Obesity is a preventable disease developed over a lifetime. While some progress is being made toward accepting obesity as a chronic disease, much work needs to be done at the clinician-practice level so it is addressed as routinely during office visits as other chronic diseases such as T2DM and hypertension. Despite a higher prevalence of CVD, T2DM, and cancer among patients with obesity, treatment is frequently either ineffective or not offered at all.1
An effective treatment of obesity would simultaneously improve body weight, body composition, and glycemic control. Given the strong association between excess weight and T2DM, the focus of a suitable antidiabetic treatment of patients with obesity and overt diabetes should, at least, include the prevention of additional weight gain.
Currently, treatment options added to lifestyle changes to improve enduring weight loss for patients with obesity may include bariatric surgery and pharmacotherapy. Both perioperative and long-term complications occur after all bariatric surgical procedures. Procedures that are less invasive or those that involve less gastrointestinal rearrangement accomplish considerably less weight loss, but have substantially lower perioperative and longer-term risk.7
New pharmacologic drug therapies such as GLP-1 RAs have the potential to improve the obesity treatment landscape significantly. While the GLP-1 RA liraglutide and the combination of naltrexone/bupropion (opiate antagonist/antidepressant) can help patients with T2DM to achieve their weight loss goals and improve their HbA1c levels,6 next-generation GLP-1 RAs such as semaglutide have demonstrated even greater effectiveness.2,5 No treatment can be effective if the patient perceives him or herself to be stigmatized because of their weight—particularly when the stigma comes from the clinicians patients rely upon to help them. Stigmatization can actually interfere with the effectiveness of any treatment by diminishing the patient’s willingness to adhere to treatment regimens that many find very challenging.3,4