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Director of Nutrition and Metabolic Research
Diabetes and Endocrine
La Jolla, California
Ken Fujioka, MD, has disclosed that he has received fees for non-CME/CE services from Novo Nordisk and consulting fees from Amgen, Boehringer Ingelheim, Gelesis, Janssen Global, Novo Nordisk, Phenomix, and Sunovion.
If you had asked me 10 years ago about prescribing antiobesity agents, I would have said, “It’s not worth it.” The history of weight loss medications was exceptionally poor, and an impressive list of medications had been pulled from the market for safety issues.
Because of this poor history, today, fewer than 2% of eligible overweight patients receive a prescription for an antiobesity agent. But I expect this to change in the next 5 years, thanks to key changes in obesity medicine and in the approach to developing antiobesity agents.
During the past 10-15 years, the FDA has instituted very specific and demanding requirements for antiobesity agents. Although safety must be demonstrated prior to approval, once an agent is approved, it must also undergo a cardiovascular outcomes trial—the highest standard for maintaining approval.
Preventing Weight Regain
The other big change that has resulted in a domino effect in the field of obesity medicine is our recent knowledge expansion about why weight loss is so challenging, including the pathophysiology behind it. Now that healthcare providers are being taught how the hypothalamus and other organs work against weight loss by shifting hormones and lowering the metabolic rate, there appears to be a place for safe antiobesity agents. Most newer antiobesity agents in development appear to influence these hormonal changes; the future of treatment may well target the hormones that drive weight back up after weight loss.
Who Will Pay?
Who will pay for these antiobesity agents? To me, the answer is health insurance. With the slow but inevitable change in how healthcare is paid for, it will become obvious that weight needs to be treated to improve the multiple problems associated with obesity, including hypertension, diabetes, dyslipidemia, nonalcoholic fatty liver disease, and more.
Obesity treatment is an area fraught with misinformation. Now that our understanding of the biology of obesity, diet, and exercise has improved exponentially, a new subspecialty of obesity medicine has emerged and has been growing yearly. The number of physicians taking the American Board of Obesity Medicine (ABOM) exam exceeded 1000 in February 2020, and thousands more have passed the exam in earlier years—this is great news both for healthcare professionals and patients. With ABOM-certified specialists available, patients can be referred to a provider who is trained and comfortable managing this exceedingly common and challenging condition.
The future of obesity medicine has never looked so good. Healthcare providers can take comfort knowing that available antiobesity agents are safe and effective. Of more importance, with our growing understanding about the biological challenges to achieving and maintaining weight loss, I believe newer treatments (particularly those currently in development) will be targeted, safe, and highly effective.
What is your comfort level with prescribing antiobesity agents to patients with obesity-defining BMI? Answer the polling question and join the discussion by commenting below.