Gillian Galway’s Post

In special issue of the American Journal of Gastroenterology covering #obesity, co-editors #JasmohanBajaj and Millie Long opine on how obesity in GI disorders provides many unique, multi-faceted insights into one of the defining disorders of our age. Obesity affects 1 in 8 adults worldwide and is increasing among children and adolescents. The economic impact is anticipated to rival most other non-communicable diseases and is an urgent clinical and public health problem. This immense burden has the potential to impact clinical care and policy decisions with important caveats pertaining to social determinants of health, disparities, and availability of therapeutic options. The current issue of The American Journal of Gastroenterology was imagined as a crossroads between the multiple specialties involved in studying obesity pathogenesis. We also aimed to highlight the burden, treatment, and challenges in implementation of programs aimed at obesity reduction. An exciting development is the emergence of GI specialists as a major hub in the management of obesity. This rapidly changing role of GI practitioners in obesity management ranges from medication utilization, to endoscopic management, to writing exercise prescriptions. Our collection of articles emphasizes the multidisciplinary management of obesity via collaboration amongst primary care physicians, gastroenterologists, endocrinologists, nutritionists, and surgeons. The frameshift in obesity management is exciting and has the potential to reach patients who would not otherwise have access to this expertise across numerous provider types. #liverhealth https://bit.ly/3ReWzpD

A JAMA Patient Page on obesity in adults. Obesity is a condition of excess body fat that affects 800 million people worldwide and approximately 42% of adults in the US. Obesity leads to a higher risk of death, heart disease, high blood pressure, diabetes, high cholesterol, gallbladder disease, metabolic dysfunction–associated steatotic liver disease, stroke, sleep apnea, osteoarthritis, depression, anxiety, and certain cancers (such as breast and colorectal cancers). Intensive behavioral programs can achieve weight loss of 5% to 10% after 6 to 12 months. FDA-approved injection medications for obesity include liraglutide, semaglutide, and tirzepatide; along with healthy lifestyle changes, they can result in an 8% to 21% weight loss. Surgery (laparoscopic gastric sleeve gastrectomy, Roux-en-Y gastric bypass) results in weight loss of 25% to 30% at 12 months. https://lnkd.in/etKN2FKp

A year in review: The field of obesity medicine in 20

"In patients treated with semaglutide, weight loss continued over 65 weeks and was sustained for up to 4 years." In addition to what appears to be cardiovascular protective effects from semaglutide before weigh loss even occurs, it's incredibly exciting to see these results as we know the recidivism rate in weight loss is extremely high. It also highlights the importance of combining GLP medication with intensive lifestyle interventions for optimal outcomes. This SELECT trial had a lower average weight loss (mean 10.2% at 208 weeks) than the STEP trials (mean 14.9% at 68 weeks) which is likely due to the lifestyle interventions (caloric restriction and exercises) that were required of the participants in STEP. As the pioneer of comprehensive obesity treatment, Calibrate continues to expand access to obesity care through our commercial program. Our proven results combine our lifestyle intervention, accountability coaching, and medication as a tool, not the entire treatment, as part of a larger, comprehensive approach to weight management to ensure that the right members are getting the right treatments at the right time for sustainable results. https://lnkd.in/gM-2xmaK

Irritable bowel syndrome (IBS) affects an estimated 5-10% of the global population and 10-15% of American adults. This condition, more commonly diagnosed in women, stems from a complex interaction between the brain, gut, and nervous system, leading to symptoms like abdominal pain, bloating, diarrhea, and constipation. IBS's impact varies widely, from mild inconvenience to severe debilitation, significantly affecting emotional, social, and professional life. Despite the high prevalence of IBS, which accounts for 20-40% of gastroenterologist visits, many do not seek medical care, with only 2.4 to 3.5 million annual visits in the U.S. While treatments are available, their effectiveness varies, highlighting the need for personalized approaches. Recent studies underscore the potential of dietary modifications over medications. Research published in The Lancet Gastroenterology & Hepatology from Sahlgrenska University Hospital, Sweden, compared dietary treatments to medication. The findings suggest that a low FODMAP diet, which limits certain carbohydrates that trigger digestive symptoms, might be particularly effective. After a 4-week treatment period, 76% of participants on a low FODMAP diet reported significant symptom relief, compared to 71% on a low-carb, high-protein diet and 58% on medication. The study emphasized the importance of diet in managing IBS and suggested continuing research into personalized treatment strategies. As the quest for effective IBS management continues, the focus remains on understanding individual dietary triggers and developing tailored interventions to improve the quality of life for those affected. https://lnkd.in/e8Q7EbhX

