Gastroenterologists can play a key role in the future of obesity research, management, and treatment through endobariatric interventions, Jennifer Phan, MD, said during her presentation at the 2023 ACG Annual Scientific Meeting and Postgraduate Course on October 21, in Vancouver, Canada.

Dr Phan is an assistant clinical professor of medicine in interventional and bariatric endoscopy at Keck School of Medicine of the University of Southern California in Los Angeles, California.

Dr Phan addressed the pathophysiology of obesity and presented different approaches to medical management. “Obesity is a disease. While 30% of the world population is overweight and obese, almost 3 million people die from complications of obesity every year,” she stated.

Hypertrophic obesity usually starts in adulthood and is typical of android abdominal obesity, Dr Phan explained. Hypercellular obesity, in contrast, typically occurs in people who develop severe obesity in childhood or adolescence. Overeating results in inflammation of the arcuate nucleus, which leads to reduced anorexigenic neurons and changes the threshold of fullness.

“Lifestyle and behavioral modifications are the first line of therapy,” Dr Phan said. However, 60-80% of patients who lose weight will regain that weight within 5-10 years, she pointed out.

That brings in the second line of treatment — medication. Antiobesity medications that are approved by the FDA for long-term use include phentermine/ topiramate, orlistat, naltrexone/ buproprion, liraglutide, and semaglutide.

However, poor insurance coverage and supply shortages are major contributing factors that limit accessibility to antiobesity medications. The out-of-pocket costs for tirzepatide “could go as high as $1000 per month,” she noted.

Dr Phan advocated for the Treat and Reduce Obesity Act and advocated for Medicare part D to cover antiobesity medications.

Obesity may lead to cirrhosis, increased nonresponse to treatment in inflammatory bowel disease, and increased risk of colon cancer, among other complications.

Given that gastroenterologists and hepatologists are at the forefront of obesity management, Dr Phan said, timely weight loss interventions, timely referrals to specialist weight management centers, or bariatric endoscopy would be highly beneficial in ensuring their role in the treatment of obesity.

Reference:

Phan J. Obesity and medical management for the GI doc. Symposium B: Obesity and liver disease: What’s the latest? Presented at: 2023 ACG Postgraduate Course. Vancouver, Canada. October 21, 2023.