OnDemand: January 2024 Grand Rounds - Present and Future of Anti-Obesity Medication-Present and Future of Anti-Obesity Medications

Video Transcription

Video Summary

Dr. Bob Kushner, an expert in obesity medicine, presented an update on the rapidly evolving field of anti-obesity pharmacotherapy, emphasizing a major “inflection point” driven by second-generation nutrient-stimulated hormone-based therapies such as semaglutide and tirzepatide. He reviewed the history of obesity drugs, noting the many withdrawals that created lingering safety concerns, but highlighted that newer agents are far more effective and now commonly discussed by primary care clinicians and patients.<br /><br />Kushner explained that these medications work primarily through appetite regulation and can produce clinically meaningful weight loss, often exceeding 10% and in many patients reaching 20% or more. He emphasized that obesity is a chronic disease: weight and cardiometabolic benefits improve while patients remain on therapy, but disease and weight tend to recur when medications are stopped.<br /><br />He also discussed the SELECT cardiovascular outcomes trial, which showed semaglutide reduced major adverse cardiovascular events by 20% in people with overweight or obesity and established cardiovascular disease. Safety issues are mainly gastrointestinal, with attention also needed for gallbladder disease and contraindications such as pregnancy and medullary thyroid carcinoma/MEN2.<br /><br />Finally, he noted unresolved questions about long-term maintenance, dose reduction, body composition, resistance training, and access/cost barriers, underscoring the need for individualized, shared decision-making.

Keywords

obesity pharmacotherapy

semaglutide

tirzepatide

appetite regulation

weight loss

SELECT trial

cardiovascular outcomes

gastrointestinal side effects

shared decision-making