‘Critical role’ of GLP-1s addressed in Australian-first obesity consensus

A new, Australian-first clinical consensus statement has stressed the potential for medications such as GLP-1s to help cut cardiovascular disease risk through obesity management.
 
Led by the Heart Foundation, the Clinical Consensus Statement on Obesity and Cardiovascular Disease, which was developed over 12 months with input from a 22-person taskforce including three GPs, was launched on Monday at the World Health Assembly in Geneva.
 
As well as pharmacotherapy, the consensus statement, which has not yet been endorsed by the RACGP, offers guidance on three other distinct areas: nutrition, physical activity, and when metabolic bariatric surgery is recommended.
 
It describes the ‘critical role’ of both surgical interventions and incretin-based medicines including GLP-1 receptor agonists, saying the latter have ‘changed the landscape of obesity management’.
 
‘High-quality trials have demonstrated incretin-based medicines improve cardiometabolic risk factors and, in some cohorts, reduce the risk of major adverse cardiovascular events,’ the statement reads.
 
However, it states ‘pharmacotherapy should complement, not replace, behaviour modifications’.
 
Professor Garry Jennings, the Heart Foundation’s chief medical adviser, said he hopes the statement is a ‘line-in-the-sand moment’ for cardiovascular care, pointing to a changing risk profile in Australia.
 
‘Two out of three Australians are now living with obesity or overweight,’ he said.
 
‘That is a big change from decades ago, and Australians haven’t changed. What’s changed is the environment in which we live, and that’s driving obesity rates, not just in Australia, but around the world.
 
‘[Obesity is] a community problem, it’s a population problem, and it’s one that contributes to damage to the heart and blood vessels, it increases rates of various forms of cardiovascular disease, and of course many other conditions as well.’
 
He also said with rapidly emerging medications ‘health professionals need very practical, evidence-based guidance, particularly in the light of the widespread use of social media, to comment on these new treatments’.
 
The consensus statement’s release comes after the Pharmaceutical Benefits Advisory Committee (PBAC) recommended the Federal Government list semaglutide (sold as Wegovy) on the PBS for those with established cardiovascular disease with obesity.
 
A subsequent PBAC report reiterated that any GLP-1 obesity treatments on the PBS should prioritise high-risk groups including patients with cardiovascular disease, before broader subsidies kick in.
 
A listing is yet to be confirmed, and Professor Jennings said it is hard to comment about negotiations taking place behind closed doors.
 
‘Firstly, it’s a very fast-moving area,’ he said.
 
‘Secondly, it’s not just a health decision that has to be made. They need to look at cost-benefit. There are commercial considerations and information … being looked at both by the PBS and provided by the companies which we’re not party to.
 
‘All we can say is that we want to see medications or any treatments indeed that are evidence-based, that are proven, available to people that need them and hopefully at minimal cost.’
 
He remarked that more available products will mean more competition.
 
‘Hopefully that would help address some of the present barriers,’ he said.
 
‘At the moment there’s a real risk that the people that need them the most, who are disadvantaged in one way or another … are the ones that are not getting these compounds.’
 
Dr Mark Mellor, a GP with a special interest in obesity management who sat on the taskforce for the statement, says it ‘offers really clear practical clinical guidance’ for GPs to manage people with obesity and with, or at risk of, cardiovascular disease.
 
‘The statement emphasises that these two conditions are not necessarily separate, that there is this interconnectedness between them, and that actually not treating the obesity in a person with cardiovascular disease misses an opportunity to improve the health of that person,’ he said.
 
He also said the statement, which also addresses stigma, emphasises that obesity is ‘a chronic relapsing, lifelong condition’, and that behavioural modification will remain a core part of treatment.
 
‘The foundational treatment for obesity and for cardiovascular disease will always be around behavioural modification, but the statement does highlight that practitioners need to think about escalating treatment, and it gives clear pathways for how to go about that,’ Dr Mellor said. 
 
‘But for some people that might not work, and it might be ineffective, and I think that the statement gives a really clear pathway about when we should be considering escalation to pharmacotherapies that are indicated for weight management and for cardiovascular disease, and even surgical treatments.’
 
He said working together with other health professionals is also important, describing the support of a dietitian as ‘the optimum level of care’.
 
Involving other health experts is also emphasised by Professor Jennings.
 
‘It’s very hard for a GP in a 15-minute, 20-minute consultation or even shorter to deal with all these things and there are proven benefits from involving dietitians, exercise physiologists, people with exercise expertise, psychologists can be important,’ he said.  
 
‘It’s a matter of building a virtual team, which generally involves the family too, around somebody who’s really struggling with dealing with an obesity management problem.’
 
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