Physicians tout 'obesity first' approach with weight loss drugs

Many physicians in obesity medicine have observed a trend among their patients: Those with obesity begin taking a weight loss drug like Wegovy, and their other chronic conditions improve or clear up entirely. 

As a result, some physicians are embracing an "obesity first" approach in which they treat obesity first with drugs approved for that purpose, anticipating other related conditions, such as high blood pressure and arthritis, will also improve as patients begin to lose weight, according to  a June 19 report from The New York Times. 

"We are treating the medical condition of obesity and its related complications at the same time," Stefie Deeds, MD, an internist and obesity medicine specialist at a private practice in Seattle, told the Times. Dr. Deeds is also an assistant professor at the University School of Washington in Seattle. 

The approach marks a shift from traditional medical practice in which patients with obesity are prescribed a number of medications to treat conditions that often accompany obesity, and advised to make diet and exercise changes. In some cases, patients are happy to be taking a single drug, experts said. 

But there's no firm consensus that this approach works, and not all physicians are on board. A primary care physician told the Times he leans toward an "obesity last" approach in which he starts by treating obesity-related conditions with drugs known to work for those conditions. If related conditions didn't improve, only then would he discuss obesity drugs with patients. 

Physicians say there is reason to believe weight loss drugs may have far reaching benefits: Evidence has indicated the drugs can reduce sleep apnea events, with Eli Lilly now seeking a sleep apnea indication for Zepbound. Novo Nordisk's Ozempic and Wegovy have also been shown to quell kidney disease risks. 

A number of trials are underway to determine whether obesity drugs have additional benefits beyond treating obesity itself. Anecdotally, people taking the drugs have reported reduced cravings for alcohol. Several trials are underway to examine whether semaglutide — the active ingredient in Ozempic and Wegovy — can curb cravings for alcohol. Trials investigating GLP-drugs as potential treatments for drug addiction and reducing the risk of dementia are also underway. 

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