Form Health

Something I have always found incredibly fascinating was that studies in people who underwent bariatric surgery (Roux-en-Y gastric bypass) showed that they subsequently had higher risk of developing various addictive behaviors, including alcohol use disorder and gambling. How can it be that a surgeon operates on the stomach and intestines, and as a result these changes to the person's brain can occur? But science continues to reveal that eating but also other behaviors and reward pathways may be interconnected to intestinally-derived hormonal signals (like GLP-1), all in a very complex and fascinating way. Some potentially good news come from a new study showing that semaglutide was associated with lower tabacco-cessation related health care visits, prescriptions and counseling in smokers with type 2 diabetes. This is an early indicator and more research is needed, but it might align with other pre-clinical studies we have seen on the benefits of GLP1. receptor agonists for substance use. An exciting area of research to watch!

The conversation around treatment of obesity and GLP1 receptor agonist medications is expanding, as we learn more about the broad health benefits of these drugs in people with obesity. Exciting (though early) results from Eli Lilly's SUMMIT phase 3 trial have been previewed. In adults with obesity and heart failure with preserved ejection fraction (HFpEF) tirzepatide significantly improved heart failure outcomes such as symptoms, activity limitations and quality of life.  We eagerly await more detailed results and peer reviewed publication. Semaglutide has also shown very positive outcomes in this population of patients. So we may be looking at yet another future indication for GLP-1s, the treatment of heart failure in people with obesity. All of these clinical trials continue to support turning the conversation from weight loss as a cultural and cosmetic issue to treating obesity for its many many benefits to health. It is exciting to see so much emerging research supporting the concept that treating obesity is at the hub of -and a very effective approach to - treating cardio-metabolic disease.

There has been a lot of media coverage this week on compounded anti-obesity medications (AOMs). A lot has been said about this, but not enough! Companies selling compounded AOMs at large scale are praying on a vulnerable population, mostly people that have struggled with obesity and its many physical and mental health consequences. There are so many ways in which using compounded and knock-off products is potentially unsafe. Most companies are compounding a salt form of semaglutide, for example, which is a different active ingredient than the FDA-approved version. There may be no, too little or too much drug in these formulations, because their production is not overseen in the same way. And there may be other ingredients included in the dosages that can be harmful to humans. Plus, there have been examples of poor safety practices at compounding pharmacies, affecting the sterility of products, which have to be injected, so this could lead to serious infections. I am now getting daily emails offering me an ample supply of compounded semaglutide - available even in raspberry flavor! - for my patients. No thank you! I am so proud that at Form Health we truly put patient safety first. Treating obesity is and should be about getting healthier!

The first generic GLP-1 receptor agonist has entered the market! Generic liraglutide is now manufactured and sold by Teva, and is available at pharmacies for patients. While this is an exciting development, and perhaps the first real opportunity to see drug prices start to come down, we are not there yet. It was disappointing to learn that the cost is about $700/month, compared to brand name Victoza at around $800/mo. Also, what has become generic is the diabetes dosing (max 1.8 mg per day), not the obesity dosing (3 mg/day) we typically use in our practice. In about 6 mos other companies may also make generic liraglutide at this dose, and perhaps then we will see the price come down more significantly. It would be amazing to start to see lower costs for these medications that can be so impactful but are also so prohibitively expensive!

A really important framework for the diagnosis, staging and management of obesity was published this month by the European Association for the Study of Obesity (https:/https://lnkd.in/euxKbHaG). I could not agree more with this figure and this is so aligned with the work that we do with patients at Form Health every day. Treatment decisions are not just about weight. They are about considering all of the physical and emotional health impacts on the individual, and their unique goals of treatment. This is not a cookie-cutter process of prescribing one class of medications, but one that requires an in-depth medical evaluation and shared decision making. And treatment plans are not one and done, they require careful consideration to start and then ongoing monitoring and evolution over time, depending on the results. So great to see more and more thought leadership emerging on this, and at the international level. Science, evidence, guidelines, and expert consensus are a counter-weight to hype, misconception and misinformation about what it means to have obesity and its medical treatment options.

A set of Patient-Centered Outcome Measures for Adults living with Obesity was released by the experts convened by the International Consortium for Health Outcomes Measurement. This important work emphasizes that treatment of obesity is not about the number on the scale! We need to (re)focus on the many ways treating obesity affects people's health and wellbeing (especially in this crazy time of people getting unregulated and knock-off products with minimal medical supervision!). This group proposes specific measures to track for critical aspects like mental health, energy, physical functioning for daily activities, sleep, as well as the metabolic parameters like blood sugars, blood pressure and cholesterol. I think following how different treatments affect health metrics beyond the scale will also be critical over time to understand which treatments are best for which individuals, as we have more and more therapy options becoming available. The proposed measures are an incredible list of those "non-scale victories" we need to be focusing on for the treatment of obesity!