InnovaTalk 22/5: Obesity and Novel Advanced Treatments

On May 22, VinFuture Foundation successfully orchestrated the inaugural 2024 InnovaTalk webinar titled "Obesity and Novel Advanced Treatments," attracting the participation of nearly 180 leading scientists and experts from 22 countries.

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Chaired the webinar was Prof. Alta Schutte (Australia), Member of the VinFuture Prize Pre-Screening Committee. Distinguished Speaker of the webinar was Prof. Jens Juul Holst (Denmark), Laureate of the 2023 VinFuture Special Prize for Innovators with Outstanding Achievements in Emerging Fields. Representing the Vietnamese medical community was Dr. Nguyen Quang Bay, MD, PhD, Head of Department of Endocrinology, Bach Mai Hospital, Vietnam. He is also the Chief of Division of Endocrinology, Department of Internal Medicine, Hanoi Medical University.

At the webinar, the speakers discussed new applications of Glucagon-like peptide-1 (GLP-1) receptor agonists in advanced obesity medications. These medications not only help individuals achieve their weight loss goals more rapidly but also reduce the incidence of side effects, such as nausea and stomach pain. Beyond the scientific evaluations, the speakers also addressed the current status of drug dissemination and obesity treatment both globally and in Vietnam.

GLP-1-based treatments for obesity and future directions

In his presentation, Prof. Holst explained that GLP-1 is a product created through the cleavage of proglucagon in the small intestine. GLP-1 has a role in stimulating insulin secretion and inhibiting glucagon secretion. Insulin and glucagon are 2 hormones that have opposite effects in blood glucose regulation. While glucagon works to increase blood glucose levels, insulin is a hormone that works to reduce blood glucose levels.

In 1994, Assoc. Prof. Annemarie Hvidberg’s team (Department of Endocrinology, Hvidovre Hospital, Copenhagen, Denmark) discovered the role of GLP-1 in blood glucose regulation through insulin stimulation and inhibition of glucagon secretion. Later in 1998, the study of Dr. Anne Flint et al. (Research Department of Human Nutrition, Center for Food Research, The Royal Veterinary and Agricultural University, DK-1958 Frederiksberg C, Denmark) reported GLP-1’s role in suppressing appetite and reducing food intake. Prof. Holst stated that although GLP-1 does not penetrate the brain, it can achieve such effects by producing stimulation signals to the central nervous system.

Natural GLP-1 is easily broken down by the DPP-4 enzyme and is also rapidly excreted by the kidneys, so one cannot use natural GLP-1 as a drug. Therefore, to develop therapeutic drugs, one needs to change the structure of the molecule to prolong the duration of the drug’s effect in the body.

Trials have shown that GLP-1 RA has many positive effects, such as reducing the risk of major adverse cardiovascular events (MACE). As a result of the SELECT trial, Semaglutide reduced the risk of MACE by 20% in overweight and obese adults and reduced the risk of type 2 diabetes onset by 73%. In addition, GLP-1 RA effectively reduces the risk of stroke that other diabetes medications do not. Semaglutide has been shown to reduce the incidence of primary stroke and slow renal function decline in patients with diabetes mellitus.

In addition, Prof. Holst presented evidence of the weight loss effects of GLP-1 RA drugs. In particular, if Liraglutide could only reduce about 7.8% of body weight after 52 weeks, Semaglutide is significantly stronger when it could reduce over 16% of body weight after 68 weeks when using a dose of 2.4 mg/week.

One new advancement mentioned by Prof. Holst was the introduction of Tirzepatide which is known to have a superior agonist effect with a weight loss effect of up to 25.8% after 88 weeks.

Although GLP-1 RA drugs are considered safe, Prof. Holst still reminds some potential risks such as undesirable effects with very low frequency. In addition, the professor said that only about 40% of patients maintain the use of the drug after a year, and emphasized that for diabetic and obese patients, regardless of treatment with any medication, it is still necessary to develop and maintain a healthy lifestyle to control the disease at the best level.

At the end of the presentation, Prof. Holst concluded that GLP-1 is an important incretin hormone in controlling appetite and affecting food intake and is expected to fundamentally change future therapies and treatments for obesity and diabetes. Furthermore, drugs developed based on GLP-1 have proven effective in protecting cardiovascular, renal, and neural health, which is a testament to its wide-reaching impact.

Challenges and Unmet Needs for Obesity Management in Vietnam

Obesity has become increasingly prevalent in Vietnam, emerging as a significant public health concern. Dr. Bay emphasized that obesity is associated with many diseases with very high morbidity and mortality rates such as diabetes mellitus, cardiovascular diseases and cancers. In addition, he also highlighted the serious effects of overweight and obesity on the economy and creating a great burden on the health system in Vietnam.

So far, the Prime Minister of Vietnam has approved the National Nutrition Strategy for the 2021 – 2030 period, with a vision toward 2045. Accordingly, the Ministry of Health has also issued Obesity Management Guidelines. Dr. Bay said that in the current treatment of obesity, three main methods are applied: (1) Intensive lifestyle therapy, which is not effective due to poor patient compliance; (2) Bariatric surgery, which is the most effective but costly; and (3) Medication, which utilizes highly effective weight loss drugs such as Orlistat and Liraglutide, but these are not covered by health insurance.

Dr. Bay pointed out that there are still many challenges in the process of managing and treating obesity in Vietnam. Although there are already National Guidelines for the Treatment of Obesity, they have not been widely implemented due to a lack of resources. Moreover, due to financial barriers, some people in Vietnam seek “traditional medicine” or unknown medicine treatments to treat obesity, which carry serious risks.

Based on the analysis of the current situation, difficulties and challenges, Dr. Bay proposed several solutions: (1) Establishing more multidisciplinary centers for the treatment of obesity; (2) Proposing the Ministry of Health approve new weight loss drugs that are very effective but currently not available in Vietnam, such as Semaglutide and Tirzepatide; (3) Having the government provide health insurance for the treatment of obesity; and (4) Carrying out more media campaigns to promote healthy lifestyles for everyone.

Summing up the presentation, Dr. Bay once again highlighted the rapidly increasing trend of obesity in Vietnam, but the control and treatment of this disease is still difficult and challenging. Although GLP-1 RA drugs are effective for weight loss, they are still expensive and difficult to access for most patients in Vietnam. Therefore, it is essential to implement more effective obesity prevention and management strategies and programs in Vietnam.

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