Anti-obesity counseling -
The new anti-obesity medications are remarkably powerful, and it can be tempting to see a patient with obesity and just write a prescription.
But as the saying goes, with great power comes great responsibility. Successful use of these medications requires an individualized approach and a great deal of patient education and attention.
Those who provide the necessary support will be able to help their patients achieve real improvements in health and well-being. Healio News Primary Care Obesity. By Katherine H. Saunders, MD, DABOM. Read more. October 10, Add topic to email alerts. Receive an email when new articles are posted on.
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Click Here to Manage Email Alerts. Click Here to Manage Email Alerts Back to Healio. Additionally, Lilly Research Laboratories announced a phase I trial with a PYY analogue for the treatment of T2D see Related links. The pursuit of AOMs has been a long-standing endeavour propelled in recent years by several concurrent developments.
These include the dramatic increase in the global prevalence of obesity, the significant advances in molecular understanding of appetite homeostasis along with the identification of several novel drug targets, as well as the success in developing incretins as drugs for T2D that has provided unprecedented efficacy in body weight management.
GLP1R agonism is establishing a heightened foundation for measuring performance with other entities, and the full depth of its efficacy and the ability to chronically sustain weight loss in multiple populations, many distinct from those in which initial drug registration has occurred, remains to be determined.
As with any rapidly advancing field, there are more questions than answers. Of primary interest is why GLP1R agonism works so well and how GIP might synergize with GLP1 to enhance weight loss.
Short of the results that have been achieved in vivo, most notably the 6-month and 1-year clinical studies that appear to indicate significant additional benefits of semaglutide when compared with liraglutide, it is difficult to ascribe a molecular basis for that difference. These two agents are both highly potent and selective GLP1R agonists, similarly fatty acylated, that provide sustained drug plasma concentrations when used as prescribed.
The difference is not simply a matter of extended time action as even a long-action Fc agonist such as dulaglutide does not match the body weight lowering of semaglutide Initial study suggests increased activity in central locations of importance to weight control However, this is just a beginning and a deeper molecular understanding might lead to even further improvements in GLP1R agonists, or other agents that might act by an independent mechanism at similar anatomical sites.
Unquestionably, the clinical results with tirzepatide have captured great attention and fuelled interest in GIP-based dual agonists and other combinatorial approaches. However, is this interest justified by these clinical results?
The situation appears to exemplify that despite the enormous advance in our molecular understanding of obesity, we remain relatively primitive in ascribing in vivo efficacy to mechanism.
It remains to be demonstrated in mechanistic detail how GIPR agonism serves as the basis for the heightened efficacy of tirzepatide relative to dulaglutide. Very recently, it was shown that CNS loss of GIPR renders mice resistant to GIP-induced body weight loss, indicating that GIP regulates energy metabolism via CNS GIPR signalling Substantiating the relevance of this finding, it is noteworthy that the superior weight-lowering effect of MAR relative to a GLP1 monotherapy of matched structure and pharmacokinetics vanished in CNS Gipr knockout mice The central mechanisms and target regions for GIP synergy with GLP1 remain to be determined, and notably there are conflicting preclinical results that promote GIPR antagonism as a therapeutic option for treating obesity In time, these questions and uncertainties will eventually be answered.
Next-generation discoveries are heavily influenced by current clinical performance and limitations in our ability to successfully translate in vitro and animal pharmacology to human experiments. High-dose semaglutide and tirzepatide are reporting sustained reduction in body weight of approximately 0.
This is a breakthrough performance relative to registered AOMs that begs the question of what the highest next priority is, and whether we have the skills necessary to properly achieve it.
Clearly, additional mechanisms of action that can match the performance of these two drugs would be welcomed, but to document this requires appreciably long studies. Underpowered 4-week, 6-week, 8-week and, even, week studies without suitable registered drugs as controls have largely failed to document relative efficacy.
Efficacy studies struggle with the question of how much additional weight reduction is advisable in a finite period, and the duration necessary for documenting it with confidence. Given the efficacy that is being achieved and the chronic nature of obesity, it is arguable that maintaining the rate in weight loss for subjects of continued excess weight is the primary objective.
These studies are lengthy and rarely undertaken until there is great confidence for success. Shortening the studies with the objective of accelerating the relative rate of weight reduction may not prove advisable for the patient and could lead to adverse effects that eliminate approaches that otherwise would prove viable, if applied less aggressively.
This is a point of particular importance in the assessment of glucagon-based tri-agonists that aim to outperform GLP1—GIPR co-agonists, as glucagon is likely an agonist of reduced therapeutic index relative to the two incretins. In a related manner, might drug candidates that fail in monotherapy prove successful when added to the best-in-class incretins either at initiation of therapy or after sizeable weight loss?
The clinical success of GLP1 with GIP raises the question of whether adjunctive therapy of semaglutide with another weight-lowering agent such as amylin, PYY or FGF21 can safely lower body weight beyond what is possible with either drug alone.
