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The diabetes epidemic requires a rethink about obesity

The outdated way we treat obesity has to change, according to SOPHIA researchers. A Q&A with Prof. Carel le Roux

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According to Prof. Carel le Roux of University College Dublin, obesity treatment has traditionally involved creating a calorie deficit using diet and exercise, an approach that has not always proved effective. It can even makes things worse. Yet despite advances in pharmacological and surgical treatments in the last decade, many healthcare professionals still lack adequate training in new approaches. “Moreover, obesity is not considered a disease in many countries,” according to Prof. le Roux, “meaning that resources dedicated to treating it are minimal.”

“This means that we are treating the disease with basic and even outdated treatments that cause temporary weight loss, leading to long-term implications like untoward changes in body composition, weight regain, increased duration of patients living with obesity-related complications, stress and depression, and diminished quality of life.”

We currently don’t know which patients will develop complications secondary to their obesity, and who will respond to the new and expensive treatments. SOPHIA has set out to identify these predictors so that we can improve the quality of care. It will be the first project of this scale to address this important question, says Prof. le Roux. A Q&A on the problem and the project:

Q. What will success look like for you at the end of this project?

A We aim to be able to change attitudes towards obesity held by the general public and healthcare professionals. Most importantly, the success of SOPHIA will be defined by achieving novel predictions of obesity risks and enabling personalised treatments based on the identification of the sub-populations of people living with obesity. We then hope to create a shared value where all the stakeholders can “do well by doing good”.

Q You’re creating a database. What will be in the database and who will use it?

A The database will initially be used within the project to identify predictors of risks of obesity complications, identify the subpopulations who are at risk of specific complications, such as type 2 diabetes, cardiovascular disease, cancers and osteoarthritis, as well as identify predictors of response to different obesity treatments. The sustainability plan of the database will be worked out at a later stage, and will depend on the outcomes, as it requires further funding beyond the scope of SOPHIA.

The federated databases will be state-of-the-art. The project partners will share all their data while remaining compliant with GDPR. This will be a major benefit for the partners as well as future researchers as the infrastructure will remain available long term.

Q How is risk of complications currently assessed/predicted/guessed at by healthcare providers?

A Currently, healthcare professionals are not able to identify which patients will develop specific complications of obesity. Neither are the healthcare professionals able to predict which treatment patients will respond to. A standardised medical approach is the use of BMI, waist circumference, and family history to identify patients with a high risk of developing any obesity-related complications, making the treatment less individualised. Moreover, the development of most complications are only identified at a late stage when the disease has already developed complications such as type 2 diabetes and cardiovascular diseases. The ability to have more accurate predictors at an earlier stage of the disease process will allow patients to receive better information, which in turn empowers them to make decisions together with their healthcare professionals.

Q Why do you wish to change the narrative around obesity in society?

A Patients with obesity are widely stigmatised which results in pressure on governments not to invest in the treatment of this disease. We aim to create a shared value where all stakeholders including governments, public and private health insurance payers, patients, clinicians and industry can benefit from the new narrative about obesity as a subset of diseases.

Q The project has described as part of its mission a desire to “(talk) to patients to learn about what they fear and hope when it comes to obesity treatment”. How is this intended to contribute to the project’s goals?

A The treatment of obesity has always been one-sided i.e. not taking patients’ views, their experience with the disease, their financial situation, and other factors into consideration when creating new treatments. For instance, we know that many patients who come to obesity clinics have financial difficulties and struggle to afford pharmacological or surgical treatments, leaving them with no choice but to continue with treatments that are not working for them.

Involving the patient’s voices will ensure our resources are better spent and patients will be able to benefit from the predictors that we will find. For example, we may find that genetic testing that costs hundreds of euros can be used to predict the right treatment, thus saving thousands of euros. If this is viewed as an unrealistic approach by patients and or payers, then we should consider approaches together, with all the other stakeholders, on how providing these tests can provide a shared value to all. Alternatively, we may redirect resources towards other cheaper, but equally validated, tools or tests.

Read more

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