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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Obesity may have met its match in GLP-1 receptor agonists. However, the role of gastroenterologists in obesity management and the administration of this revolutionary class of drugs is complicated and has yet to be defined. \u201cGastroenterologists are on the front lines of the obesity epidemic,\u201d Andres Acosta, MD, PhD, associate professor of medicine and consultant in the division of gastroenterology and hepatology at Mayo Clinic and American Board of Obesity Medicine diplomate, told Healio. \u201cWe need GIs to embrace the disease and all of its impacts, including GERD, IBD, MASLD, fatty liver disease and obesity-related cancer risk.\u201d
Image: Andres Acosta, MD, PhD. Reprinted with permission.
Hepatologists and primary care providers can handle some of these downstream effects of obesity. They often do, shutting gastroenterologists out of the equation. \u201cIt is my overall impression that there still is not sufficient commitment or embrace of the idea among cardiologists, hepatologists, pulmonologists and others that there is this opportunity to treat obesity itself,\u201d Michael Camilleri, MD, DSc, consultant in the division of gastroenterology and hepatology at Mayo Clinic and professor of medicine, pharmacology and physiology at Mayo Clinic College of Medicine and Science, said in an interview. \u201cA couple years ago I was almost evicted from a meeting because I suggested that hepatologists should be treating obesity and not just abnormal liver enzymes,\u201d Camilleri said. Michael Camilleri There is growing recognition that gastroenterologists could play a larger role in obesity management, as well, largely because of GLP-1s. \u201cThere is this opportunity to embrace the pharmacology that is available with the FDA approval of GLP-1 receptor agonists,\u201d Camilleri added. As uptake of these medications expands, adverse events are sure to follow. Many of them, such as nausea, constipation, delayed gastric emptying and motility issues, are commonly managed by gastroenterologists. But because the medications are not always prescribed by gastroenterologists, they are often not involved in management of the side effects. Also up for discussion is where GLP-1s fit into wider weight loss paradigms, from diet and exercise to bariatric surgery and endoscopic sleeve gastroplasty. \u201cMany people who offer bariatric and metabolic procedures see this drug class as complimentary to procedural interventions,\u201d Marianna Papademetriou, MD, director of endoscopy and motility at Washington VA Medical Center and associate professor at Georgetown University School of Medicine, told Healio. \u201cWe are still learning how to best integrate drugs with procedures.\u201d The next concern is that more patients are turning to GLP-1s to manage obesity not by recommendation from their doctor, but as a result of direct-to-consumer advertising. \u201cThe digital and DTC platforms are certainly factors that risk fragmented oversight,\u201d Camilleri said. \u2018Truly frightening\u2019 For Sonali Paul, MD, MS, hepatologist and associate professor at University of Chicago Medicine, \u201cfragmented oversight\u201d with this class of drugs is an understatement. Sonali Paul \u201cThe rapidly growing companies that are doing digital or direct-to-consumer prescribing of GLP-1s is truly frightening,\u201d she said. \u201cFirst, these drugs are often compounded so there is a risk of contamination, inconsistent dosing and improper or unsafe formation. Additionally, often there is no virtual visit or visit with a doctor or nurse practitioner prior to prescribing. Some have only a questionnaire.\u201d Paul described a scenario in which a patient with an eating disorder who was severely malnourished was regularly prescribed GLP-1s for months without one consultation with a physician. \u201cGIs have a unique role in bringing structure and safety, but we cannot do it alone,\u201d she said. \u201cGiven the widespread use of GLP-1s across many medical specialties, we as a physician entity need to demand better safety and prescribing parameters.\u201d While Papademetriou acknowledged many of these concerns, she took a more measured view. \u201cThere are plusses and minuses to online health platforms,\u201d she said. \u201cOn the one hand, it is an effective way to improve access to care. On the other hand, many online platforms are zoomed in on the prescribing of weight management medications, and do not necessarily tailor that management to the patient\u2019s overall medical issues.\u201d Marianna Papademetriou For example, a patient with a history of erosive esophagitis and GERD who begins taking a GLP-1 may experience an escalation of symptoms that previously had been under control, according to Papademetriou. \u201cThe platforms do not appear to have the capability to work through that issue with a patient,\u201d she said. The complications only get more complicated from there. \u201cThat patient may go back to their PCP or their gastroenterologist, and the GLP-1 is not on their medication list, or the patient may feel stigmatized about bringing up their use of GLP-1s,\u201d Papademetriou said. \u201cTheir physician is now trying to work through this sudden change of symptoms without having the full picture. That could lead to unnecessary procedures or medication changes that could be avoided with better integrated care.\u201d But there is a solution to this particular issue, according to Papademetriou. \u201cWe need to do a better job of improving access to these drugs through conventional medical pathways, and we need to reduce the stigma around these conversations with our patients,\u201d she said. \u201cMany people probably assume that people utilize telehealth for weight management for the ease and convenience,\u201d Papademetriou continued. \u201cBut I suspect a significant part of the demand for this is also the bias people experience with conversations surrounding weight in the medical setting.\u201d Whether that bias will decrease with more direct-to-consumer advertising and more patients taking GLP-1s remains to be seen. What is certain is that these patients are likely to experience gastrointestinal-related adverse events commonly reported with these medications. \u2018Significant impact\u2019 Patients experiencing side effects of these drugs, including nausea, vomiting, diarrhea and constipation, are<\/p>\n","protected":false},"author":1,"featured_media":2396,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2395","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/2395","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2395"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/2395\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/2396"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2395"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2395"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2395"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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