Melanie Cole, MS (Host): The U.S. Food and Drug Administration has approved Eli Lilly and Company's obesity management drug tirzepatide. While the approval of the drug marks a step forward, getting this class of drugs to the right patients who need them continues to be the challenge. Today, we're talking about changing the conversation around obesity. Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. Joining me is Dr. Robert Kushner, professor of Endocrinology and Medical Education at Northwestern Medicine. Dr. Kushner, I'm glad to have you join us today. As I mentioned in my intro, the new obesity management drug tirzepatide was approved. Can you tell us a little bit about that and how it was approved for patients who are overweight or have obesity with weight-related medical problems?

Robert Kushner, MD: Sure. First of all, I'm happy to be here, Melanie. Thank you for having me. Tirzepatide represents a new class of highly effective medications called dual agonists. It combines two gut hormones into one molecule—GLP-1, known from other drugs like liraglutide or semaglutide, and another gut hormone called GIP. This dual action results in greater weight loss and suppression of appetite. Tirzepatide has already been approved for treating type 2 diabetes under the trade name Mounjaro. It was recently approved for weight management under a different trade name, ZepBound.

Melanie Cole, MS: Now, this is approved for weight loss, correct?

Dr. Kushner: It is. The drug was approved by the FDA a few days ago under the trade name ZepBound. It is the exact same compound as the one used for diabetes but with a different trade name.

Melanie Cole, MS: That's interesting and timely. In your clinical experience, Dr. Kushner, what challenges have you faced when attempting to shift the focus of obesity discussions from weight loss to broader health considerations? Because, as an exercise physiologist myself, I've seen that this is a challenge we all face in those discussions. Even when discussing childhood obesity with our children, keeping that discussion around health concerns, not just weight gain.

Dr. Kushner: For too long, we have focused on weight loss, often what brings patients into their healthcare professional. Changing the conversation from just weight loss to improved health is crucial. Weight is just one marker of health, and we need to move away from the scale when measuring success. We should focus on improved quality of life, increased functioning, improved self-esteem and a reduction in diabetes or the need for hypertension medications. Part of this is rooted in societal stigma and bias against individuals living with obesity. When people hear they're too overweight, they focus on "I need to lose weight, and life will be better." So, we're not only trying to change the minds of individuals seeking help but also among other healthcare professionals and society at large.

Melanie Cole, MS: Well, that's an important point, Dr. Kushner. For providers, which these episodes are for, it's important to note that those discussions can be uncomfortable and awkward but are vital. It's really crucial that we get it right when we have a chance to discuss that with our patients. I'd like you to speak about the SELECT trial, part of the semaglutide 2.4 trial for preventing cardiovascular events, and the new SELECT trial data that's come out.

Dr. Kushner: This is a landmark study recently published in the New England Journal of Medicine and presented at the American Heart Association meeting. For the first time, a medication approved for weight management has reduced cardiovascular events in individuals with overweight or obesity and pre-existing cardiovascular disease — by 20%. These 17,000 individuals worldwide were already receiving optimal management for their cardiovascular disease, yet the drug still resulted in a 20% reduction in major cardiovascular events. This is unprecedented and may change how we manage individuals at high risk due to their underlying obesity.

Melanie Cole, MS:  There are so many comorbid conditions that come with obesity. Do you think there's a need for a paradigm shift in medical guidelines or recommendations regarding obesity management to better align with a holistic health approach? We need to look at people with obesity as a whole, considering all those comorbid conditions, such as high blood pressure and cardiovascular events.

Dr. Kushner: Absolutely. We need a holistic approach. Traditionally, we've viewed obesity as a condition people bring upon themselves, attributing it to lack of willpower or motivation. Now, we recognize obesity as a chronic, progressive disease, similar to diabetes or hypertension. It underlies many other complications and comorbidities. A slow change is happening, recognizing obesity as a disease and incorporating it into the management of patients with related problems. The American Heart Association's recent advisory renamed metabolic syndrome to cardiovascular kidney metabolic syndrome, emphasizing the foundational role of weight management in treating these complications.

Melanie Cole, MS:  In your experiences and incredible expertise in this area, what would you say to other physicians about how they can contribute to destigmatizing obesity and promoting a more inclusive and supportive healthcare environment? Have you found varying attitudes or perspectives on shifting that conversation? And, how can the medical community work together to foster a more unified approach?

Dr. Kushner: Healthcare professionals vary in their attitudes, and while some are changing, there's still a long way to go. We need to examine our biases and stigma when seeing patients. The words we use matter when discussing overweight or obesity, and we must be sensitive and empathetic. Stigmatizing words lead to internalization and hinder progress. Asking permission to approach the topic and being proactive in patient care are essential. It starts with recognizing our internal biases, the words we use and our attitudes toward individuals living with obesity.

Melanie Cole, MS:  Thank you. As we wrap up, what approach does the Northwestern Medicine Center for Lifestyle Medicine take, and what aspects of these initiatives make them successful?

Dr. Kushner: The Center for Lifestyle Medicine at Northwestern Medicine is an interdisciplinary group practice with medical providers, registered dietitians and health psychologists. We take a holistic approach to help individuals manage their weight and improve their health. Our services range from foundational lifestyle management to intensified therapy, including pharmacotherapy with drugs like semaglutide and tirzepatide, and bariatric surgery services. At the heart of what we do is respect and trust in working with our patients.

Melanie Cole, MS:  What an educational and informative episode this was, Dr. Kushner. Thank you for joining us today. For more information or to refer your patient, please visit our website at breakthroughsforphysicians.nm.org/endocrinology to connect with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. Please remember to subscribe, rate and review this podcast and all other Northwestern Medicine podcasts. I'm Melanie Cole. Thanks for joining us today.