Josefa García Barrado
Full Professor of Pharmacology and researcher in the Neuroendocrinology and Obesity group at the University of Salamanca
Is the study of good quality?
“This is a thorough study that presents the design of an algorithm to assist medical professionals in establishing pharmacological treatment for people suffering from obesity. It is endorsed by the European Association for the Study of Obesity. The study is of very good quality, published in a journal of the highest prestige in the scientific field, such as Nature Medicine. The authors are renowned researchers and clinicians, and although most declare that they have no conflicts of interest, their scientific reputation fully supports the design of the algorithm they developed.”
What new information does it offer compared to previous research?
“Currently, obesity treatment is complex because it is a multifactorial disease that requires body weight control and involves many factors, both pathophysiological and emotional. Currently, there are approved medications, especially those that act as GLP-1 and/or GIP agonists, that achieve significant body weight reduction (more than 10%), compared to placebo.
This study can be of great help to healthcare professionals. In particular, it analyzes the advantages and limitations of each of these drugs on obesity and type 2 diabetes and the comorbidities associated with them, and establishes the best indications in each case.”
What limitations does it have?
“In the treatment of obesity, there is a non-pharmacological aspect necessary to achieve weight loss goals. Furthermore, the physician and his or her clinical judgment are best placed to establish treatment for each patient. Algorithms only help support some therapeutic decisions. This study is exhaustive, although in analyzing these medications, the authors clarify that they were based on the treatment of individual complications and state that their therapeutic potential is yet to be determined; that is, direct evidence for many conditions remains limited.”
What implications does this have for clinical practice?
"The study lays the groundwork for regulatory agencies such as the US Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the Spanish Agency for Medicines and Health Products (AEMPS) to modify their therapeutic positions on the treatment of obesity with or without complications and on the treatment of type 2 diabetes with or without complications.
It should be noted that these treatments are expensive and often have limited coverage, making them less affordable for many people. Specifically, in Spain, funding from the National Health System does not cover treatment with tirzepatide, and the indications for semaglutide are very limited".