Lesa Walton, 57, from Wenatchee, Washington, had long suffered from rheumatoid arthritis, high blood pressure, and obesity. Despite efforts to diet and exercise, her health issues persisted. That changed when she found Dr. Stefie Deeds, an internist and obesity medicine specialist, who prescribed Wegovy, a new obesity drug. Ms. Walton lost over 50 pounds, her arthritis cleared up, and she no longer needed blood pressure medication.
Dr. Deeds represents a growing movement in obesity medicine called “obesity first,” which treats obesity with medications approved for that purpose. The idea is that controlling obesity can lead to improvements in related chronic conditions.
However, some experts are cautious. Patients with obesity often react negatively when doctors focus on their weight. While obesity drugs may reduce inflammation and have other benefits, they are expensive, and many potential advantages lack rigorous study confirmation.
Dr. Gordon Guyatt, a clinical trials expert at McMaster University, advocates using well-tested, inexpensive generic drugs to treat conditions related to obesity, like high blood pressure, high cholesterol, arthritis, and sleep apnea.
Yet, many doctors, including Dr. Deeds, are influenced by anecdotal success stories. They believe the drugs’ benefits may extend beyond weight loss. The approach marks a shift from traditional medical practice, where doctors often treat each condition separately and advise diet and exercise without clear guidance.
Dr. Caroline M. Apovian, an obesity medicine specialist at Brigham and Women’s Hospital, notes that by starting with obesity drugs like Wegovy or Zepbound, doctors can simultaneously address obesity and related conditions using just one medication. This approach excites patients who have struggled with multiple drugs and unsuccessful diets.
However, few rigorous studies demonstrate that treating obesity can eliminate accompanying medical conditions. Large clinical trials are needed to confirm these effects. Historically, treatments presumed effective were later disproven in clinical trials, such as menopause hormones for heart disease and beta carotene supplements for cancer prevention.
Despite the need for more research, there is optimism about the new obesity drugs. They seem to impact the brain and body beyond reducing food cravings. For instance, a clinical trial by Novo Nordisk found that Wegovy reduced cardiac complications early in treatment, before significant weight loss occurred. Similarly, Ozempic, another drug from Novo Nordisk, preserved kidney function independently of weight loss.
Dr. Daniel Drucker, an obesity researcher, suggests these drugs reduce inflammation quickly, even before weight loss. His research on tirzepatide (Zepbound) showed significant inflammation reduction in mice, and patients reported similar benefits.
Eli Lilly and Novo Nordisk are exploring variations of their obesity drugs to enhance weight loss and treat other conditions. Wegovy improved physical function in people with diabetes and heart failure, while Zepbound helped with sleep apnea. Trials are also testing these drugs for depression, addiction, schizophrenia, Parkinson’s disease, and Alzheimer’s disease.
Dr. Ezekiel Emanuel of the University of Pennsylvania praises the rigorous research behind these drugs but acknowledges that clinical trials take years and are costly. Many doctors, however, are eager to try these promising treatments now.
Dr. Scott Hagan, a primary care doctor in Seattle, prefers a cautious approach. He treats obesity-related conditions with proven drugs first and only discusses obesity drugs if those conditions do not improve. He emphasizes that patients with obesity often have had negative experiences with doctors focusing on their weight.
As the debate over the “obesity first” approach continues, the medical community remains divided. Some advocate waiting for more research, while others are eager to use these potentially transformative drugs now. The future of obesity treatment may hinge on the outcomes of ongoing and future clinical trials.
