Neha Pagidipati, MD: New Approaches in Obesity Management

In an interview with HCPLive, Neha Pagidipati, MD, Assistant Professor of Medicine, Duke University School of Medicine, discussed updates in obesity management and her talk of the same name at the 30th Beaumont Annual Cardiovascular Conference at Beaver Creek.

Pagidipati’s approach in the talk highlighted her own approach to weight management with patients who have obesity, as well as cardiometabolic risk factors. She outlined the approach with a focus on lifestyle management and then the potential for medications or bariatric surgery, as well as advocating for a low carbohydrate, low-salt Mediterranean diet.

“I kind of outline my approach to help patients adhere to that diet, help patients do increased aerobic activity, and then outline my approach to thinking about medication surgery,” Pagidipati said.

She further discussed knowing what to advocate for in a patient population undergoing lifestyle interventions, with further challenges in making a sustainable shift for patients in their diet. Pagidipati advocated for a slow, consistent change where patients make one action to bring themselves to a healthier diet.

Additionally, Pagidipati spoke to the low uptake of weight regulating medications, due to cost and lack of insurance coverage. Other medications with potential adverse events are harder to use in high risk cardiovascular risk patients.

She highlighted the newer agents such as GLP-1 receptor agonist semaglutide, as data show its lower dose is both safe and beneficial for patients with type 2 diabetes from a cardiovascular disease perspective.

“However, if we try to get for example 2.4 milligram dose semaglutide which leads to considerable weight loss, almost on the order of bariatric surgery, that is very difficult in my experience to get covered by insurance programs,” Pagidipati said. “It's so expensive. It's basically prohibitive to ask somebody to do it out of pocket.”

Pagidipati then spoke to low rates of referral for metabolic procedures for those who may be eligible for metabolic surgery. Although there are often varying degrees of efficacy, procedures like the roux-en-Y gastric bypass can lead to significant weight loss and can benefit those with type 2 diabetes, as they may be able to stop taking medications.

“Though it hasn't been tested prospectively for cardiovascular outcomes in a randomized manner, at least when we look at observational data across several cohorts, there seems to be a significant benefit not only in all cause mortality, but also in things like heart failure,” Pagidipati said.

As for the future, Pagidipati noted her excitement regarding the ongoing SELECT trial randomizing patients with obesity and CVD to placebo versus semaglutide 2.4mg dose.

“That's going to be really important not only to see what that does for the patients in terms of weight, but really what that does for cardiovascular outcomes,” she said. “Those are really exciting kinds of spaces where the field is going.”