Our key takeaways from the 30th European Congress on Obesity 17-20 May 2023 – Part II/II

We are witnessing the dawn of a new era for obesity pharmacotherapy

Significant progress has been made in the past decade in the development and application of novel treatments for obesity treatment:

• Both marketed therapeutics for obesity treatment (e.g., semaglutide) and assets in clinical development (e.g., tirzepatide) are now demonstrating double-digit weight loss with associated health benefits, with some pipeline assets (e.g., retatrutide) approaching the realm of bariatric surgery in terms of weight loss
• The growing body of clinical data empowers physicians to choose pharmacotherapy based on the comorbidity of interest
• There is an increased appreciation that the focus of pharmacotherapy treatment should be the broad improvement of health parameters, not solely weight reduction, and should include outcomes that the patients identify as important

However, challenges remain in the advancement of existing and novel therapeutics:

• Obesity medications are intended as a long-term treatment strategy – clinical trials consistently demonstrate weight regain when treatment is stopped. However, this is also true for lifestyle and dietary interventions.
• Not all patients respond equally well to pharmacotherapy due to the variability in the disease pathogenesis, and physicians should therefore be prepared to rely on trial and error before we have the tools to properly stratify patients
• With increasing number of treatment options, we should be able to predict which treatment is better for an individual – we need more studies designed to investigate treatment heterogeneity in obesity

Future obesity care – increasing effectiveness and decreasing the costs

 In the past 45 years, not a single country has experienced reduction in the prevalence of obesity, while we have made progress in virtually every other disease area, including HIV, cancer, cardiovascular disease etc. However, as our understanding of obesity grows, so does our ability to combat this disease.

In order to treat obesity more effectively, it will be necessary to:

• Fully understand why it is a disease and what it being a disease means for the effective care of obesity
• Fully understand the barriers to effective obesity care
• Keep the needs and goals of all people living with obesity central to the discussion around obesity care

Furthermore, to reduce overall costs of care in obesity, we need to seek alternative models of equitable access. A common strategy is to increase overall access to drive greater equity – this is economically and politically untenable in the context of obesity treatment. Instead, we need to:

• Increase the equity of access based on prioritisation parameters (e.g., overall clinical severity of obesity or predicted response to a particular type of therapy)
• Measure and optimise clinical and economic benefit (e.g., durably maintained weight and decreased cost of care)
• Scale-up based on observed results

Importantly, future obesity care needs to be driven by engaged primary care providers, who can diagnose and refer patients to obesity care specialists and treatment centres.