Elena A Christofides, MD: Obesity Management in Type 2 Diabetes Patients

Elena A Christofides, MD

As the 2021 American Diabetes Association Virtual Meeting concludes, important conversations have taken place surrounding diabetes prevention and treatment, as well as the makeup of at-risk patient populations.

HCPLive recently spoke with Elena A. Christofides, MD, Endocrinology Associates, on her thoughts about semaglutide and what the FDA approval ultimately might represent for managing obesity and diabetes.

Check out part 2 of the interview below:

HCPLive: Since semaglutide was recently approved for chronic weight management, for people with one other weight-related condition, including type 2 diabetes, do you think that approval plays into this larger conversation on the relationship between those diabetes and obesity?

Dr. Christofides: Absolutely. So, you know, obesity is clearly a chronic disease. Obesity clearly has risk factors associated with the progression or the onset of obesity with diabetes, with vascular disease, hypertension, arthritis, et cetera. So there are clear relationships between weight and these comorbidities and we all are very clear that obesity is a chronic illness. The importance of the semaglutide approval really rests on the fact that it's the first time we've had drug management that could actually challenge the surgical paradigm.

Previously, so long as the medications were inadequate to normalizing body weight, then society and the medical world as a whole could continue to pretend like it was completely in the hands of the patient and completely self-induced and could avoid that conversation about weight management with medications until such time that somebody becomes so ill, that they can only do surgery. In which case, it becomes like a Hail Mary pass.

And there are entire mechanisms built into the healthcare system to prevent that from happening, prevent people from getting surgery, but then, you know, once you do that's, that's sort of like that's all you're supposed to ever do after that ever again. So having a drug that can actually challenge that paradigm in such a manner that is so safe and so well-accepted in the class that’s already been around for 16 years.

I think there's a really interesting paradigm shift and it's deliberate on Novo's part. I mean, they have said on the outside that they are trying to change this paradigm and force the conversation around the fact that we need to be more attentive to the different modalities of managing obesity for people. Surgery isn't the be all and end all for everybody, because it carries a high risk of surgical complications, morbidity, and death. And this isn't an appropriate option for a lot of people.

HCPLive: In your opinion, are these treatments the future of care, particularly in those higher risk populations and populations who may be more at risk of it due to things including environmental exposure?

Dr. Christofides: I think that they're the future of therapy for obesity before you get there. I mean, ideally the point would be to start managing obesity, before you get the comorbidities before or before the co-morbidities become so set in stone that you're just trying to pull them back from the precipice. And by all means, before you get to the severity that requires surgical intervention to correct.

HCPLive: Is there anything else you'd like to add surrounding the conversation?

Dr. Christofides: I think a fundamental issue with diabetes, cardiometabolic disease and obesity is that there is a fair amount of societal and clinical bias and fat shaming, diabetes shaming. And I think that there's a fundamental lack of education and understanding both in the medical community as well as in the public. And I think we need to have more conversations about the metabolic consequences of the environmental destruction, the medical destructions.

There's a lot of things that people do that actually contribute to obesity on the medical side. There's a lot of things that society does to contribute to obesity, but refuses to accept and acknowledge that component because it's something that they want. For example, we accept drunk driving as a consequence of drinking because we want to drink and we want alcohol.

And so if it's, if it's something that we deem desirous, then we're willing to accept the consequences and we believe that to be then self-induced. So, we want to have fast food options available to us because we're lazy or we don't cook, or we don't know how to cook, or we don't have the resources to cook, or we don't have the socio-economic fundamental mental health to do so, whatever the case may be, we have accepted fast food as a necessary part of our society. Therefore, we accept that obesity is self-induced because you are doing something for yourself that you know is wrong, and that is lazy inherently.

So, we accept all these consequences as a society. Then, we create bias around that, but there's a huge and fundamental failure to understand that there are large portions of the population who consume things that are bad for them, not out of willfulness, but out of either ignorance from an educational perspective, socioeconomic perspective, or simply access to resources and that is not something society is prepared to deal with.

I believe we are going to see a backlash against the obesity medication now that we have one that's really freaking amazing and impressive. I think you're going to see an interesting backlash amongst the medical community as a result, because the medical community is going to be absolutely unwilling to accept that their biases is what's keeping them from accepting the need for these therapies and that their bias is based on the fact that they're unwilling to accept societal ills as the origin point because they don't want to go back that far to fix it.