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Michael Albert, MD Profile picture
@MichaelAlbertMD
May 14, 2022 • 5 tweets • 3 min read • Read on X
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Why is losing weight hard? Evolutionary adaptations to prevent starvation and death constrain weight loss. Conversely, hypothalamic inflammation can promote wt gain affecting the fxn of the homeostatic feedback system that constrains wt.
-Dr. Katherine Saunders #YWM2022Virtual
Weight Loss Goal? Not a number but a health improvement. With modern treatments, I would argue we should aim for 10% TBWL. #YWM2022Virtual
An example of a patient's AOM weight loss journey. Weight loss journeys should be realized over years as virtually no one gains all their weight in 3-6 months. Setting expectations early on is essential!! #YWM2022Virtual
Treatment Options #YWM2022Virtual
What's in the med pipeline? #YWM2022Virtual

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More from @MichaelAlbertMD

Michael Albert, MD Profile picture
Sep 1
🌍 The world is preparing to be transformed by nutrient-stimulated hormone-based therapies (NuSHs) like GLP-1 medications.

However, here’s the problem: more than 99% of clinics aren’t ready to deliver them at scale.

Here’s why ⬇️ 🧵benefitspro.com/2025/08/05/glp…Image
1⃣ Insurance navigation
Most clinics lack the workflows and staff necessary to obtain prior authorizations efficiently.

Even though >50% of their patients (modest estimate) could qualify for these medications, they can only push through a handful of approvals because:
🔹Prior auth processes are slow and fragmented
🔹There’s little reimbursement to justify hiring dedicated support
pmc.ncbi.nlm.nih.gov/articles/PMC11…
2⃣ Clinical infrastructure
These aren’t “set-and-forget” drugs. Patients often need:
🔹Slower titration schedules
🔹Dose adjustments
🔹Ongoing counseling & support
🔹Side-effect management (remember: >50% of users experience side effects)

Most clinics don’t have systems in place to deliver this kind of continuous, specialized care. diabetesjournals.org/care/article-a…Image
Read 8 tweets
Michael Albert, MD Profile picture
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
Michael Albert, MD Profile picture
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
Michael Albert, MD Profile picture
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
Michael Albert, MD Profile picture
Nov 11, 2022
NASH Treatment Strategies:
1) Reduce Adiposity
2) Improve adipose tissue function (more difficult; PPARg agonists)
link.springer.com/article/10.100…
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
Michael Albert, MD Profile picture
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

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