Form Health

Reducing loss of muscle mass during the weight loss process is a major priority for anyone practicing obesity medicine. The review "Strategies for minimizing muscle loss during use of incretin-mimetic drugs for treatment of obesity," co-authored by my mentor Zhaoping Li, MD, PhD, discusses the impact of obesity and weight loss on muscle mass and function, changes in lean muscle with the use of highly effective weight loss medications, and strategies to mitigate muscle mass loss during weight loss. Weight loss medications like Wegovy and Zepbound can lead to significant weight loss in patients, and this includes not just fat loss but also loss of muscle. The authors put this in a sobering perspective: "the estimated loss of skeletal muscle in these two major trials (10% or more during 68–72?weeks of treatment) approximates the average decline in muscle mass during 20?years of aging-related muscle loss in adults older than 30?years, estimated at 3%–5% per decade." Clearly we need more long-term studies to understand the impact of such profound muscle mass loss over such a short period of time. It also highlights the importance of lifestyle changes (adequate protein intake, muscle strengthening activities) that are not found in a pill (or injection for that matter). Article: https://lnkd.in/grGdETxC Image citation: Obesity Reviews, First published: 19 September 2024, DOI: (10.1111/obr.13841). Note: estimated declines in total lean mass during the 68-week STEP-1 and 72-week SURMOUNT-1 trials were normalized to 52?weeks based on the simplifying assumption that the decline in lean mass was linear over time.

When I was a medical resident at Brigham and Women's Hospital I gave my first talk on the medical treatment of obesity. I proudly quoted data about commercial programs that were giants in the space, with decent published data about the benefits that structured lifestyle programs, based on education, tracking, accountability and support for behavior change. I encouraged fellow residents to manage obesity as a health condition, and to consider such programs as a tool in their tool box. Now I am watching as more and more of these reputable lifestyle change programs start to sell compounded medications, and I am truly worried. People with obesity have a medical condition, which carries tremendous stigma and increased health risks. The last thing they need is more health risk from "treatment"! This study highlights some of the craziness going on in the world - not just compounded, also fakes, sold, without prescriptions, purchases confirmed on WhatsApp. With all of this, US poison control centers report a 1500% increase in calls related to severe side effects of "semaglutide". Please encourage anyone you know, or care about, or employ, to use only FDA-approved medications with rigorous quality and safety testing and randomized trial data to support efficacy and safety!

Metabolic dysfunction-associated steatotic liver disease (MASLD, formerly NASH) is the most common chronic liver disease, affecting more than 1/3 of adults in the world! It can lead to end stage liver disease (cirrhosis), a need for liver transplantation and hepatocellular carcinoma. A recent study found that GLP-1 receptor agonist use was associated with a lower risk of developing cirrhosis and death in patients with MASLD (without cirrhosis) and type 2 diabetes.?This study included over 15,000 patients with MASLD and type 2 diabetes who were taking a GLP-1 receptor agonist and subdivided those into with vs. without cirrhosis.?The GLP-1 receptor agonists included in the study were exenatide, dulaglutide, liraglutide or semaglutide, and the majority were on semaglutide (75.6%).?Note, however, that for patients who already had cirrhosis at the time of the study, there was not a statistically significant difference in terms of developing complications of cirrhosis or mortality compared to those not taking a GLP-1 receptor agonist. This study highlights the potential impact GLP-1 therapy could provide for patients with diabetes and MASLD, and the need for long-term randomized controlled trials in this patient population to confirm these benefits.?Furthermore, it suggests (not surprisingly) that *prevention,* in this case before cirrhosis develops, is a more effective approach. https://lnkd.in/g3ayieuq MASLD stats: https://lnkd.in/gpneDeJR

New research published this week from the Cleveland Clinic describes their "real world" results of the impact of GLP1 medications on weight. For semaglutide (Ozempic, Wegovy) it was significantly less than originally described in clinical trials. When I think about these results, and how complex it is to drive weight loss outcomes, I also think about the many conversations I am having with health benefits buyers. They have tough decisions to make. They are trying to understand what are best practices in clinical care when using these medicines, and how they can drive the greatest impact for dollars spent. I believe these results from a renown institution underscore that point solutions out there prescribing asynchronously, providing no supportive care or only from bots and/or unlicensed coaches, are never going to have what it takes to make real health impact. We need to arm patients with all of the science-based tools in the toolbox, ensure that the right patients are selected for treatment, and then allow reliable access to it. Most importantly, obesity like diabetes is a chronic and complex medical condition, and your partners should have the medical depth to support these patients and complex medical decision-making, and manage a rapidly evolving landscape in the treatment of metabolic disease. Also, we are excited to share some of Form's clinical results, so stay tuned for our live reporting from The Obesity Society annual meeting in early November!