Obesity Week 2024 Tackles Treatment, Prevention and Access

SAN ANTONIO — The upcoming Obesity Week meeting will feature new clinical trial data for glucagon-like peptide 1 receptor agonist (GLP-1 RA) drugs, along with deep dives into clinical, social, and economic issues around their use, nonpharmacologic obesity treatment and prevention starting in childhood, and obesity complications including fatty liver disease.

The Obesity Society’s annual meeting runs from November 2 to 6 in San Antonio. “The state of the science in obesity medicine is being presented during those few days…Anybody who is treating these patients is going to get the latest and greatest information in the field. It’s really important because the space is moving so fast,” Conference Program Chair Sarah Messiah, PhD, professor and director of the Center for Pediatric Population Health at the UTHealth Houston School of Public Health, Houston, told Medscape Medical News.

One highly anticipated session will feature full detailed 3-year outcomes from Eli Lilly’s SURMOUNT 1 of once-weekly tirzepatide (Zepbound). The company released topline data in August 2024, showing that the drug significantly reduced the risk of developing type 2 diabetes among people with prediabetes and overweight/obesity.

Another noteworthy session will highlight new data and subanalysis for the SELECT cardiovascular outcomes trial of semaglutide (Wegovy). First reported at the American Heart Association meeting and published in The New England Journal of Medicine in November 2023, SELECT showed about a 20% reduction in cardiovascular endpoints over about 3 years in people with overweight/obesity but not diabetes.

And in an oral abstract, data will be presented for the randomized OASIS 4 clinical trial of once-daily 25 mg oral semaglutide in adults with overweight/obesity. The dose is half of that used in the OASIS 1 trial. If shown to be as effective as the higher dose, it could have major cost and access implications, Obesity Society President Jamy D. Ard, MD, told Medscape Medical News.

“For some people, it may be the convenience of not having to give themselves an injection. But I think it might also potentially have an impact on the cost of the product…and if ramped up, could help avoid shortages.”

Meeting Will Address Many Issues Around Medication Use

Symposia related to the use of these medications will address their long-term use, ethical and economic dilemmas around access to them, and their use in special populations.

Messiah noted, “It is still early, early days with these, GLP-1 RAs…There are a lot of issues we don’t have answers to beyond the clinical outcomes. What happens when you go off these? The first thing you see in the media is you gain the weight back immediately. Well, why is that? Maybe we need to be thinking about support interventions. And maybe we don’t want everybody on these for life…Maybe some people only need to be on them for 3 months, and that’s the kickstart they need, while others need to be on them for 6 or 12 months, and maybe some people need to be on them forever. These are all the kind of questions that we brought up in the planning of the whole program, and I think we’ve addressed throughout in different ways.

“The access and the expense of these medications is real. It’s a huge challenge…We don’t have access to these drugs for kids yet, and we know nothing about long, long-term impacts, and we know very little about short term, and certainly in diverse populations. And how do we deal with pediatric obesity? All of that is on the program,” Messiah said.

In his Presidential Plenary and panel discussion on the evening of the first day, Ard will “tackle the essential issue of equitable healthcare for individuals with obesity, underscoring the impact of bias and stigma on care quality and access. The plenary will spotlight scientific progress in obesity research and holistic health strategies that promise to enhance health outcomes,” according to the meeting program.

Ard, who is co-director of the Weight Management Center and medical director of medical weight management at Wake Forest University School of Medicine in Winston-Salem, North Carolina, told Medscape Medical News, “A lot of what we’re talking about has to do with this idea of health equity. What explains the differences in treatment response? Is it something genetic or something in the environment? Is it social determinants of health? What is driving obesity in the first place? We’ll have those types of analyses.”

In addition, Ard said, “We’re starting to spend more time talking about the complications of obesity and understanding that they aren’t just associated with obesity but are actually caused by obesity…It highlights the centrality of treating obesity effectively in preventing obesity in the first place to prevent a lot of these chronic conditions that come along with it.”

He pointed to a special 90-minute symposium on “Obesity, Metabolic Syndrome and Liver Disease in Latin America” and a key hour-long lecture “What Flips the Switch? Shining Light on the Causes of Fatty Liver in Obesity.”

The meeting won’t neglect diet, though. The topic of “Food as Medicine” will be featured in two sessions: One a symposium and the other a debate. Another symposium will address the question for older adults, “How do pharmacotherapy and diet styles measure up?”

And importantly, obesity prevention is on the agenda. Ard said, “we’ve always had a strong contingent group of investigators who are looking at strategies for prevention, and obviously that focuses a lot on childhood…You’ll see a couple of key lectures and other symposia around eating behaviors, especially for kids and parents, and the food environments that kids grow up in.”

Even when it comes to environmental and other nonclinical barriers to obesity prevention, Ard said clinicians can play an important role. “It may not be something you can write a prescription for, but it’s something you can acknowledge, or at least be aware of and then think okay, what are the other things that we can do right now that might help to offset that? Sometimes it’s just awareness and recognition of the issues that the patient is going through.”

Messiah had no disclosures. Ard received grants from Nestlé Healthcare Nutrition, Eli Lilly, Novo Nordisk, Epitomee Inc., UnitedHealth Group, KVK Tech, WeightWatchers, Regeneron, and Boehringer Ingelheim and personal fees from Intuitive, Brightseed, Nestlé Healthcare Nutrition, Eli Lilly, Novo Nordisk, WeightWatchers, Regeneron, and Boehringer Ingelheim.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape Medical News, with other work appearing in the Washington Post, NPR’s Shots blog, and Diatribe. She is on X: @MiriamETucker.