Rajesh Aggarwal MD PhD FRCS FACS’ Post

Management of obesity in cardiovascular practice

COMBINATION THERAPY FOR OBESITY MANAGEMENT- MAKES SENSE AND IS ANYTHING BUT NOVEL. Why do I say that? *obesity "by definition" is chronic and progressive, and so like other chronic diseases, will eventually require an intensification of therapy *foundations for obesity management = lifestyle interventions PLUS adjunct therapy (could include a combination of VLED, AOM & MBS) *we presented at IFSO London 2018, the first Australian experience: "addition of liraglutide to the management of people who had undergone bariatric surgery and either (i) sub-optimal initial response to metabolic bariatric surgery [MBS] OR (ii) late post-operative clinical deterioration after MBS" [NB: these are the updated terms as per IFSO Naples meeting, 2023] *however we weren't the first. At the time there were a handful of other studies utilising various other anti-obesity medications [AOMs] in similar cohorts eg Stanford SOARD 2017 *over the years the plethora of real-world data and a few RCTs (eg , Miras Lancet Diab & Endo 2019) has added further gravitas to this *the Australian National Obesity Strategy 2022, encourages HCPs to be proactive in managing obesity, and to manage relapses in a timely fashion. *for this to occur, the treating clinician & the patient need to collaboratively develop an "ACTION plan", empowering the patient to develop self-efficacy, but also clearly indicating "when" and "how" to reach out for external HCP support which might also include intensification of therapy

The European Association for the Study of Obesity recently released a new framework for the diagnosis and management of obesity. Form Health Chief Medical Officer, Florencia Halperin, explains how this framework aligns with Form's comprehensive approach to obesity treatment. This new framework underscores the importance of a thorough medical evaluation and individualized treatment plans, which is at exactly how we provide care at Form Health. Want to learn more about our science-based, individualized approach? Reach out to employers@formhealth.co.

Excited to share my another latest ASHP (American Society of Health-System Pharmacists) certification in "Clinical Case Studies: Best Practices for Pharmacotherapy in Obesity!" Our journey into the depths of obesity management was not just insightful but transformative. Let's dive into the details together! Obesity is chronic, relapsing, multifactorial neurobehavioural disease. Increase in body fat leads to adipose tissue dysfunction resulting in advance metabolic, biomechanical and psychosocial health consequences. Pharmacotherapy emerges as a pivotal tool in managing obesity, with a variety of medications tailored to individual needs. From Orlistat to the groundbreaking Semaglutide and Tirzepatide, each medication brings unique benefits and considerations to the forefront. Since this is a chronic disease, long-term adherence to therapy is essential. The efficacy for weight loss while choosing glucose lowering agent is very high in case of Semaglutide and Tirzepatide. Semaglutide shines not only in weight loss efficacy but also in its remarkable cardiovascular advantages, making it a compelling choice in clinical practice. Additionally, Dulaglutide demonstrates promising potential in enhancing cardiovascular health too, while Tirzepatide remains under study, offering exciting prospects for future treatments. The webinar also highlighted the importance of individualizing treatment plans, considering factors such as cost, potential drug interactions, and cardiovascular benefits. Moreover, insights were shared on optimizing medication combinations, dosage adjustments, and monitoring for adverse effects. It's crucial to navigate through the complexities of treatment options with precision, ensuring optimal patient outcomes and long-term success in combating obesity. Continuing to stay informed and updated on advancements in pharmacotherapy for obesity management ensures the best possible care for patients. Here's to empowering healthier futures together! 🤝🏼 #ASHPWebinar #ObesityManagement #Pharmacotherapy #Weightloss #ClinicalCaseStudies #AmericanSocietyofHealthsystemPharmacists

