Time to view obesity as a chronic disease

The notion that obesity is a result of a character or behavioural flaw should be corrected and dispelled, say experts.

According to Dr Sue Pedersen, a specialist in endocrinology and metabolism, Calgary, Canada, it is important to look at obesity as a chronic disease. This involves the change of perception that people are obese because of a character flaw or dietary choices. Obesity is a result of many contributing factors including genetics, environmental, biological and behavioural. Each of these interact with each other to contribute to obesity and without help, one will find it difficult to lose weight.

Obesity affects about 650 million adults across the globe and constitutes a significant public health issue worldwide. [Available at: http://www.who.int/mediacentre/factsheets/fs311/en/ Accessed on 18 June] In Malaysia, the numbers are similarly alarming—based on the National Health and Morbidity Survey 2015, one-in-three adults over the age of 18 are overweight, and 30.6 percent are obese (?based on BMI measurement – suggest clarify/define the term ‘obesity’ – example below, also see discrepancy in ‘over-weight’ definition).

Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. A crude population measure of obesity is the body mass index (BMI), a person’s weight (in kilograms) divided by the square of his or her height (in metres). A person with a BMI of 30 or more is generally considered obese. A person with a BMI equal to or more than 25 is considered overweight. [https://www.who.int/topics/obesity/en/]

Dr Zanariah Hussein, consultant endocrinologist, Hospital Putrajaya, said as a chronic medical condition, obesity is known to cause serious health complications, chief of which is type 2 diabetes. However, it is also linked to cardiovascular complications, hypertension and even certain cancers. She said: “It (obesity) is linked to lower life expectancy and impaired quality of life. Any person with obesity who loses just 5 to 10 percent of their body weight will likely have significant improvements in health.”

Zanariah and Pedersen were speaking at the launch of Saxenda® (liraglutide 3.0 mg, Novo Nordisk), a glucagon-like peptide-1 (GLP-1) receptor agonist. GLP-1 regulates appetite by increasing the feeling of fullness and satiety, thus leading to a reduced food consumption. However, GLP-1 has a very short half-life, which renders it inactive in a few minutes. Liraglutide has a much longer half-life at about 13 hours, which means a once-daily application is enough to last the entire day.  It is sold in the form of an injectable pen and only available by prescription. Liraglutide 3.0 mg is indicated in Malaysia to be used in conjunction with a reduced-calorie diet and increased physical activity for long-term weight management in obese (BMI ≥30 kg/m²) or overweight (BMI ≥27 kg/m² to <30 kg/m^²) adults with weight-related medical problems such as hypertension, hypercholesterolaemia, type 2 diabetes or obstructive sleep apnoea.

Fat keeps coming back
One of the major problems facing persons with weight issues is that their weight keeps bouncing back after an initial loss. Pedersen said the choice of treatment depends on the patient’s history of weight loss treatment and BMI and whether the patient has obesity-related disease.

Liraglutide 3.0 mg demonstrated its effectiveness in helping patients lose weight and maintain it in the SCALE* study. The 56-week, double-blind trial involved 3,731 patients with a BMI of at least 30 or a BMI of at least 27 along with treated or untreated dyslipidaemia or hypertension. All of them did not have type 2 diabetes. At the end of the study, a total of 63.2 percent of patients on liraglutide lost at least 5 percent of their body weight compared to only 27.1 percent of patients in the placebo group (p<0.001). [N Engl J Med 2015;373:11–22]

When asked about the risk of pancreatitis associated with the use of GLP-1 receptor agonists, Zanariah said physicians are aware of the possible side effects and will avoid prescribing this class of drugs to patients with a prior history of pancreatitis.

“For people with obesity, it is not just about losing weight, it is about improving their health and enjoying better quality of life,” said Richard Abela, vice president and general manager (Malaysia, Singapore, Brunei, Sri Lanka and Maldives), Novo Nordisk Pharma (M) Sdn Bhd. “With Saxenda, Novo Nordisk is pleased to offer a treatment option that is clinically proven to help people to achieve meaningful weight loss. This launch in Malaysia is an important milestone in our long-term commitment to improving the lives of people with chronic diseases such as obesity in Malaysia,” he added.

* Satiety and Clinical Adiposity—Liraglutide Evidence in Nondiabetic and Diabetic Individuals