GLP-1 agonists – a class of medications such as Ozempic and Wegovy that can help manage Type 2 diabetes and obesity – have been making headlines for their effectiveness in weight loss.
Keerthana Kesavarapu and Kunal Shah, two professors from the Rutgers Robert Wood Johnson Medical School who lead the Rutgers Center of Metabolic Health and Weight Management, discuss the implications for obesity treatment – and how to maximize the impact.
We’ve been losing the fight against obesity for 50 years. Are we finally at a turning point?
Kesavarapu: I think we're finally gaining ground. With the advent of GLP-1 agonists like Ozempic, we're seeing weight loss results almost comparable to bariatric surgery but with fewer risks and side effects. This is a game-changer.
While bariatric surgery still has its place, I expect these medications to play an increasingly prominent role in obesity treatment.
Speaking of availability and insurance coverage, have you seen changes in this area recently?
Shah: We've seen significant improvements in the past few months. When we started our clinic two years ago, availability was a major issue, even when insurance would cover the medication.
Now, we're having much less trouble finding medication for our patients. Insurance coverage has also improved, particularly for commercial insurance plans.
We're still facing challenges with Medicare, Medicaid and charity care coverage, but there's movement in this area, too. Medicare is considering how to incorporate weight loss medications into its coverage, which could be a huge step forward in the next couple of years.
What other improvements could help us turn the tide?
Kesavarapu: We recently completed a study looking at how fiber impacts appetite pathways in obese individuals and found that high-fiber diets can change satiety hormones and alter brain responses to high-fat foods. When you're on a high-fiber diet, you don't get as much stimulation from fatty foods.
We also observed significant changes in the gut microbiome with high-fiber diets. There's increased diversity and production of beneficial short-chain fatty acids, which improve appetite regulation, weight loss and metabolic factors like blood sugar control.
How does this research complement medical treatments for obesity?
Kesavarapu: This research underscores the importance of a holistic approach to weight management. While medications like GLP-1 agonists are powerful tools, they work best with dietary changes.
The appetite-suppressing effects of fiber complement the action of GLP-1 agonists, potentially enhancing their effectiveness. Moreover, the positive changes in the gut microbiome associated with high-fiber diets may contribute to overall metabolic health, which is a key goal in obesity treatment.
What's your advice for incorporating more fiber into one's diet, especially for those on weight-loss medications?
Shah: We recommend aiming for at least 25 grams of fiber daily, more than double what the average American consumes. It's best to get fiber from your diet rather than supplements, as you get various fiber types from whole foods. Vegetables, fruits (especially with skins), legumes and seeds are excellent sources.
For those on weight-loss medications, increasing fiber intake can help manage some gastrointestinal side effects, particularly constipation. It's important to increase fiber intake gradually and with plenty of water to avoid digestive discomfort.
If dietary changes aren't enough, fiber supplements can be beneficial. Most current supplements only provide one type of fiber, but there's ongoing research into more complex fiber supplements that mimic the variety found in a healthy diet.
Looking ahead, what developments do you anticipate in obesity treatment?
Shah: I think we’ll see many exciting developments in the next five to 10 years. Several new medications are in the pipeline, including potential oral versions of current injectable drugs. We're also likely to see improvements in existing medications, with higher doses and potentially fewer side effects.
