Review of obesity treatments

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Eddy Edson

Eddy Edson

Well-Known Member
Relationship to Diabetes
Type 2
New review of current & future obesity treatments by some leading researchers plus some younger up-and-comers in the field: https://www.sciencedirect.com/science/article/pii/S0140673622024035?dgcid=coauthor


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Lifestyle interventions (low carb, low fat, WW, Virta Health, whatever) struggle to achieve durable clinically beneficial weight loss in many people.

Gastric sleeve-type interventions do a lot better, but bariatric surgery is the star intervention.

For meds: liraglutide is meh, roughly the same as lifestyle interventions; semaglutide/Wegovy is kind of similar to gastric sleeves, with most people getting 10%+ weight loss; and tirzepatide/Mounjaro is even better but not as good as bariatric surgery. And for each drug, not everybody is a "responder", which is not so much the case with the physical interventions. New drugs in the pipeline may well improve the comparison.

(Yes you have to take the drugs forever, probably, as is the case for most chronic conditions. It's not a very interesting point. No it's not a matter of people just not knowing about or not trying hard enough at some magic lifestyle/diet change.)

EDIT: Should say that all of these therapies include diet+lifestyle. Difference is what gets added to that.
 
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It's always drugs or surgery...how strange that the only "effective" ways make loads of money for the drug companies or keep the surgeons in business..

So I guess we are saying that crash diets don't "work" well either ... so much for Prof Taylor and DiRECT... hmmm
 
bulkbiker said:
So I guess we are saying that crash diets don't "work" well either ... so much for Prof Taylor and DiRECT... hmmm
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Isn’t the review posted above based on options to treat obesity, whereas Prof Taylor’s work in to do with type 2 diabetes?

There may be overlap, but I don’t think they are looking at the same things?
 
bulkbiker said:
It's always drugs or surgery...how strange that the only "effective" ways make loads of money for the drug companies or keep the surgeons in business..

So I guess we are saying that crash diets don't "work" well either ... so much for Prof Taylor and DiRECT... hmmm
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Nope, no one is saying that.
(Well, unless you are prone to yo yoing anyway, then it seems you believe no matter what you do, the weight will come back on. But that's based on your personal experience. Then medical intervention would help there it seems.)
 
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everydayupsanddowns said:
Isn’t the review posted above based on options to treat obesity, whereas Prof Taylor’s work in to do with type 2 diabetes?

There may be overlap, but I don’t think they are looking at the same things?
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Taylor's work is all about T2 and obesity hence the concentration on weight loss to achieve remission..?

You can't really separate the two surely... DiRECT only had obese people selected...
 
travellor said:
Nope, no one is saying that.
(Well, unless you are prone to yo yoing anyway, then it seems you believe no matter what you do, the weight will come back on. But that's based on your personal experience. Then medical intervention would help there it seems.)
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My personal experience of losing a chunk of weight and maintaining most of that loss you mean?
 
bulkbiker said:
Taylor's work is all about T2 and obesity hence the concentration on weight loss to achieve remission..?

You can't really separate the two surely... DiRECT only had obese people selected...
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I guess your post just felt unnecessarily dismissive of Taylor’s research and findings? Which were able to show things in a peer reviewed research setting that hadn’t been clearly shown before (eg that T2D is not necessarily inevitably progressive).

The mechanism may be weight loss, but I think the nuance around recovering beta function and visceral fat seems to give it a slightly different focus.

What strikes me from the graphs above (and it’s something we know well on the forum) is that ALL the approaches work brilliantly for the right people, but none of them work brilliantly for everyone.

Personally I’m not sure we have the surgical/clinical resources and capacity of appointments or surgeons to decide that the ‘only thing that works’ is a physical/surgical intervention.

I also believe there are some data showing that benefits gained from surgical interventions can be lost over time in some (but I’d have to go looking for that as it’s a few years since I came across it).

