Obesity is a public health problem and today there are drugs to combat it: il punto- breaking latest news

Is it true that obesity should be considered a disease? And what can be a risk factor for diabetes?

Obesity in constant growth in industrialized countries is a public health problem for associated pathologies and its close relationship with diabetes mellitus. The 82nd congress of the American Diabetes Association recently concluded and among the topics discussed, the scene dominated obesity issue due to the need to extend the prospects for treatment to a wider population, thus rethinking the approach to treating diabetes. It is now seriously considering include weight reduction among the primary goals of treatment. Obesity defined by the World Health Organization (WHO) as an abnormal or excessive accumulation of adipose tissue, especially abdominal tissue, which poses a health risk.

Extra pounds and diabetes

Weight is the simplest and most reproducible parameter that allows its measurement, even if it does not always define the state of pathology in an optimal way. But weight also plays an important role in the history of diabetic disease, sometimes preceding, sometimes aggravating alterations in metabolism and is therefore already one of the additional goals of care. A recent review of the scientific literature, which appeared in Lancet in early 2022, it reminds us how a weight loss of at least 10-15% can really change the course of the diabetic disease, causing an improvement or, in some cases, even remission, if obtained at a very early stage (generally in the first year from the diagnosis of diabetes). Achieving such ambitious weight losses in a short time and, above all, being able to maintain them is certainly not easy. Usually, intervention on diet and lifestyleeven if intensive, they are effective in only 2 out of 10 patients.

Bariatric surgery

The better the results of the bariatric surgery, which, however, cannot be offered to everyone, due to its complexity and operational risks. New enthusiasm was aroused by the availability of innovative pharmacological options, effective in promoting weight loss in cases of obesity and even diabetes. In the United States, 5 molecules are approved for this purpose, 4 of which are also marketed in Italy: orlistat, which acts on the absorption of fats; liraglutide and semaglutide, which mimic the action of glucagon-like peptide 1 (GLP1), an intestinal hormone involved in the stimulation of insulin secretion, but also in the regulation of food transit and appetite; the naltrexone-buproprion combinationpsychotropic drugs that act on the feeling of hunger.

Prevent the disease

Finally, recently tirzepatide, a new combination of two hormones (GLP1 and GIP gastric inhibitory peptide) has completed the studies required for commercialization. In the Surpass study, tirzepatide did record a weight reduction of up to 11% after 40 weeks in people with diabetes. In conclusion, although promising, drugs alone still fail to reduce body weight by 15%, so multidisciplinary interventions remain necessary. It is important to note, however, that the goals of care now tend to shift from what used to be glycemic control and prevention of complications to possibility of preventing the diseasewaiting to finally find the definitive cure.

* Endocrinology SSD Diabetologist – ASFO Pordenone, Association of Diabetes Doctors (AMD)