There is no one-size-fits-all approach to treating people with obesity or who are overweight. According to specialists, the best choice of treatment involves a combined series of interventions based on lifestyle, through diet and an educational or more structured food plan such as the ketogenic diet, personalized physical activity, but also on use of pharmacological therapies. While surgical options should be reserved for severely obese people with significant medical comorbidities or physical conditions.
Over the years, pharmacotherapy has been the protagonist of an evolutionary process which, in some cases, has also suffered defeats. Currently, however, it is a valid and safe proposal, as the drugs used to treat obesity have nothing to do with those that caused a sensation years ago, such as amphetamines for example. Today they are controlled and safe and have a benefit profile for the patient in metabolic terms and, according to specialists, they also have an educational function for the patient. They work by primarily reducing appetite and have a protective metabolic effect on complications caused by obesity. What was underlined during the SIO Congress is that obesity is a pathology and has the right to its own pharmacological therapy, even as a first choice if the specialist deems it appropriate. Furthermore, drugs currently on the market contribute to a further improvement in obesity-related health risks.
Studies have revealed that adding medications typically improves short- and long-term weight loss compared to lifestyle modification alone. The best results, however, were achieved when the drugs were combined with an intensive lifestyle modification program. The two approaches may have synergistic effects where behavioral treatment appears to help obese individuals control the external environment, namely that related to food. While pharmacotherapy can control the internal environment by reducing hunger or nutrient absorption.
According to specialists, pharmacological treatment should be initiated immediately because changing one’s lifestyle is much more complex and takes a long time. However, obesity therapy must be individualized and factors such as: sex, degree of obesity, individual health risks, psychobehavioral and metabolic characteristics, and the outcome of previous weight loss attempts must be taken into consideration. In the not too distant future, an evaluation of the hormonal and genetic determinants of weight loss could also contribute to a better choice of individual therapy for obese people. Thanks to recent studies it is currently possible to treat obesity also thanks to new drugs. In recent years there has in fact been a turning point in the pharmacological treatment of the disease due to the encouraging results obtained with the use of semaglutide, a drug for the treatment of patients with type 2 diabetes capable of also inducing weight loss.
In Italy today, however, an innovative drug for the treatment of obesity and diabetes arrives on the market: tirzepatide, the first and only GIP and GLP-1 receptor agonist. This mechanism involves a significant weight reduction with improvement in cardiometabolic parameters, both in adult patients with obesity and in those who are overweight with at least one related comorbidity. For type 2 diabetes, the molecule has also demonstrated important results in the glycemic control of adult patients, with a
reduction in glycated hemoglobin and weight. The drug is available on the Italian market on medical prescription.
“Despite the progress made in recent years, obesity remains a very complex condition to deal with for health professionals and systems, with important cultural and healthcare deficiencies, due to its multifactorial nature, its chronic and progressive course, and the many associated clinical complications and, ultimately, to the difficulty in obtaining lasting results in reducing body weight”. Rocco Barazzoni, President of the SIO, Italian Society of Obesity, explained: “Today we are finally entering a new phase in the treatment of obesity, with a new pharmacological paradigm that will allow us not only to provide responses to care needs that have so far been largely unsatisfied, restoring time and quality of life for patients, but also to prevent the numerous associated pathologies in the long term and to reduce their dramatic impact today.”
