Complex genetic disease needs personalized treatment plans and deserves greater levels of advocacy and research funding, says physician from a top American hospital, Cleveland Clinic
Cleveland, Ohio: More than 800 million people worldwide who have obesity could potentially benefit from a hormone-mimicking medication typically used to treat diabetes and now shown to be effective for weight loss, says an expert at a top American hospital, Cleveland Clinic, ahead of World Obesity Day on 4 March.
Dr. W. Scott Butsch, Director of Obesity Medicine, Cleveland Clinic’s Bariatric & Metabolic Institute, said: “Obesity is a complex, highly heritable disease with a strong biological basis. We estimate 40 to 70 percent of the variability of the BMI in the population is due to genetic traits, which makes it very challenging for people to lose weight. Treatment plans need to be personalized and include different approaches, such as lifestyle interventions, obesity medications, and bariatric and metabolic surgery. Importantly, the recent STEP 1 trial showing the beneficial impact of diabetes drug semaglutide on weight could be a game-changer in helping many people with obesity to lose a significant amount of weight.”
Semaglutide mimics the glucagon-like peptide-1 (GLP-1) hormone to increase insulin secretion and has been marketed as a drug for type 2 diabetes. The STEP 1 clinical trial of semaglutide saw the majority of patients with obesity lose at least 10 percent of their body weight, with one-third losing at least 20 percent.
Obesity is one of the world’s most prevalent diseases, with the United Nations estimating 800 million people have obesity worldwide. Another 40 million children are considered overweight.
People are classified as having obesity if their body mass index (BMI) is higher than 30, and at a higher metabolic risk if their waist circumference is above 89 cm for women or 102 cm for men. BMI is calculated by taking a person’s weight in kilograms and dividing this by the square of his/her height in meters.
Patients who have obesity are at higher risk for more than 220 medical conditions such as heart disease, stroke, high blood pressure (hypertension) and diabetes.
In terms of treating obesity, the medical establishment has moved on from measures such as drastic diets and energy pills to focus on treating obesity as a complex disease with multiple factors that need to be considered. Less serious cases may be treated by exercise, healthier diets, or certain medications that target pathways involved in weight regulation. People with more severe cases may need bariatric and metabolic surgery such as a gastric bypass or a sleeve gastrectomy, which could help them lose 20 to 40 percent of their body weight.
While there is not one cause for obesity, research points to a combination of genetic, environmental, and psychological factors, and, in some, may be caused by brain trauma or surgery. Environmental factors can include lack of physical activity, poor sleep, increased stress and not having access to healthy foods. Certain medications can cause weight gain. In rare cases, patients may have genetic mutations, for example with their leptin hormone, which regulates the body’s appetite.
“Obesity can develop across any population, any age group, and anywhere in the world – and we have to pay attention to it, especially in our children,” said Dr. Butsch. “Because it is highly likely that those who develop obesity at an early age are likely to continue to have obesity as an adult.”
Dr. Butsch adds that the complexities of the disease are compounded by societal pressures, and lack of research and understanding.
“Many patients who have obesity face stigma in body shaming from society, and also from their healthcare providers, public policies, and insurance coverage plans,” said Dr. Butsch. “Obesity deserves greater levels of advocacy, research funding, and health insurance coverage.”
About Cleveland Clinic:
Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 67,554 employees worldwide are more than 4,520 salaried physicians and researchers, and 17,000 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties. Cleveland Clinic is a 6,026-bed health system that includes a 165-acre main campus near downtown Cleveland, 19 hospitals, more than 220 outpatient facilities, and locations in southeast Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2019, there were 9.8 million total outpatient visits, 309,000 hospital admissions and observations, and 255,000 surgical cases throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries.