Evolving treatment and approaches to obesity

Obesity is a complex chronic disease which needs multiple treatments and a multidisciplinary approach, delegates attending the Irish Society of Gastroenterology Winter Meeting 2023 heard, during a dedicated symposium on the modern approach to obesity and bariatric surgery

Noted obesity expert Prof Carel le Roux, Professor of Metabolic Medicine, University College Dublin, discussed the evolution of scientific evidence on obesity as a disease and the need to treat it like any other condition, such as cancer or diabetes. He described obesity as a neurological disease and a “fundamental biological dysregulation of where your [fat mass] thermostat is set”.

“The disease of obesity causes people to over-eat and if you treat it, people will eat less.”

Prof le Roux pointed to the overall impact of obesity on the development/exacerbation of a number of health conditions, such as type 2 diabetes, cardiovascular disease, infertility, liver disease, sleep apnoea, gout and joint issues. Treating the underlying condition, ie, obesity, can help dramatically improve/cure many of these associated conditions.

There are now a range of successful and evidence-based treatments for obesity, including bariatric surgery and medications, such as the GLP-1 inhibitors; however, treatment and access remain a challenge, Prof le Roux said. He added while diet and lifestyle offer benefits for some people, and should continue to be advised, they clearly do not work for the majority of those with obesity.

The data also show that the long-term benefit of anti-obesity medications, such as GLP-1 inhibitors, requires continued treatment, as once they are stopped most people regain the weight, Prof le Roux stated. He questioned reimbursement regimes that put a time cut-off on access to these medications.

Concluding, Prof le Roux said the future of obesity care will include chronic treatment “aimed at health gain not weight loss”, recognising the different subtypes of the disease, and the need for tailored treatments for each, and “not blaming our patients for their disease or if they don’t respond”.