Welcome from J. Michael Gonzalez-Campoy, MD, PhD, FACE
On September 11, 2014, the U.S. Food and Drug Administration (FDA) Endocrinologic and Metabolic Drug Advisory Committee (EMDAC) voted 14-1 to recommend liraglutide 3 mg (Saxenda®) for approval for weight management. On December 23, 2014, liraglutide became the fourth medication recently approved for weight management, joining Qsymia® (phentermine and topiramate combination tablets), Belviq® (lorcaserin), and Contrave® (bupropion and naltrexone combination tablets). In addition to the successful introduction into the market of effective medications for weight management, there have been major developments that have advanced the medical, social, political and economic avenues to optimal medical care for people with overweight, obesity, and adiposopathy.
Science now recognizes adipose tissue as a very active participant in metabolism, not just a place for passive storage of energy. Adiposopathy, or sick fat, plays a role in the development of metabolic diseases. This knowledge led to the development of bariatric endocrinology; a field of endocrinology that focuses on the diagnosis of adipose tissue dysfunction, and returning adipose tissue to normal function as a means to improve metabolic derangements.
As a society, we still have major challenges to overcome. There is wide recognition of the burden of disease that comes from the development of obesity complications. Major government institutions all agree that dealing with the obesity epidemic is a priority. Yet public health interventions have failed to stop the increasing prevalence of this disease. While we continue to address obesity as a society, the standard of care now is to help each affected patient with individual weight management.
After the American Medical Association (AMA) recognized obesity as a chronic, treatable disease in 2012, multiple parallel efforts by specialty societies have been put in place to overcome medical inertia. Most American physicians were not taught how to treat obesity, and are not comfortable doing so. It will take time for these historical barriers to be overcome in medicine. A major step in this direction came in 2014 with the recommendations of the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE), to base decisions about medical interventions not on weight alone, but on the burden of disease affecting individual patients. Perhaps the most significant development was the inception of the American Board of Obesity Medicine (ABOM), which is now certifying physicians in obesity medicine.
A major obstacle for patients to have access to the care they need has been the lack of coverage for treatment of overweight, obesity and adiposopathy by third-party payers, including the federal government. It is reassuring that with the implementation of the Accountable Care Act (ACA), payments for medical nutrition therapy services are now covered by the federal government in primary care clinics. This mandate has extended to state programs. Politically, we have started the process of removing obsolete laws that excluded bariatric care from coverage, with bills before the US Congress and state legislatures that address this need.
As we receive 2015, we can look back to significant recent progress in overweight, obesity, and adiposopathy care. And we can look forward to bariatric endocrinology helping us address the central role that adipose tissue pathophysiology plays in the genesis of metabolic disorders.