After more than 5,000 attendees traveled by car, train, bus and plane to Boston for Obesity Week in November, 2014 ended with a bang. The breadth of this meeting — which featured over 100 sessions scheduled across dozens of hours — combined with the presence of many expert researchers, practitioners and advocates made Obesity Week not just a space for comprehensive review, but also an opportunity for creative synthesis.
This meeting at the end of 2014 signals what is to come for obesity research in 2015. Here is a list of what the sessions and chatter at the conference suggest we look out for in the new year.
- We’re treating people, not a disease.
- Get ready for a breakout year in public policy.
- Combination therapies show the most promise.
- There’s a gut feeling.
- A pivotal year for pricing.
- A step away from obesity toward obesities.
- Labeling obesity as a disease is supporting a paradigm shift.
- More tools in the toolbox.
- Innovation may come from the unlikeliest of places.
- Who are our treatments reaching and who is our research helping?
Motivated by decades of first-person accounts and compelling research, several obesity-focused organizations banded together to launch a campaign supporting “People-First Language for Obesity.” Led by the Obesity Action Coalition, the campaign calls upon practitioners to use the term “people with obesity” rather than “obese people.” While this paradigm is not currently the norm, its prominent display during the conference indicates that 2015 will be a transitional year for use of language in the field.
Although 2014 was an important time for policymaking — Mexico successfully implemented a soda tax and the U.S. Department of Agriculture (USDA) released an interim rule on healthy snacks in schools — Obesity Week heralded the beginning of a breakout year.
Not only did multiple presentations comment on the strategies and early results of these policies, but many speakers told us to look out for implementation of major policies in 2015. Chief among these is the passing of a soda tax in the city of Berkeley, California. Furthermore, the FDA is expected to release an updated food label and final rule on restaurant menu calorie counts.
To many researchers, these new policies will make 2015 about tipping a mixed evidence base. For many providers, the realization of more impactful policies this year will continue shifting the existing environment that patients go home to.
A number of sessions extolled the potential of combination drug therapies. Moving beyond the already approved medications, such as phentermine/topiramate (Qsymia, Vivus) and naltrexone/bupropion (Contrave, Takeda Pharmaceuticals), Arena Pharmaceuticals and Eisai presented a paper on combination lorcaserin/phentermine.
Not only do medical treatments benefit from combinations, but public health policies do better in layers as well. At the meeting, Steven L. Gortmaker, PhD, of the Harvard School of Public Health, presented early findings from the CHOICES study that investigated the relative cost-effectiveness and additive effects of many different public policies.
Finally, Carel Le Roux, PhD, of Imperial College London, reminded conference attendees about the search for the “medical bypass” — combinations of therapies and interventions that can approximate the effect of highly potent gastrointestinal bypass surgeries. Combinations are likely to continue capturing our attention well into 2015.
Perhaps one avenue for a successful medical bypass lies in the role gut microbiota play in bypass surgeries. Lee Kaplan, MD, PhD, of Massachusetts General Hospital, presented more fascinating findings in this field of inquiry, revealing at Obesity Week 2014 that the microbiome’s composition following surgery does not flow from an obese-profile to a nonobese-profile so much as it moves from an obese-profile to an altogether different state of equilibrium. This combined with Dr. Kaplan’s research on post-surgery fecal transplants promises the presentation of further trailblazing research as a fertile ground for intervention in 2015.
With many more pharmacotherapies approved by the FDA, the developing conversation on treatment strategies partially centers on drug pricing comparisons and insurance coverage. In response to the relatively high price of Qsymia (phentermine/topiramate), at least one conference speaker told attendees that he prescribes generic combination therapies in the place of approved, but expensive, versions of anti-obesity agents. However, in another session, Scott Kahan, MD, MPH, of Johns Hopkins University, argued that Contrave (naltrexone/bupropion) is priced favorably relative to other approved combination therapies.
A second conversation concerns the open question of whether insurance plans and public policies will cover these prescriptions. Both themes will heavily influence what treatments are perceived as accessible, as well as how far drug companies are willing to go to reach a larger patient population.
Talks on divergent surgery outcomes, drug efficacy, behavioral interventions and local policies at Obesity Week continue to direct our attention toward what Dr. Le Roux called the goal of “personalized care,” or the movement disposing of a one-size-fits-all approach to obesity therapy in favor of studying and applying what therapies work for which patients. While he focused his remarks on performing responder analyses on the SCALE trial for Novo Nordisk’s Saxenda (liraglutide), 2015 will likely continue the momentum in this direction.
The dust has settled since the American Medical Association’s resolution recognizing obesity as a disease. Speakers at Obesity Week frequently demonstrated how the growing acceptance of obesity as a chronic disease is shifting care algorithms toward a complications-centric model, and institutional advocacy toward reconfiguring how obesity is handled in medical education. As algorithms crystallize, medical schools take notice, and the American Board of Obesity Medicine certifies more providers, 2015 may be a coalescing year for the standard of care.
As year-end conferences go, Obesity Week did not disappoint with a wide array of sessions that showcased the latest in treatment and intervention. Zafgen presented results showing significant weight loss in its phase 2 trials for its anti-obesity injectable beloranib. Stacy Brethauer, MD, of the Cleveland Clinic, also summarized the growing field of novel endoluminal devices. Additionally, not long after the conference, Novo Nordisk’s injectable, liraglutide, gained FDA approval for chronic weight management.
With the growing number of tools in our toolbox, it’s possible that Obesity Week 2015 will be among the last conferences in which providers and researchers wring their hands at the dearth of treatment options.
A hodgepodge of sessions at Obesity Week showed us that innovation can take root beyond the boundaries of the field. In particular, two talks by Kristina Lewis, MD, MPH, SM, of Kaiser Permanente, showcased creative practices that could be applied to obesity. Her first talk drew on the advent of personal shoppers in the retail fashion industry. Researchers conducted a pilot intervention applying this concept to nutrition advice dispensed by dietitians in grocery stores. Her next talk made a compelling case for applying a cap-and-trade policy to added sugars. As researchers look for more treatment options, expect the notion of “thinking outside the box” to gain attention in 2015.
In a keynote address to Obesity Week attendees, James S. Marks, MD, MPH, of the Robert Wood Johnson Foundation, challenged us to consider who our treatments are reaching. While obesity prevalence is plateauing, or even declining in some groups, rates are worsening among low-income populations and minorities.
In terms of research methods, Sara Bleich, PhD, of Johns Hopkins Bloomberg School of Public Health, implored investigators to step outside the lab to bring their research methods directly to communities. With an eye on disparities in care growing keener and with the increasing availability of treatments, 2015 will be a crucial year to bring this wealth of knowledge and care to the communities that need it most.
Rajiv Narayan recently completed an MSc in Medical Anthropology at the University of Oxford as a Rotary Ambassadorial Scholar. He entered the obesity field after losing 100 lbs. himself.