In this regard, it should be noted that leptin therapy proved successful in reducing body weight when used following sizeable weight loss in obese mice , , Might the same prove true in selected patients with obesity now that comparable percent reductions in body weight with what has proven successful preclinically are being achieved with semaglutide and tirzepatide?
Finally, there is the question of what is most needed to accelerate the realization of the next leap forward in safely normalizing body weight. Next-generation multi-omics have provided some novel targets, but, overall, rapidly evolving enabling technologies have been more useful in characterizing preclinical mechanism of action than in discovery of clinically successful drug candidates.
Iterative rodent testing largely using diet-induced obese mice and rats has been the primary screen to assess body weight lowering.
Genetic models and, even more so, engineered mice where specific receptors have been deleted, and increasingly so in a target-specific manner, have proven of indispensable value to investigation of mechanism of action.
The clinical situation is more challenging, where there is infrequent access to individuals homozygous-deficient in a specific biological mechanism.
In those rare instances, the nature of the obesity and the response to therapy differ from the general population. Additionally, selective antagonists suitable for pharmacological use are seldom available to selectively silence a single mechanism of action to explore its relation to endogenous control of body weight, or to block the action of a specific drug or a single element in a multi-action peptide, such as the incretin co-agonists.
Lastly, the simultaneous comparison of peptides matched in structure and pharmacokinetics, but otherwise devoid of a single biological activity, constitutes a prohibitive investment when the length of study is measured in months. Consequently, what we most need to speed drug discovery and optimization is correlative diagnostic means to complement a body weight scale.
If we could serologically or non-invasively predict with increased confidence those patients and mechanisms that are likely to succeed long term, this would promote better outcomes and increase exploratory clinical research to identify molecular entities and combinations that most justify assessment in long-term studies.
In analogy, it is readily recognized what plasma glucose monitoring and HbA 1c have meant to diabetes care and drug discovery relative to urine testing or monitoring of longer-term microvascular outcomes.
If a predictive correlate between metabolic profiling and propensity to weight loss can be established, this could have a profound influence on the future of healthcare in obesity. Pharmacological management of obesity has a lengthy history populated with multiple prominent disappointments.
The basis of failure has been multifactorial and pertains to the limited translational value of animal models to predict cardiovascular safety coupled with considerable patient heterogeneity.
Patients with obesity are often at high risk for vascular diseases and afflicted with comorbidities that complicate assessment of drug safety. Long-term, large-scale clinical trials in heterogeneous patients with obesity are expensive to conduct and difficult to justify when success has been so elusive and failures so prominent.
Clinical application will continue and focus on relative efficacy and safety, which is difficult to ascribe when best-in-class candidates are simultaneously rapidly advancing and not immediately accessible for direct comparative clinical study Independently, setmelanotide and leptin have proven successful in obesity management of individuals with congenital deficiency in genes of the leptinergic—melanocortinergic pathway.
These successes illuminate the paths for future research targeting other monogenetic forms of the disease and the possibility for additive pharmacology in broader populations of patients with obesity. A more thorough characterization of patients should serve to increase the near-term likelihood for success and provide informed direction for advancing the next generation of AOMs.
Ongoing clinical studies will determine whether more efficacious drugs than semaglutide and tirzepatide might achieve efficacy comparable with bariatric surgery. The many prospects currently being considered suggest that one or more might achieve this lofty objective. Afshin, A. et al.
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Request an appointment. By Mayo Clinic Staff. Show references Overweight and obesity. National Heart, Lung, and Blood Institute. Accessed Dec. Goldman L, et al. In: Goldman-Cecil Medicine. Elsevier; Kellerman RD, et al.
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As a chronic Anti-oobesity relapsing disease, coundeling impairs metabolism and causes cardiovascular diseases. Although coknseling Garlic in salad dressings Anfi-obesity important for the treatment Anti-obesity counseling obesity, it is difficult Collagen supplements achieve an couneeling weight or Anti-obesity counseling the process Quercetin and diabetes long-term Ati-obesity loss. Therefore, the obesity control guidelines strongly recommend lifestyle interventions along with medical treatment for patients who are overweight. There is sufficient evidence supporting that pharmacotherapy in combination with behavior-based interventions can result in significant weight loss and improved cardiometabolism. However, very recently, on February 13,the US Food and Drug Administration FDA ordered the withdrawal of lorcaserin from markets, as a clinical trial to assess drug safety showed an increased risk of cancer. However, they are costly and may have adverse effects in some individuals.
Highly Anti-obeskty new anti-obesity medications Garlic in salad dressings as semaglutide and tirzepatide have led to a sea change in expectations for Counselig treatment of obesity, dounseling new hope to individuals who have struggled with excess weight for years.
