By Kevin Grove, PhD, Scientific Vice President, Global Drug Discovery, Novo Nordisk
More than 40 percent of Americans live with obesity today – many of our friends, family and loved ones. Our black and Hispanic communities are disproportionately affected, and rates continue to rise. Yet despite decades of evolving research showing us obesity is a chronic disease, it remains largely misunderstood, undertreated, and underdiagnosed. It’s time to change that.
Weight is not simply a matter of willpower – obesity is influenced by our biology, genetics, and the environment. It is also strongly linked to more than 60 other serious health conditions, including severe illness and hospitalization due to COVID-19. Now more than ever, there is a pressing need for us to collaborate across industries, communities, and sectors to change the narrative around weight and health and focus on long-term, sustainable solutions. Together, we can work towards making respect, support and care a reality for people who live with obesity.
Further, obesity has proven to be an incredibly difficult disease to “solve” – with challenges including deep-seated stigma, as well as significant personal, healthcare, and economic impacts. Unfortunately, many people with obesity self-assign the burden of blame. While there have been positive cultural developments in recent years and we are now more inclusive and accepting as a society, we are still not having open and honest conversations about weight. The stereotypes of obesity perpetuated by consumers, media and even healthcare professionals have compounded the challenges of the disease, which is often seen as a lifestyle issue. It is time to lift the burden off people living with this disease and start addressing obesity as we would with any other chronic disease.
There are some fundamental problems that are impeding this process from happening. First and foremost, unlike other diseases such as cancer or heart disease, there is no healthcare specialty to manage obesity. Doctors, in general, are not specifically trained on how to treat it and the people who live with obesity have limited access to the few treatment options that are available. In fact, one of the more troubling aspects of obesity is that only about 10 percent of people in the U.S. seek help from a medical professional – perhaps due to shame associated with the condition or the defeated feeling that there is nothing to be done.
Further, there is a lack of understanding and recognition of the scientific evidence that shows that obesity is largely influenced by genetics and biology, with lifestyle choices representing only a small piece of the picture. With obesity, a person’s hormones and metabolism are out of balance. The body wants to have more fat than is healthy which causes increased hunger. Contrary to popular belief, the science around obesity shows that while consuming too many calories does lead to the weight gain associated with obesity, the overeating is not due to lack of will-power, but secondary to changes in the drive to eat.
Another obstacle is that many healthcare professionals lack the tools needed to truly understand patients early in their course of disease and to detect underlying causes. Markers such as blood lipids, blood sugars and insulin, weight and BMI are pillars of determining management of obesity, but these do not tend to get to the underlying cause of obesity itself. This means that healthcare professionals cannot properly and consistently discern whether a person is developing obesity because of a biological imbalance that is driving an increase in appetite, or if there’s a psychosocial or environmental issue driving the person to use food as a comfort.
To achieve complete care for patients, we need to truly understand their environment, genetics, and biology. The old “eat less, move more” advice for patients is outdated and does not align with the science. For appropriate patients, weight-loss surgery or medicines may be an option. There are also other options such as nutritional counseling and behavior therapy. Regardless of the journey, it is imperative that we start creating an environment where people are not afraid to ask for help and there is an open and ongoing dialogue between patients and physicians. A strong argument should be made for the fact that this discussion should start before an individual becomes a patient.
The Future of Care
Fortunately, science is making promising headway. I am proud to be a part of the Novo Nordisk research center in Seattle, as well as a larger global organization, that is driving a paradigm shift for the future of obesity treatment. The obesity research team is working to identify underlying risk factors and the biologic root causes and factors contributing to obesity or susceptibility to it, to better understand and formulate early intervention capabilities that will allow individuals to be treated before they develop severe complications.
Looking ahead there is much to be hopeful about as we work toward more meaningful, integrative solutions. We are already finding ways to better understand patients’ real-world behaviors, so disease management and treatment approaches can meet them where they truly are. We are forging strategic collaborations and information-sharing partnerships within industry, academia, and global health organizations to ensure synergies and cohesion in our shared fight against obesity.
This involves a focus on a developing a wholly integrative approach that goes “beyond the pill” to address obesity as a chronic disease – including consideration for individual patients and their unique circumstances and health, customization of treatment paradigms, the importance of a well-rounded healthcare team, managing expectations and short- versus long-term outcomes and goals, and looking beyond weight loss while maximizing health.
When it comes to obesity, we know that when we maximize weight loss, we can maximize improving health outcomes – but we also now know that focusing on weight loss alone is not sufficient. Rather, it’s about maximizing health and treating obesity holistically. With that in mind, we are working on developing tools that aren’t just pharmacological, but also behavioral, as well as digital health platforms that offer detection and intervention from different angles and earlier in disease progression.
The potential impact could be multifold: empowering and equipping healthcare providers to feel comfortable engaging patients in an appropriate, supportive way prior to the progression of severe disease, and benefiting all patients who are living with or are at risk for obesity with options that offer everyday support on their journey to improve health.
The economics side of the obesity equation also highlights the burden of obesity and chronic diseases for which obesity is a factor. In fact, the total cost of chronic diseases due to obesity and overweight was found to be $1.72 trillion in 2016 (Milken Institute, 2018, p. 1). Given this, we can anticipate there would be healthcare savings if obesity could be treated earlier or prevented.
Given the multi-faceted nature of disease, the future lies in advancing science and innovation to change the way chronic diseases, including obesity, are understood, diagnosed and treated. The collective fight to prevent, treat and cure obesity will not be easy, but it is critical.
Dr. Grove is a renowned academic and industry scientist with an unrelentless drive to understand the biology of obesity to find new treatments. Dr. Grove is currently the Scientific Vice President of obesity research at Novo Nordisk’s research center in Seattle, Washington.
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