Summary Listen
- Obesity is now recognized as a complex, multi-faceted disease, not merely a BMI over 30. Guidelines emphasize addressing complications like type 2 diabetes and fat-delivered diseases. Management should involve a multidisciplinary team, with collaboration between physicians and dietitians.
- Weight loss goals should initially target 3-5%, then 5-10% over six months, leading to improvements in lipid profiles and HVA1C. Newer medications like Mounjaro and Wegovy can achieve much greater weight loss. It's crucial to establish long-term programs to maintain weight loss after discontinuing medication.
- GLP-1 agonists like semaglutide (Wegovy) decrease gluconeogenesis, inhibit glucagon, and increase theato-stereotosis in the liver. In the intestine, they decrease gastric emptying and gastrointestinal motility. In the brain, they reduce food intake and alter behavioral eating patterns.
- Semaglutide demonstrated a mean weight loss of 22% in people without diabetes. Up to 96% of patients achieved more than 5% weight reduction in trials, and 40% achieved over 25%. Pancreatitis incidence was similar to placebo in trials, and there was no increased risk of malignant neoplasms.
- Guidelines recommend GLP-1 agonists for those with a BMI over 30 or over 27 with comorbidities. Common questions arise regarding stopping GLP-1s. Tapering down the dose or using it PRN are strategies, but there are no definitive guidelines.
- Patients often lose muscle mass, requiring a balanced approach of cardio and resistance training. Weight loss plateaus occur due to biological set points and metabolic adaptation. After stopping medication, appetite increases, and the body tries to compensate to regain weight.
- Combination therapies involving different mechanisms for weight loss are being explored. Emphasis should be placed on lifestyle changes, including resistance and aerobic training, and adequate protein intake (0.8g/kg/day). The obesity medication pipeline is rapidly expanding.
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About the Speakers
Dr. Yanal Salam
Head of Internal Medicine Department, Emirates Hospital, Jumeirah, Dubai, United Arab Emirates
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