Perspectives across metabolic and obesity care – 2/5

Dear Friends, trust everyone had a great week; and welcome to February already! A quick run down of materials over the past seven days, related to obesity and metabolic care.


  • Supplies of Wegovy should improve this year, from Novo Nordisk
  • Weight bias and obesity education in medical schools
  • Brain thinning in Alzheimer’s disease patients is seen in individuals with obesity


  • A quiet week.


  • NBC News reports that the maker of Wegovy, Novo Nordisk, is ramping up production such that more supply of the drug becomes available over the next few months.
  • Dr. Arnold Saperstein, Chief Medical Officer at Cecilia Health, a virtual-care company to help patients manage chronic disease writes a blog post on equitable access to weight management. I like the sentence ’The perfect storm between clinical evidence, insurance coverage, supply in the form of new pharmaceutical entrants, and public demand are creating an environment ripe for meaningful change.’ which relates to a expectation of an uptick in weight management programs. Unsurprisingly, Cecilia Health has a weight management program consisting of nutrition, stress management, psychosocial support, and medication management – we will have to watch this space to see if they will also be following others such as Ro to become another entrant to the GLP-1 prescription market, or if it will be truly more comprehensive.


  • TIME magazine takes on weight bias this week, with the quote from a patient regarding her provider office ‘From the moment I walk in, my fatness is considered a problem to be solved… I’m considered lazy, non-compliant, and less worthy of care than a thin person.’ The article reports on studies that have shown higher-weight individuals to experience patronizing and disrespectful treatment, and quotes Sabrina Strings from the University of California, Irvine that ‘Use of BMI is rated in anti-Blackness and sexism’ as the measure was developed to assess a population and is based upon white men. An issue here is that patients experience bias and stigmatizing language and avoid seeking care, reduced continuity of care, and increased rates of depression and anxiety.
  • Aligned with the TIME article, is an article in NPR News on the 10 hours of obesity education in medical schools, perpetuating weight stigma and how best to treat patients. I think this is a legacy issue, with the implications of almost half of the US adult population being obese by 2030, and the multitude of treatments that are at the tipping point to become mainstream, namely medications and bariatric surgery.
  • An article from NPR on the costs of GLP-1 drugs is illustrated through the experience of Yolanda Hamilton, who with an elevated BMI, high BP and raised blood sugar successfully reduced her weight by 60 pounds on Wegovy. The cost of the medication was originally covered by her insurer, Aetna, but her new plan BCBS Illinois denied coverage; Yolanda has now gained back 20 pounds. Dr. Robert Kushner of Northwestern University explains that it is not a surprise that when people stop taking the medication, their hunger returns and the weight loss recedes. This brings up four key concerns – first, is that patients need to remain on the drug long-term to maintain weight loss, second on the economic implications of such long-term therapy, third the levels of medication adherence to be expected and achieved, and fourth that the coverage for GLP-1 medications varies according to payor.


  • A JAMA Research Letter reports on the ten-year follow-up results of a randomized clinical trial of 220 adults with obesity, recruited to vigorous, moderate or non-exercise groups over a 12-month intervention period. With great follow-up of over 80% of subjects at 10 years, there was a reduction in diabetes incidence of 50% in the vigorous and moderate exercise groups, compared with the non-exercise group. The results are incredible, though the focus here is upon prevention of diabetes versus treatment per se.
  • An tweet from 2016 data shows 40.0% of the total US adult population to be obese, versus 4.2% for the same in Japan. Seems that higher food prices, and greater numbers of steps taken per day in Japan may be contributory factors!
  • NBC News reports on a study from my alma mater, McGill University, that being overweight in midlife is linked to a greater risk of developing Alzheimer’s disease or dementia. From brain scans of over 1.300 individuals, there was similar brain thinning in regions involved in learning, memory and judgment in those with obesity and Alzheimer’s patients.

Kind regards, Raj.


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