This is a beautiful study, answering many of the questions we clinicians and our patients are asking:

🤔What happens if I stop the GLP1?

Here's one punch line that we all could've guessed:
⭐️Exercise mitigates #weight regain when anti #obesity #medicine is stopped⭐️

But there's a lot more to observe here:

🧵1/ Here's the study method:

There's an "induction" phase 1 where #weightloss is caused by a low-calorie #diet over 8 weeks

Then everyone is randomized to 1 of these 4 groups

After 1 year, all of these interventions are stopped, and researchers just watch to see what happens to #weight

2/

Packed room with Richard J. Auchus, MD, PhD, FACE on #adrenal #hypertension

- drugs can cause false negative screens but not false positive screens
- you can probably just treat with mineralocorticoid antagonist instead of going through the diagnostic steps

#AACE2023

1/ This is such an excellent talk that I don’t have much commentary to add. Just sharing high yield slides!

2/

Interesting to see anti #obesity and #diabetes #medication management from the perspective of PharmDs

I'm always pro-collaborative care!

Here are some learning points and fact checks:

#AACE2023 #endocrine #endocrinology #pharmacology

1/

https://twitter.com/endojorm/status/1654224072979660800

- "Tirzepatide is a dual agonist"
👉It ↑GIP activity but GLP-1R agonism is less than that of endogenous GLP-1
- "Hypoglycemia is not a concern if you're not on insulin"
👉Risk of hypoglycemia ~1.4% vs. 0.2% in placebo in SURMOUNT-1

nejm.org/doi/full/10.10…

2/

@DrKarlNadolsky presents the overarching themes and calls to action of @TheAACE 's new #obesity guidelines:

#AACE2023
1/ 👉Reduce #WeightStigma
The bidirectional relationship between #weightbias and #obesity is unequivocal

I'm moved by the enormous consensus among multiple professional societies, MDs PhDs MPHs experts etc, on how important this is

@ConscienHealth @scottkahan
2/

@alpanashuklamd takes the stage at the @ColumbiaMed @WeillCornell #Obesity Conference @alpanashuklamd et al examined the effect of macronutrient sequencing (carbs first vs carbs last) in ppl with diabetes, prediabetes, or gestational diabetes

This study looked at those with prediabetes:
dom-pubs.onlinelibrary.wiley.com/doi/abs/10.111…

2/

Always a pleasure to listen to @KevinH_PhD discuss his testing of hypotheses in contributors to #obesity
1/ Many people remember his 14-day study of ultra processed foods (UPF) vs unprocessed foods (n=20) that found energy intake was ~500 kcal/d LESS with unprocessed meals

cell.com/cell-metabolis…
2/

Ready for an #obesity #research disruptor?
@bcorkey 's studies on hyperinsulinemia and inflammation are a perennial favorite

1/ We often focus on slow or fast metabolism but there isn't enough talk on *energy efficiency*. See how much additional Δkcal is required (beyond that calculated) to effect 10% weight Δ: nejm.org/doi/full/10.10…

2/

Tony Ferrante MD PhD of @ColumbiaMed providing an excellent systems based overview of the "metabolic" complications of #obesity and potential mechanisms: lipotoxicity, inflammation, adipokines

Some highlights:

1/ Neurology:
Check out this relationship where higher BMI is associated with ↑ risk of #dementia EXCEPT in age >70 when it's better to be in "overweight" category

👉Aiming for a "normal BMI" is not the best goal for everyone
2/

@scottkahan up next, challenging us to challenge our own #weightbias

#obesity

1/ For example:

Are you asking patients to "try lifestyle changes" first before referring them to specialty care? (eg, endocrinology, bariatric surgery)

This is a subtle example of #weightbias
(Assuming they haven't tried already)

2/

SO EXCITED FOR THIS

Dr. Rudy Leibel of @ColumbiaMed, everyone Key quote:
"The RISK of developing obesity comes from genes."

Note that he doesn't say obesity itself is caused by genes. This would be an oversimplification!

2/

I usually tweet about #obesity but since I recently had a pt with type 2 #diabetes go from 100 units/d insulin to 0 with tirzepatide, this is a good time to review #insulin management when you start a GLP1 / GIP

#endocrine #endocrinology #research #clinicians
1/ SURPASS-5: tirzepatide + basal insulin vs. placebo

Method: If baseline A1c<8, ⬇️long acting insulin dose by 20% at start of study

Result: At end of study, insulin was ⬇️11% for 15-mg tirzepatide group vs. ⬆️75% for placebo

jamanetwork.com/journals/jama/…

2/

Though not its intention, this study from #OW2022 illustrated the concepts of satiation vs satiety very well

Colloquially we use these terms interchangeable

But they are technically different

#obesity #science #research #physiology #pathophysiology
#weight

1/ Satiation is the feeling of fullness WITHIN a meal while satiety is the feeling of fullness IN BETWEEN meals

Even though current meds like GLP1s seem to affect both, it’s an impt distinction especially when some peptides (eg, amylin)

Empagliflozin is now my go-to SGLT2i for pts with #diabetes and #CKD or #CHF, over cana or dapa or ertu.

Why?

A: EMPA-KIDNEY: nejm.org/doi/full/10.10…
and EMPEROR-Reduced and EMPEROR-Preserved
1/ EMPA-KIDNEY is unique because it enrolled GFR 20-45 *without* proteinuria whereas others (DAPA CKD, CANVAS) enrolled pts with CKD+proteinuria, though DAPA-CKD conducted a subgroup analysis for UACR < and > 1000