🧑⚕️💉 ɴᴇᴡ ᴏʙᴇꜱɪᴛʏ ᴛʀᴇᴀᴛᴍᴇɴᴛꜱ ᴄᴏᴜʟᴅ ꜱᴘᴇᴇᴅ ᴜᴘ ᴍᴇᴛᴀʙᴏʟɪꜱᴍ, ꜰɪɴᴅꜱ ᴄʟɪɴɪᴄᴀʟ ᴛʀɪᴀʟ A new study at St. Vincent's University Hospital (SVUH) suggests that weight-loss medications such as Ozempic, Wegovy, or Monjaro may not just suppress appetite but also speed up metabolism. A randomised controlled trial led by Professor Donal O’Shea, SVUH and UCD School Of Medicine found a strong relationship between the amount of weight lost and increases in metabolic activity caused by daily use of medications based on the hormone Glucagon-like peptide-1 (GLP-1). The findings published in the Journal of the Obesity Society challenge the belief that recent weight loss medications work just by simply causing those who use them to eat less. “It always seemed oversimplistic to me that these new treatments were just making people eat less,” said Professor O’Shea. “So, this study finding is an exciting step forward in our understanding of how these new medicines for obesity work.” Adding: “This study challenges the main narrative about these newer treatments which is that they simply make you eat less, and that any action on energy burn is minimal. “The findings also provide science to support the fact that the treatment of obesity is not simply to eat less and move more – that’s the prevention piece – treatment is more complex than that.” In the randomised controlled trial, which involved 30 patients, those who had low metabolic activity before starting treatment benefited the most from medications such as Ozempic, Wegovy and Monjaro. The patients had specialised imaging of the fat within their abdomen using a PET-CT scanner, with scans carried out before and after six months of treatment. The results showed a strong correlation between increased metabolic activity and the degree of weight loss. Furthermore, those with low metabolic activity before starting treatment benefited the most from it. “The strength of the association is surprising given the relatively small numbers studied and suggests this increase in metabolic activity is a significant contributor to how these drugs work,” said Professor O’Shea. “Safe medical treatment for obesity is still in its infancy and we need to understand fully how the treatment works. Understanding how these agents increase energy burn should be an important part of future research. “I hope the companies involved in the development of these treatments will examine this area in more detail because these are very expensive studies to carry out and we are very grateful to the Health Research Board and University College Dublin for supporting it.” The study ‘GLP‐1 therapy increases visceral adipose tissue metabolic activity: lessons from a randomised controlled trial in obstructive sleep apnea’ was co-authored by Professor Silke Ryan, SVUH, funded by the Health Research Board (HRB) and supported by University College Dublin.

A common lipid profile seen in patients with obesity: ⬆️ TG, ⬇️ HDL-C, ⬆️ apo B, ⬆️ LDL-C, an effect of adiposopathy (dysfunctional adipocytes) associated with increased ASCVD risk. Recognizing the importance of treating BOTH obesity and dyslipidemia, Obesity Medicine Association and the National Lipid Association have published this joint expert review. #obesitymedicine #obesitytreatment #collaboration

Yours truly at twenty30 health writes at MedCity News on ‘Why GLP-1s Alone Cannot Solve the Obesity Crisis.’ I begin that ‘…Any siloed approach to weight loss – whether it’s medication, behavioral changes, or surgery – is not the answer…’ and go on to promote ‘…a multimodal and holistic approach… [to] …keep the weight off and support a person’s overall health.’ I wholeheartedly support GLP-1s and applaud their development, as a bariatric surgeon and PhD scientist. A new lens understands obesity as a disease, not as a character flaw. We must offer people with obesity ‘…a range of suitable treatments as well: behavioral, nutrition, exercise, medication and surgery, through a coordinated and holistic approach under one roof, with a care coordinator.’ And this aligns so well with cancer care, as a useful model – obesity ‘…is a sophisticated disease and it needs a comprehensive and ongoing treatment model. GLP-1s may be part of that equation, but they, alone, cannot solve the problem.’ https://lnkd.in/eEbMBE7N

Thrilled to share our latest publication "Gut-Derived Peptide Hormone Analogues and Potential Treatment of Bone Disorders in Obesity and Diabetes Mellitus" 📝 In this review, we delve into the intricate relationship between obesity, diabetes, and bone health, highlighting the alarming rise in bone fracture risk associated with these metabolic disorders, independent of bone mineral density effects. 💡 What's truly fascinating is the promising role of gastrointestinal (GIT)-derived peptide hormones and their analogues in promoting bone remodelling and microarchitecture, thus reducing fracture risk. Specifically, incretin peptides like GLP-1, GIP, and GLP-2 exhibit significant benefits on bone metabolism. 🔍 Curious to learn more? Dive into the full article here: [https://lnkd.in/e--HHk3r] Big shoutout to my supervisor for their invaluable insights! Peter Flatt and Nigel Irwin Doctoral College, Ulster University #BoneHealth #Obesity #Diabetes #MetabolicDisorders #ResearchPublication

I want to share a recently published paper on the evidence of GLP-1 receptor agonist use for the management of obesity in practice. It highlights the importance of an adequate patient preparation and optimisation before the start of the GLP-1 receptor agonist therapy for ensuring the longer-term benefits of the treatment. It is an important role of healthcare professionals to ensure that the patient is aware of the potential side-effects and the importance of a holistic approach for obesity management. Moreover, health professionals should consider an increased risk of shame and negative judgment towards the weight loss medication and surgery that their patients may experience and be sensitive about it, as a wrongly used term may negatively affect the patient and cause more harm than good. https://lnkd.in/ek4SKGCM