Robert Kushner, MD: Why Aren't Weight Loss Agents Reaching Patients With Obesity?

According to Robert F. Kushner, MD, Professor of Medicine at Northwestern University Feinberg School of Medicine, the global "diabesity" epidemic is in large part due to the fact that a high proportion of patients with diabetes also suffer from obesity.

"It really doesn't make sense to treat diabetes, get the blood sugar down, and not pay attention to the other cause and effect--which is diabetes," he explained in an interview. "We are on the verge of having very powerful medications that are emerging for treatment of both diabetes and obesity combined, and trizepatide is one example of that combined treatment."

Kushner addressed this at the Pri-Med Midwest 2022 Conference in his presentation "Weight Matters: Refocusing Diabetes Care in People with Obesity". Primary Care Physicians (PCPs) are often on the frontlines of obesity management but their ability in providing optimal comprehensive long-term care for these patients can be inhibited by a variety of factors.

Unfortunately, biases surrounding individuals with obesity can impact clinical judgement. Kushner shared expert insight on how PCPs can shift their approach to obesity as a chronic illness with evidence based strategies, and by addressing the intrinsic and extrinsic biases that can negatively affect the provider-patient relationship.

Additionally, the emergence of treatment options for this particular population with diabetes and obesity is anticipated to allow PCPs and specialists to expand their armamentarium and a better understanding of what to expect from new therapies and weight loss agents.

One of the things he's excited about in the coming year, is the development of more medication options like tirzepatide and semaglutide 2.4 mg among others. However, he's predominantly looking forward to the acknowledgment and progress around clinical obesity treatment.

Despite the benefits that these therapies offer in areas like primary care, cardiology, endocrinology, obstetrics and gynecology, the uptake in use of the medications is extremely minimal.

"Currently in the United States, less than 2 or 3% of individuals with obesity—who are candidates for pharmacotherapy—actually receive a medication," Kushner emphasized. " So, unless these medications are adopted and used with patient care, they're going to sit on the shelf."

"We need to increase education, increase confidence and competence among primary care providers and specialists on how to treat, and how use these medications," he concluded.