Obesity Canada’s new medication guidelines include 13 recommendations for when and how doctors can offer weight-loss drugs to patients.Hollie Adams/Reuters
When Obesity Canada first released its treatment guidelines in 2020, the chapter on medications included three drugs and six recommendations for their use.
On Monday, the health charity published its latest chapter update in the Canadian Medical Association Journal – and the number of drug options and recommendations have both doubled.
Recent years have seen the world of obesity care disrupted by the emergence of drugs like GLP-1 receptor agonists, sold under brand names like Ozempic and Wegovy. Today, GLP-1s and their cousins are poised to dramatically transform treatment regimes – not just for obesity but a slew of other ailments now being feverishly explored as potential uses for these drugs.
In the new guidelines, experts made 13 recommendations for when and how obesity medications should be offered to patients, together with health behaviour changes.
To get a clearer picture of this rapidly-evolving landscape, we spoke to Sue Pedersen, lead author of the updated guidelines and an endocrinologist and obesity medicine specialist at C-ENDO Clinic in Calgary.
What’s the current state of obesity in Canada?
There was a great paper published just a couple of weeks ago, looking at obesity in Canada from 2009 to 2023. And obesity’s actually become more prevalent; in 2009, about 25 per cent of Canadian adults had obesity and in 2023 about 33 per cent were living with obesity. So one in three Canadian adults are currently living with this chronic disease.
If you look at obesity and overweight together, the majority of Canadian adults are living with elevated weight. So it’s very, very common, and it’s getting progressively worse.
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Your pharmacotherapy chapter in Obesity Canada’s clinical practice guidelines has been updated twice in just five years. Do the other 18 chapters get updated this frequently?
My chapter is the one that’s most frequently updated. There’s just so much changing in weight management medications.
What exactly has changed since the last chapter update three years ago?
A lot of things have changed, even in that time frame. There’s two new medications that have been approved in Canada, Zepbound (tirzepatide) and Imcivree (setmelanotide).
In our recommendations, we have taken the focus off of body mass index (BMI) to prescribe obesity medications. BMI is a calculation based on height and weight; it tells us nothing about where is the body fat, how much is muscle, how much is fat. So we recommend to look at other parameters as well, like waist-to-height ratio and circumference.
We put more emphasis on individualizing care and set our targets in partnership with patients that we’re treating. What are their goals in weight management? We look at health improvement as one of the main goals.
And importantly, there’s been new health benefits that have been proven with weight loss medication since 2022 – for cardiovascular disease, osteoarthritis and heart failure. And for pre-diabetes, diabetes, fatty liver disease, sleep apnea – there’s new data for more medications to improve health and show benefits.
What are the big take-home messages from this latest update?
The key points are that medications to treat obesity are effective and safe, and what they do is they support and make it easier for people to adhere to healthier lifestyles.
The next key point is that the focus of treating obesity should be improvement in health parameters; it’s not just about the weight loss. We try to move away from looking at the numbers on the scale and looking at improving health.
Third key point is that obesity medication should be tailored to the individual, and we should adjust the medication – both as tolerated and as needed – to achieve their treatment goals.
And the fourth one is that weight management medications are intended to be a long-term treatment strategy. Every study ever done of a weight-loss medication has shown us that when we stop treatment, weight goes back up and we have a loss of those health benefits that we’re seeing with the medication.
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It feels like every day we’re seeing headlines about a new GLP-1 study or obesity drug. Just last week, drugmaker Eli Lilly shared the latest results from trials testing its new obesity pill. How rapidly is this landscape shifting?
It’s progressively more complicated to write these guidelines. I mean, it’s an embarrassment of riches, and that’s a good problem – we have more and more treatments available that can help our patients, and that’s great. But yes, it’s very fast paced and it’s continuing to accelerate.
The great thing is that with more medications becoming developed and approved, we can really find the right treatment for the right patient. And with more competition, there should be decreasing costs which is really important, because these medications are unobtainable for so many people who deserve to have access to treatment.
This interview has been edited and condensed.
