New Advances in Obesity Management, but Challenges Remain

 My career has really been around clinical research in obesity and diabetes. I was part of the Diabetes Prevention Program, the Look AHEAD study, and the POUNDS LOST study. I helped develop the DASH diet. All of these studies focused on trying to help patients lose weight so that we can better treat these chronic diseases that are filling our offices.

I have to say, I don't think I was ever really successful in translating what I knew from those clinical research studies into practice. There was always this resistance of primary care practitioners in trying to be effective in weight management. I didn't really have any tools to give them that would work in a modern practice. Primary care practitioners today are very time-pressured. They're seeing patients at these 15-minute intervals, so I need to give them tools that work.

I'm very hopeful about some of the newer medications that are coming out. I think this is likely to change our approach to diabetes management and to management of all chronic diseases. I think we're going to take a much more weight-centric approach.

Some of our newer medications are targeting glucagon-like peptide 1 (GLP-1). GLP-1 and gastric inhibitory polypeptide (GIP) are incretin hormones that improve glycemia and also have an effect on weight. Some of these newer medications are leading to dramatic improvements in weight loss.

I feel like our doctors are finally going to have some tools that are going to help them. Believe me, this has been a long, hard struggle for me. I've been involved in the development of many medications — some of which succeeded and some of which failed — around weight management. I kissed a lot of frogs. Finally, I feel like I'm getting some princes.

Just having effective medications is not enough. Our doctors need to understand how to use these medications and to provide weight management instructions to their patients. Even more important, we have to be able to get these medications into the patients' bodies.

One of the problems is that our payers — our employer-based insurance companies our federal insurance companies — don't always reimburse for these really incredible scientific achievements in drug discovery, and that's especially true around obesity medications.

We have to solve the problem of drug pricing in America if we're going to be able to get these really great drugs into our patients' bodies so that we can make weight management the driver of all these chronic diseases, and so that we can make weight management central to chronic disease management.

Donna H. Ryan, MD is Past President of the World Obesity Federation and professor Emerita at Pennington Biomedical in Baton Rouge, LA, where she directed clinical research for 22 years. Her own research includes participation on the teams that developed and executed the DASH (Dietary Approaches to Stop Hypertension), POUNDS Lost, DPP (Diabetes Prevention Program) and Look AHEAD Studies. Dr. Ryans continuing research interests focus on translation of effective weight management into primary care practices.

https://www.medscape.com/viewarticle/975096