Weight Loss Pharmacotherapy: Brief Summary of the Clinical Literature and Comments on Racial Differences

Disparities in Access and Quality of Obesity Care

Obesity is a chronic disease and a significant public health threat predicated on complex genetic, psychological, and environmental factors. Individuals with higher body mass index are more likely to avoid health care due to weight stigma. Disparities in obesity care disproportionately impact racial and ethnic minorities. In addition to this unequal disease burden, access to obesity treatment varies significantly. Even if treatment options are theoretically productive, they may be more difficult for low-income families, and racial and ethnic minorities to implement in practice secondary to socioeconomic factors. Lastly, the outcomes of undertreatment are significant. Disparities in obesity foreshadow integral inequality in health outcomes, including disability, and premature mortality.

Racial and Ethnic Disparities in Financial Barriers Among Overweight and Obese Adults Eligible for Semaglutide in the United States

Background Semaglutide holds the promise for weight loss and risk reduction. Less is known about racial and ethnic disparities in financial barriers among the semaglutide-eligible population. Methods and Results We conducted a cross-sectional analysis of adults aged 18 years or older using data from the National Health and Nutrition Examination Survey 2015 to 2020. We analyzed adults eligible for semaglutide based on Food and Drug Administration labeling and assessed financial barriers and social determinants of health among the eligible population overall and by race and ethnicity. A total of 13 711 adults were included in the final analysis. In 2015 to 2020, 51.1% (48.3%-53.2%) of US adults (≈43.3 million) met the Food and Drug Administration eligibility criteria for semaglutide. The percentage of adults eligible for semaglutide was highest among Black adults (56.6% [54.2%-59.1%]), followed by Hispanic adults (55.0% [52.8%-57.3%]). Among adults eligible for semaglutide, 11.9% (10.1%-13.6%) were uninsured, 13.3% (12.1%-14.5%) lacked a usual source of care, 33.6% (30.2%-36.9%) had low family income, and 38.9% (36.5%-41.3%) lacked higher education. Compared with White individuals, significantly larger proportions of Black and Hispanic individuals were uninsured, lacked a usual source of care, had low family income, or lacked higher education (P<0.001 for all). Conclusions Many Americans who were eligible for semaglutide were likely to be unable to afford the medication. Among the eligible population, a larger proportion of Black and Hispanic adults had financial barriers than other subgroups.

Systemic and Environmental Contributors to Obesity Inequities in Marginalized Racial and Ethnic Groups

Obesity is a multifactorial disease that disproportionally affects diverse racial and ethnic groups. Structural racism influences racial inequities in obesity prevalence through environmental factors, such as racism and discrimination, socioeconomic status, increased levels of stress, and bias in the health care delivery system. Researchers, clinicians, and policy makers must work to address the environmental and systematic barriers that contribute to health inequities in the United States. Specifically, clinicians should quantitatively and qualitatively assess environmental and social factors and proactively engage in patient-centered care to tailor available treatments based on identified needs and experiences.

Racial differences in prevalence and severity of non-alcoholic fatty liver disease

The aim of this review is to assess the evidence regarding racial differences in the prevalence and severity of nonalcoholic fatty liver disease (NAFLD). We reviewed the published literature that reported prevalence, severity, and genetic associations of NAFLD in different ethnic groups. The metabolic syndrome (MetS) has been associated with NAFLD, but each component of the MetS is present in various races in different percentages and their effect on NAFLD appears to be dissimilar. An elevated triglyceride (TG) level seems to have the strongest association with NAFLD. The latter is more prevalent in Hispanic patients; Blacks have lower TG levels and a lower NAFLD prevalence, compared to Caucasians or Hispanics. The severity of liver fibrosis is lower in some, but not all biopsy-based studies of Black patients. No study has evaluated the severity of liver disease controlling for the individual components of MetS, especially TG. Important racial differences in the prevalence of selected genetic polymorphisms, particularly PNPLA-3 and MBOAT7 have been documented, together with their effects on the prevalence of liver steatosis and fibrosis. Data on overall and liver mortality have found no significant differences according to race/ethnicity, with the possible exception of one paper reporting lower cirrhosis mortality in Black patients. We conclude that NAFLD is more prevalent in Hispanics and less in Blacks. This is supported by differences in key genetic polymorphisms associated with hepatic fat storage. However, there is presently insufficient evidence to firmly conclude that race, per se, plays a role in the development of liver fibrosis and its complications. Further studies, appropriately controlled for diet, exercise, and individual MetS parameters are needed.

