What is the future of obesity care? | Melanie Jay, MD, MS | TEDxNYU Langone Health

Key Concepts:

• Obesity as a disease: Recognizing obesity as a chronic disease with genetic and environmental factors.
• Weight set point: The brain's regulation of weight, making weight loss challenging.
• GLP-1 receptor agonists: Medications like semaglutide and tirzepatide that signal satiety to the brain.
• Obesity stigma: Negative attitudes and discrimination towards individuals with obesity.
• Access disparities: Unequal access to obesity care based on socioeconomic status.
• Miracle moment: A transformational period with opportunities for significant progress in obesity care.

1. The Obesity Care Landscape Before 2023

• Prior to 2023, obesity research was primarily confined to academic journals, limiting its reach to patients and the public.
• Bariatric surgery was the most effective treatment, involving stomach reduction and intestinal shortening.
• The prevailing belief was that obesity resulted from a lack of motivation to eat less and exercise more, leading to negative attitudes towards individuals with larger bodies.
• Example: The case of a woman in the ER in 2003, whose obesity complicated her diagnosis and care, highlighting the impact of weight stigma in healthcare.

2. Obesity as a Disease: Genetics, Environment, and the Brain

• Obesity is now recognized as a disease influenced by genetics (as heritable as height) and environmental factors.
• Environmental factors include food deserts, lack of safe spaces for physical activity, stress, medications, and pollution, disproportionately affecting vulnerable communities.
• Obesity can impact almost every organ system in the body, causing various medical complications.
• The brain regulates weight like a thermostat, creating a weight set point. When attempting weight loss, hunger hormones increase, and calorie burning decreases, leading to weight regain.

3. The Role of GLP-1 Receptor Agonists

• New medications containing GLP-1 receptor agonists (e.g., semaglutide, tirzepatide, Wegovy, Ozempic, Zepbound) signal to the brain that we aren't hungry, allowing people to maintain a lower weight set point.
• Example: The speaker's sister, Lauren, experienced significant improvements in weight, blood pressure, glucose levels, and back pain with semaglutide, alongside psychiatric medication.

4. Challenges and Disparities in Accessing Obesity Care

• Over 60% of people stop taking obesity care medications within a year, often due to high costs (over $500/month) not covered by insurance.
• Other reasons for discontinuation include the need for more support in managing lifestyle changes and side effects like nausea, vomiting, and constipation.
• Example: The speaker's patient, Jose, could no longer tolerate semaglutide due to dietary changes after an injury.
• Patients may discontinue medication once they lose weight, not recognizing obesity as a chronic disease, leading to weight regain.
• Significant disparities exist in access to obesity care, with affluent individuals able to afford medications while vulnerable patients cannot.
• The celebration of ideal body types in media has led to dangerous counterfeit drugs, bogus herbal supplements, and unregulated compounding pharmacies.

5. Obesity Stigma and its Impact

• Over 60% of people with obesity report experiencing stigma in healthcare, leading to avoidance of medical care.
• Example: Lauren, the speaker's sister, is frequently told she should have lost weight "the natural way," highlighting the persistence of obesity stigma.
• The speaker argues that we don't apply the same logic to other chronic diseases like diabetes, where medication is considered essential.

6. A Miracle Moment for Obesity Care

• Despite the challenges, the speaker now believes we are in a "miracle moment" for obesity care.
• For the first time, patients can achieve better health outcomes, prevent diabetes and heart attacks, and improve liver, kidney, and sleep apnea.
• New medications are being developed, offering more options and benefits.
• Stories like Lauren's are changing perceptions, recognizing obesity as a disease, not a lack of willpower.

7. Call to Action: Three Key Steps

• Fund obesity research: More research is needed to improve treatment and prevention strategies.
• Improve access to obesity care: Ensure access to lifestyle interventions, medications, and surgery for all patients who need it.
• End obesity stigma: Treat obesity like the chronic disease that it is.

8. Conclusion

• Miracle moments are transformational opportunities to solve difficult problems.
• The speaker initially hesitated to call it a miracle moment but now believes it is, urging everyone to seize this moment to transform obesity care.