other medical condition is: obesity.

In fact, for many individuals, the excess fat mass and dysfunctional fat (aka adiposopathy, check out my previous blog on that here) is at the root cause of type 2 diabetes, high blood pressure, and high cholesterol. Some numbers may help:

Approximately 90% of individuals with type 2 diabetes have overweight or obesity1

It is estimated that 65-78% of hypertension is attributable to overweight or obesity2

And here is the encouraging news - as little as 5% weight loss is enough to improve type 2 diabetes, blood pressure, and cholesterol numbers! We know that this is easier said than done, as important physiology is at play that makes maintaining weight loss difficult. And for this reason, anti-obesity medications, such as semaglutide and tirzepatide, have been serious game changers in the obesity world. We now have impactful medications that have the potential to assist individuals in losing not only 5% of their baseline weight, but even up to 15-20% or more.

So - what if we were to change the treatment paradigm to first focus on a common denominator, likey obesity, rather than treating the sequelae? This would lead to a whole paradigm shift, where the medical field would start to address obesity, the medical condition it is, earlier and in turn, could help prevent the progression and development of other obesity-related complications.

This of course requires that health care systems and health care providers become knowledgeable about obesity, work on addressing and reducing obesity stigmas, have unbiased conversations about obesity with patients, and appropriately diagnose and treat obesity with impactful interventions utilizing lifestyle optimizations and pharmacotherapies.

You see - the paradigm shift calls on identifying and treating the common denominator first (obesity), instead of waiting for other medical conditions to result and then having to treat several other health conditions, with one or more medications for each one.

Treating obesity matters.