A new set of guidelines for the management of obesity, commissioned by the National Heart, Lung, and Blood Institute (NHLBI) and developed by the American College of Cardiology, the American Heart Association and The Obesity Society, was released online in Circulation on November 12. Following on the American Medical Association's recognition of obesity as a disease and considering that the last set of NHLBI obesity guidelines was published in 1998, it serves to highlight how the medical importance of obesity is increasing. Although not universally approved by experts in the field, reportedly, these guidelines will add to the resources available for obesity specialists and primary care physicians (PCPs) and at least serve to reinforce the importance of weight management as part of a holistic approach to health care.
Further evidence of the health risk posed by excess adiposity was recently published online in JAMA Intern Med (November 11, 2013), where the concept of the healthy obese patient was challenged. In essence, the study showed that being overweight or obese carries an independent threat to health, over and above that which comes with the factors associated with metabolic syndrome (chiefly hypertension, dyslipidemia and hyperglycemia), which frequently co-exist with obesity.
To me, obesity is both very simple and very complex. Fundamentally, it follows a basic equation: energy in > energy out = obesity. However, the various genetic factors, the complex physiology of energy metabolism and the numerous environmental factors that promote poor diet and a lack of physical activity all make obesity a disease that can far too easily develop, and one which can be very difficult to cure. Many people will have experienced how hard it can be to move a few pounds. For those who are severely obese, it can be even more challenging, particularly if exercising is difficult or concomitant disease is present. Yet the evidence is there to show that even a relatively small reduction in weight can make a difference to the risk of complications. Primary care physicians, in particular, will welcome the additional direction offered by the new guidelines, to help them better manage obesity in daily practice.
Unfortunately, the new guidelines do not provide detailed guidance on the pharmacotherapy of obesity; they were developed before the launch of Vivus's Qsymia (phentermine/topiramate) and Arena Pharmaceuticals/Eisai's Belviq (lorcaserin). As a substantial proportion of the obese and overweight population will either not qualify for bariatric surgery or not respond to lifestyle interventions, more advice on the drug treatment of obesity would have been beneficial, even if it came at the expense of delaying publication of the guidelines. Moreover, none of the available drug therapies have the optimal blend of efficacy and safety, making guidelines all the more important for assisting with individualizing treatment. When added to diet and exercise, a drug treatment could make the difference required to reduce the risk of complications or provide the encouragement to continue persevering with diet and the exercise.
Decision Resources? recently published Obesity Pharmacor provides an overview of the obesity therapeutic area, with a focus on antiobesity medications, and an Obesity DecisionBase report covering PCPs? and payers? opinions on current and emerging obesity therapies will be published soon.
Tim Blackstock, M.B. Ch.B., is a business insights analyst in the Cardiovascular, Metabolic and Renal Disorders team at Decision Resources Group.
In-depth analysis of the obesity area, with accompanying epidemiology driven sales forecast models, is presented in Decision Resources? Obesity Pharmacor. The 2013 edition was published on October 31.