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If they stop, they will almost certainly regain the weight. Antk-obesity, stopping may limit their Beta-carotene and bone health options: if Alcohol and blood sugar control discontinue a medication counsseling regain counseking, it is possible that the same medication may no longer work as well or at all the next time.
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Anti-obesity medications should be selected based on a comprehensive evaluation because different people have different needs, risk factors and comorbidities, and they respond differently to different medications.
Providers must also create a personalized dose titration schedule and help patients make necessary changes to diet and meal timing to minimize side effects. The new medications are generally well tolerated when dose escalation protocols are tailored correctly and patients are properly supported, but inappropriate prescription can lead to more side effects, a complete lack of appetite or too much weight loss.
Close monitoring will become increasingly important with the even more powerful medications in the pipeline. With weight loss approaching bariatric surgery levelspatients are likely to experience vitamin deficiencies, for example, if not monitored carefully. Most patients cannot afford the latest anti-obesity medications without insurance coverage, and many health plans exclude obesity care.
As increasing evidence demonstrates the significant health benefits of weight loss — from diabetes remission to a notably reduced risk for serious cardiac events — insurers will likely recognize that preventing weight-related health complications by directly treating obesity is less costly than waiting to treat these conditions after they develop.
In the meantime, though, providers may need to be flexible. Flexibility may also be needed in response to supply issues. If keeping abreast of prior authorization requirements, day-by-day pharmacy supply and anti-obesity medications other than GLP-1 receptor agonists sounds too intimidating, clinicians can refer their patients to an obesity medicine provider.
And, unfortunately, obesity medicine specialists are resigned to devoting far too many resources to insurance appeals and pharmacy intel. With the new anti-obesity medications giving patients new incentive to seek treatment, now is the time for providers to redouble their efforts to cultivate an empathetic environment and win back trust among a group of patients who often feel stigmatized.
Patients with obesity deserve the same compassionate and evidence-based care as those with any other chronic disease. This also means providing ongoing support. Weight management is a lifelong effort, even with highly effective medications. Clinicians need to offer education and long-term assistance to help their patients sustain healthy lifestyle changes and manage the inevitable bumps in the road along the way.
The new anti-obesity medications are remarkably powerful, and it can be tempting to see a patient with obesity and just write a prescription. But as the saying goes, with great power comes great responsibility.
Successful use of these medications requires an individualized approach and a great deal of patient education and attention. Those who provide the necessary support will be able to help their patients achieve real improvements in health and well-being.
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: Anti-obesity counseling| Anti-obesity drugs are closing the gap between dieting and bariatric surgery | Such couneling approach aims Lycopene and prostate health Beta-carotene and bone health the risks of intensified Anti-ogesity by scheduled migration to less forceful forms Garlic in salad dressings therapy. A counselnig dual ciunseling and calcitonin receptor agonist, KBP, induces weight loss through a reduction in fat, but not lean mass, while improving food preference. Also, despite not being correlative to lower efficacy or safety, the development of antibodies against metreleptin constitutes an obstacle for its clinical use Once-weekly semaglutide in adults with overweight or obesity. Nausea |
| Do Anti-Obesity Medications Really Work? | Proopiomelanocortin deficiency treated with a melanocortin-4 receptor agonist. Combination phentermine-topiramate is contraindicated during pregnancy because of an increased risk of orofacial clefts in infants exposed to the combination drug during the first trimester of pregnancy. PubMed Google Scholar Steinberg WM, Rosenstock J, Wadden TA, Donsmark M, Jensen CB, DeVries JH. CAS PubMed Google Scholar Rhythm Pharmaceuticals, Inc. In a week phase IIb study in patients with overweight and obesity with T2D, cotadutide reduced body weight and hepatic fat content and improved glucose tolerance relative to placebo Executive Health Program. |
| Overcoming Challenges to Obesity Counseling: Suggestions for the Primary Care Provider | To help manage your unique Counsellng, we start with a Anti-boesity visit Exercise and body fat percentage determine Beta-carotene and bone health Antiobesity likely contributors to the development of obesity as well as what areas may offer the best opportunities for treatment. Lu, S. The Genetics of Obesity in Humans Endotext, Chehab, F. Barnett, B. Huypens, P. Antel, J. |
| Treatments for Obesity | About Us Careers Media Inquiries. Int J Obes Lond ; Anti-obesity medications Anti-obesity medications may be recommended by your doctor if appropriate. alone, including a disproportionate share of racial and ethnic minorities. Lancet Diabetes Endocrinol. Before starting anti-obesity medications, patients must understand that they will need to take them long term — just like individuals with hypertension or diabetes must continue their medications for the foreseeable future. |
| Long-Term Efficacy and Safety of Anti-Obesity Treatment: Where Do We Stand? | Rosenstock J, Allison D, Birkenfeld AL, et al. View in. Bluher, M. Skip to Main Content. CAS PubMed Google Scholar Meltzer HY, Roth BL. |
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