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

Massive Pulmonary Embolism as the Initial Presentation of Acromegaly: Is Acromegaly a Hypercoagulable Condition? https://lnkd.in/eNE6SyFF The clinical presentation in acromegaly is usually insidious, with headaches or visual disturbances being the most common symptoms. Previous studies have shown higher fibrinogen levels, lower protein C and S ac- tivity values, and enhanced platelet function in patients with acromegaly compared to a normal population. Nevertheless, the link between hypercoagulability and acromegaly is often overlooked and rarely reported in the literature. Case Report: We report a case of a young man with a massive pulmonary embolism as the initial presentation of acromegaly. Extensive workup excluded other causes of thrombophilia. Furthermore, the diagnosis of acromegaly was con- firmed by the patient’s clinical features as well as laboratory and radiological testing. A literature review on the link between hypercoagulability and acromegaly was performed. Conclusions: This case report shed light on hypercoagulability as an under-recognized serious complication of acromegaly and paves the road for future studies on this topic (PDF) Massive Pulmonary Embolism as the Initial Presentation of Acromegaly: Is Acromegaly a Hypercoagulable Condition?. Available from: https://lnkd.in/eNE6SyFF [accessed Apr 01 2024]. This author has reported on Acromegaly (giantism) since Q1 2020 that Growth Hormone (GH) blocks formation of 25(OH)D3 competitively and in doing so facilitates high levels of fibrinogen. The journal article cited here also found elevated fibrinogen. Acromegaly is not taken seriously enough except perhaps by basketball scouts looking for very tall BB players. Close friends of this author, physicians themselves, have died prior to age 50 years for fairly obvious reasons-low D3 and high fibrinogen. Calcitriol supplementation appears to be the obvious answer. GH blockers could also improve the clinical course of this endocrine disaster. #acromegaly #giantism #GH #growth hormone #fibrinogen #vitaminddeficiency #D3_up! #calcitriol supplementation

🚀 Advancing Obesity Treatment Research 🚀 We are pleased to share important advancements in obesity management, guided by the expertise of our Chief Medical Officer Thomas Forst, Prof. Dr., Head of Medical Affairs Dr. Sara Armani, and Clinical Investigator Dr. med. Maria Marinez. Their recent research explores incretin-based therapies, including GLP-1 receptor agonists, which are showing promise in supporting weight loss and overall health improvement! 🌟 Key Insights from the Research: Significant Weight Loss: Patients achieved a 6% to 21% reduction in body weight, with many losing over 10%. Health Benefits: These treatments may help reduce cardiovascular risks, prevent diabetes, aid liver health, and support weight maintenance after surgery. Innovation in Progress: With dual and triple co-agonists under development, we are dedicated to evaluating these emerging therapies. While these treatments offer substantial potential, challenges such as cost, potential weight re-gain, and side effects still need further exploration. Our team remains committed to developing more effective treatments to combat obesity and enhance patient care worldwide. 🙌 🌍 Read the full study here: https://lnkd.in/ehg_a-xB #ObesityResearch #IncretinTherapies #GLP1 #CRS #WeightManagement #HealthInnovation #PatientCare

Could Ozempic delay ageing? 🤔 New research suggests that Ozempic, a drug used for Type 2 diabetes and obesity, might also help slow down ageing. Researchers found that the drug could be used to treat a wide range of illnesses linked to heart failure, arthritis, Alzheimer's and even cancer. In a study of 17,600 people, those on Ozempic had lower death rates from various causes, including cardiovascular issues and COVID-19. While promising, this potential breakthrough still requires careful medical supervision. Could this be a game-changer for health and longevity? PS: If you found this insightful, share it with your network ♻️ BBC article: https://lnkd.in/eYtR6CHM #HealthResearch #Ageing #Ozempic #Longevity

People who use semaglutide, such as Ozempic or Wegovy, frequently experience significant weight loss, which results in both fat and muscle loss. The fat mass/lean mass ratio has a positive relationship with knee osteoarthritis. Thus, the effect of semaglutide on OA in obese patients remained uncertain. In our recent article published in Obesity Science and Practice,  an official journal of World Obesity (WO) and The Obesity Society (TOS), after controlling for demographic and clinical variables, semaglutide use (regardless of the medication) was associated with a 16% early reduction in the risk of OA (first 6 to 8 months), but there was no significant effect on OA with prolonged use. Being just ten pounds overweight increases the force on the knee by 30-60 pounds every step. However, muscle loss induced by significant weight loss experienced by semaglutide users may lessen the favorable effect on the risk of developing OA.  You can access our published article via this link: https://lnkd.in/d8zf_eNk #Semaglutide #Osteoarthritis #WeightLoss #MuscleLoss #MedicalResearch