An overview of therapeutic options of obesity management in India: the Integrated Diabetes and Endocrinology Academy (IDEA) 2023 Congress update

ABSTRACT

Introduction

With newer anti-obesity medications (AOMs) being introduced at a rapid pace, it is prudent to make a concise and updated clinical practice document that may help busy clinicians in daily clinical practice. A group of metabolic physicians, diabetologists, endocrinologists, and bariatric surgeons assembled during the Integrated Diabetes and Endocrine Academy 2023 Congress (IDEACON, July 2023, Kolkata, India) to compile an update of pharmacotherapeutic options for managing people with obesity in India.

Areas covered

After an extensive review of the literature by experts in different domains, this update provides all available information on the management of obesity, with a special emphasis on both currently available and soon-to-be-available AOMs, in people with obesity.

Expert opinion

Several newer AOMs have been shown to reduce body weight significantly, thus poised to make a paradigm shift in the management of obesity. While the tolerability and key adverse events associated with these AOMs appear to be acceptable in randomized controlled trials, pharmacovigilance is vital in real-world settings, given the absence of sufficiently long-term studies. The easy availability and affordability of these drugs is another area of concern, especially in developing countries like India.

KEYWORDS:

• Obesity
• body mass index
• anti-obesity medications
• glucagon-like peptide receptor agonists
• semaglutide
• tirzepatide
• retatrutide
• bariatric surgery

Article highlights

• The prevalence of obesity has reached pandemic proportions globally and is rapidly rising in developing countries like India.

• Obesity is associated with several comorbidities, including, but not limited to, metabolic and cardiovascular consequences, and increased risk of cancer. These associated conditions increase morbidity and also the risk of mortality.

• Lifestyle management is the basic platform in the management of obesity on which various medical and surgical therapeutic options are built. Patient-centric and specific dietary interventions are the keys to success.

• Several novel anti-obesity medications (AOMs), including higher strength glucagon-like peptide 1 receptor agonists (GLP-1RA) [such as liraglutide 3.0 mg and semaglutide 2.4 mg], dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists [dual GLP-1/GIP-R agonist, such as tirzepatide], and triple GLP-1R, GIP, and glucagon receptor agonists [triple GLP-1/GIP/GR agonist, such as retatrutide] have shown weight loss ranging between 7−26%.

• Among the various GLP-1RA-based AOMs, subcutaneously administered liraglutide (3.0 mg once daily) and semaglutide (2.4 mg once weekly) are approved for use in obesity by both the United States food drug administration (USFDA) and European Medicine Agency (EMA), whereas dual GLP-1/GIP-RA tirzepatide (once weekly) has just been approved by the USFDA.

• A few of these GLP-1RA-based AOMs are already available in some developing countries. It is expected that another GLP-1RA will soon be available for use in obesity.

• While bariatric surgery is still the most effective of all weight loss therapies, newer AOMs appear to close this gap significantly. Moreover, bariatric surgery requires careful patient selection, meticulous post-operative care, and long-term follow-up.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.