Weight loss differences seen between glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors for treatment of type 2 diabetes

BACKGROUND

Weight loss is an advantageous quality for diabetic medications because it can improve insulin sensitivity and glucose control and reduce cardiovascular risk factors and comorbidities. Glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors are both preferred agents for use after metformin therapy, and both cause modest weight loss.

OBJECTIVE

The aim of this study was to evaluate the difference in weight loss between GLP-1 receptor agonists and SGLT-2 inhibitors in patients with type 2 diabetes (T2D).

METHODS

This was a retrospective study that was conducted at a level 3 patient-centered medical home in Buffalo, NY. The participants were adults with T2D treated with either a GLP-1 receptor agonist or an SGLT-2 inhibitor, in addition to background diabetes medications, between January 1, 2012, and September 20, 2017. The outcome measures included the median weight loss after 6 months of consecutive therapy compared between the 2 antidiabetic classes and the median differences in blood pressure, glycosylated hemoglobin (A1C) levels, and renal function markers compared between the 2 classes.

RESULTS

A total of 73 patients were included in the final analysis, with 31 receiving SGLT-2 inhibitors and 42 receiving therapy with GLP-1 receptor agonists. The SGLT-2 inhibitor cohort presented a median weight loss of -2.80 kg (interquartile range [IQR] -5.40 to -1.50), and the GLP-1 receptor agonist cohort presented a median weight loss of -1.15 kg (IQR -3.38 to 0.975) (P = 0.014). There were no statistically significant differences in A1C levels, blood pressure, or renal function markers.

CONCLUSION

SGLT-2 inhibitors, when used in combination with background diabetes regimens, can lead to more statistically significant weight loss than GLP-1 receptor agonists without compromising renal function.

Effects of Gelidium elegans on Weight and Fat Mass Reduction and Obesity Biomarkers in Overweight or Obese Adults: A Randomized Double-Blinded Study

The edible seaweed Gelidium elegans (GEE) is known to inhibit adipocyte differentiation. However, there has been no report on its effects in humans. In this study, we investigated whether GEE reduces body weight or fat mass in obese or overweight individuals. A total of 78 participants were randomly assigned to the test (GEE extract 1000 mg/day) and placebo groups at a 1:1 ratio, and treated for 12 weeks. At six or 12 weeks after randomization, they were evaluated for anthropometric parameters, biomarkers, and body composition. Changes in body weight and fat mass between the two groups was significantly different, as determined using ANCOVA adjusted for baseline, calorie intake, and physical activity. Body weight and fat mass were significantly decreased by GEE after 12 weeks but increased in the placebo group. Moreover, although not significant, triglyceride levels tended to decrease after GEE intake. There was no significant difference in other laboratory biomarkers between the two groups. Taken together, these results suggested that GEE significantly reduced body weight, especially fat mass, in overweight or obese individuals.

Racial Disparities in Obesity Treatment

PURPOSE OF REVIEW

Obesity rates in the USA have reached pandemic levels with one third of the population with obesity in 2015-2016 (39.8% of adults and 18.5% of youth). It is a major public health concern, and it is prudent to understand the factors which contribute. Racial and ethnic disparities are pronounced in both the prevalence and treatment of obesity and must be addressed in the efforts to combat obesity.

RECENT FINDINGS

Disparities in prevalence of obesity in racial/ethnic minorities are apparent as early as the preschool years and factors including genetics, diet, physical activity, psychological factors, stress, income, and discrimination, among others, must be taken into consideration. A multidisciplinary team optimizes lifestyle and behavioral interventions, pharmacologic therapy, and access to bariatric surgery to develop the most beneficial and equitable treatment plans. The reviewed studies outline disparities that exist and the impact that race/ethnicity have on disease prevalence and treatment response. Higher prevalence and reduced treatment response to lifestyle, behavior, pharmacotherapy, and surgery, are observed in racial and ethnic minorities. Increased research, diagnosis, and access to treatment in the pediatric and adult populations of racial and ethnic minorities are proposed to combat the burgeoning obesity epidemic and to prevent increasing disparity.