Michael
Nov 2, 2021 8 tweets 5 min read Read on X
1/ Dr. Lee Kaplan: What Does the Future of Obesity Care Look Like? #OW2021

Every time I hear Dr. Kaplan speak, I am blown away by his knowledge and perspective. He, once again, delivered a masterclass on obesity.

Point #1: We are undertreating obesity Image
Point #2: An active, involuntary physiological system determines body fatness at any one time. #OW2021 Image
Point #3: All our available interventions help to readjust down the increased fat mass setpoint (in theory). #OW2021 ImageImageImage
Point #4: treatment goal => restore normal physiology. #OW2021 Image
Point #5: Treatments are improving. #OW2021
Check out: Image
Point #6: understand that individual responses to treatments will follow a normal distribution. #OW2021 Image
Point #7: Treatment needs to be patient-focused. #OW2021 Image
Q: Is obesity an expression of normal biological variability?
A: (paraphrase) I would liken it to autoimmune disease for which we have much more. Genes prime the individual and the environment causes permanent abnormal physiological changes that result in pathology. #OW2021

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More from @MichaelAlbertMD

Aug 6, 2023
1/ WHAT YOU NEED TO KNOW ABOUT THE QUALITY OF WEIGHT LOSS. 🧵 Image
2/ When you lose weight, you don’t just lose from fat but also from other body compartments, including lean tissues. Image
3/ Why should you care about where the weight comes from?
Excess loss from specific lean tissues is associated with many adverse health outcomes: reduced QoL, osteoporosis, sarcopenia/frailty, decreased ability to perform ADLs, etc.
Read 19 tweets
Feb 19, 2023
1/ Are lean mass losses a real concern with GLP1 meds?
peterattiamd.com/the-downside-o…
🧵
2/ Simply, yes. And it is a concern any time you lose significant wt. I would remind people that human outcomes are the most informative, as physical functioning scores and QoL improved in STEP trials & SURMOUNT-1. However, the LT health impacts of LM loss need to be monitored.
3/ Fortunately, we have some high-quality data from Lundgren et al., 2021.

👉Structured Exercise + Liraglutide (GLP-1RA) led to FM loss and LM gain.
Read 6 tweets
Dec 22, 2022
1/ Merry 🧵-mas
---
WHY DECADES OF "EAT LESS AND MOVE MORE" WAS TERRIBLE ADVICE

For starters, remember semaglutide? How could you not? Journalists have written 1000+ celebrity weight loss stories on it.
2/ If you're familiar with semaglutide, you may know it is FDA-approved for treating obesity and chronic weight management under the brand name "WE-GOVY."
3/ Our story begins with the STEP Trials, a slate of phase 3 clinical trials that served as clinical validity for a novel drug platform for obesity.
Read 10 tweets
Nov 11, 2022
NASH Treatment Strategies:
1) Reduce Adiposity
2) Improve adipose tissue function (more difficult; PPARg agonists)
Pts w/ F2 or F3 fibrosis, SEMA 0.4 mg SQ Q at 0.4 mg was superior to placebo for resolution of NASH w/o worsening of fibrosis after 72 wks of tx, with 59% of the pts in the 0.4-mg group having a response, as compared with 17%. (OR, 6.87; 95% CI, 2.60 to 17.63; P<0.001)
Read 9 tweets
Nov 10, 2022
Treat-to-target for NAFLD/NASH:
🔑 is ≥ 10% weight loss.
journal-of-hepatology.eu/article/S0168-… Image
Bariatric surgery is exceedingly effective for people with obesity and NASH.
Aminian et al., JAMA. 2021.
jamanetwork.com/journals/jama/… Image
Mediterranean diet adherence is inversely associated with liver steatosis, 10-yr ASCVD risk, and NAFLD-associated incident T2DM.
linkinghub.elsevier.com/retrieve/pii/S…
Read 5 tweets
Nov 2, 2022
1/DAY 1 of #OW2022 in the books.

My highlight 🧵:
2/The Effect of COVID on Clinical Research by Drs. Laughlin and Evans:
—Significant increase in new onset diabetes
—A lot of COVID specific research for years to come
—COVID19 disproportionately impacted female scientists, parents and caregivers #OW2022
3/Update on the Use of Genetic Information to Tailor Obesity Treatment by Dr. Kaplan:
—People respond uniquely to treatments
—Genetic info can be used to predict treatment response and risk for weight gain over one’s life
—Precision genetic research IS EARLY #OW2022
Read 12 tweets

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