Anthony Auriemma, MD: A New Era of Obesity Management

The management of obesity is currently undergoing a transformation period, as new pharmacotherapy options and the expansion of the disease categorization may have forever shifted the care landscape.

In an interview with HCPLive, Anthony Auriemma, MD, Medical Director, Ascension Illinois Weight Loss Solutions, examined this paradigm shift from the perspective of cardiovascular comorbidities, medication efficacy, and the larger, more detailed role of stakeholders in the fight.

The surrounding factors or comorbidities related to obesity are often the reason behind morbidity and mortality in patients, from cardiovascular disease to diabetes, Auriemma noted. He explained that often, visceral fat is collected around organs, including the collection of epicardial fat linked to diastolic heart failure.

“A secondary way cardiovascular disease is affected by obesity is actually just the fat mass itself, the weight of the mass, so that leads to things like sleep apnea, we get all this extra tissue in the throat region,”  he continued. “Also, the increased risk of thromboembolic events from compression of the veins in the lower extremities.”

Auriemma went on to review the way new weight management agents have changed the treatment landscape, noting his excitement for the new advances in the field, including semaglutide. However, he noted the lack of cardiovascular outcome trials specifically for the treatment of obesity.

“I'm very hopeful that eventually, we will have cardiovascular outcome trials, showing that these medications do reduce the risk of cardiovascular disease in obesity, and that's going to be a game changer,” he said. “Because that's what we're trying to do. We're trying to reduce the most common cause of death for our patients with obesity, and that's cardiovascular disease.”

But, even given the efficacy of these new medications, Auriemma believes it short sighted to believe they will replace bariatric surgery or a more intense therapy for patients. Within the trials, Auriemma pointed out a high non-responder rate despite them being highly selected and motivated, meaning a larger percentage of people will not achieve at least 5% weight loss.

“I think actually these new therapies for treatment of obesity are going to heighten the need and the paradigm shift that obesity is a medical disease that requires professional intervention from healthcare providers,” he said. “I actually think in the long run, we will actually see more bariatric surgery because of these therapies, not less.”

Regarding the growing rates of obesity, he noted that there needs to be all hands on deck from stakeholders involved in obtaining a solution for obesity. Data show about 42% of the US population is overweight or has obesity.

Auriemma called to mind organizations and professional associations who led the way to combat smoking cessation, noting the all hands on deck solution did not only include health care providers.

“I think that's really what we're going to need to have the solution because even the greatest pharmacotherapy or the greatest surgery that comes out isn't going to prevent it for everyone,” he said.