My takeaway:

Obesity is complicated and multifactorial. Here are some things you can try that are all very effective for different individuals (and less so for others). See how they work for you, and try to find the one that suits your situation best.
 
everydayupsanddowns said:
(but I’d have to go looking for that as it’s a few years since I came across it).
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This is an older study (and may have been superseded), but paints a less than rosy picture of outcomes once you get past 2 years, particularly in the superobese group.

pubmed.ncbi.nlm.nih.gov

Long-term weight regain after gastric bypass: a 5-year prospective study - PubMed

Weight regain was observed within 24 months after surgery in approximately 50% of patients. Both weight regain and surgical failure were higher in the superobese group. Studies in regard to metabolic and hormonal mechanisms underlying weight regain might elucidate the causes of this finding.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

Outcomes may be very different with the addition of some of the newer meds of course (including monogenic-obesity targeting ones)
 
everydayupsanddowns said:
Obesity is complicated and multifactorial.
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Indeed but I'd always prefer to listen to those who have managed to overcome it rather than someone with a PhD and a vested interested in making money from it?
 
bulkbiker said:
Indeed but I'd always prefer to listen to those who have managed to overcome it rather than someone with a PhD and a vested interested in making money from it?
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I think there is merit in listening to both.

One has personal experience of an approach that worked for them as an individual (and perhaps negative experiences of approaches that didn’t suit them).

The other has a wider view of options across many more people, and which approach or combination of approaches seem to have the best chance for most people.

I’m not sure that people make money from their PHDs. Those studying for them seem to find them more of an emotional and financial pit of despair rather than a overflowing fount of plenty.

A Dr who recommends tablet A could equally recommend tablet B. Or lifestyle intervention C. And we need folks who specialise in different surgeries that the first Dr can refer the right candidates on to.
 
everydayupsanddowns said:
A Dr who recommends tablet A could equally recommend tablet B.
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And therein lies the problem the vast majority of doctors will simply recommend tablets...assuming you even get to see a doctor after a T2 diagnosis.. I never did.
The Diabetes Nurse who knew substantially less than I did about T2 gave the usual useless advice to take metformin and "lose weight using the Eatwell Guide" nonsense.

Luckily for me I knew better and confounded then with my results.
 
bulkbiker said:
Indeed but I'd always prefer to listen to those who have managed to overcome it rather than someone with a PhD and a vested interested in making money from it?
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Taylor.jpg

A bit of a shallow reason for my criteria to be honest, but fair enough.
Professor Roy Taylor MBE.
The man clearly isn't a yoyo dieter.
 
bulkbiker said:
And therein lies the problem the vast majority of doctors will simply recommend tablets...
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You missed the bit where I said “or lifestyle intervention C”? 😉

Plus based on experiences of members here the tablets are usually recommended after lifestyle interventions have been given a chance.

bulkbiker said:
assuming you even get to see a doctor after a T2 diagnosis.. I never did.
The Diabetes Nurse who knew substantially less than I did about T2 gave the usual useless advice to take metformin and "lose weight using the Eatwell Guide" nonsense.
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Yes from what you have shared it seems you weren’t very well supported. And you certainly aren’t the only member to have been offered suggestions that didn’t work for you, or not offered much help at all.

I can completely understand how people become disillusioned, hardened, and begin to view any suggestions from HCPs with suspicion - or just dismiss them as useless. :(
 
everydayupsanddowns said:
Plus based on experiences of members here the tablets are usually recommended after lifestyle interventions have been given a chance.
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Odd then that on many other diabetes fora the experience is completely different and metformin is almost always the first port of call once diagnosed..
As a T1 I guess you have never had to experience the ignorance of many HCP's when faced with a T2 or received the useless advice many of us are given?
 
bulkbiker said:
Odd then that on many other diabetes fora the experience is completely different and metformin is almost always the first port of call once diagnosed..
As a T1 I guess you have never had to experience the ignorance of many HCP's when faced with a T2 or received the useless advice many of us are given?
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Ah I think we all have a few HCP interaction horror stories up our sleeves :(

Just reflecting experiences I’ve seen over 10+ years here sharing experiences with T2s. Met is a common first line offering, and sadly many do get sent away with a prescription and er… that’d about it.

But quite a few are given the opportunity to try lifestyle changes first - often depends on the A1c at diagnosis.

There’s a GP flowchart I’ve seen somewhere,
 
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everydayupsanddowns said:
a prescription and er… that’d about it.
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Don't forget the usually poorly photocopied "Eatwell Guide" ...poor dietary advice for anyone let alone a newly diagnosed T2. "Base all meals around starchy carbs " if you want to be on medication for the rest of your life..
 
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