The year in obesity: New data on semaglutide and tirzepatide, sarcopenic obesity and more
Key takeaways:
- Data from SURMOUNT-OSA and a prespecified analysis of the SELECT trial were among the biggest obesity studies in 2024.
- Researchers also examined differences in physical activity benefits between men and women.
New findings on semaglutide and tirzepatide published in 2024 revealed that the medications may have benefits beyond lowering glucose levels and body weight.
At the Cardiometabolic Health Congress in October, Robert H. Eckel, MD, professor of medicine, emeritus in the division of endocrinology, metabolism and diabetes and division of cardiology, the Charles A. Boettcher II Chair in Atherosclerosis, and professor of physiology and biophysics at University of Colorado Anschutz Medical Campus, discussed new data published in 2024 on the impact of pharmacotherapy, physical activity and diet on obesity. Among the data Eckel discussed were findings from the SURMOUNT-OSA trial, which assessed the impact of tirzepatide (Zepbound, Eli Lilly) on apnea-hypopnea index and body weight for adults with obesity and obstructive sleep apnea (OSA); and a prespecified analysis of the SELECT trial examining the effects of semaglutide (Wegovy, Novo Nordisk) on cardiovascular outcomes for adults with obesity and heart failure (HF).
Tirzepatide approved for OSA
SURMOUNT-OSA consisted of two phase 3 trials in which adults with obesity and moderate or severe OSA were randomly assigned to once-weekly tirzepatide or placebo for 1 year. One trial enrolled adults not using positive airway pressure (PAP) therapy and the second included only adults using PAP therapy. In both trials, tirzepatide was associated with significant reductions in both apnea-hypopnea index events and body weight.
“Tirzepatide also reduced high-sensitivity C-reactive protein, systolic blood pressure and sleep-related patient-reported outcomes,” Eckel said during a presentation.
In December, the FDA approved a new indication for tirzepatide to treat moderate to severe OSA plus obesity. Read more of Healio’s coverage on the SURMOUNT-OSA trial.
Semaglutide benefits in HF
In an analysis of data from the SELECT trial, researchers compared CVD outcomes for adults with and without HF receiving semaglutide vs. those receiving placebo. At 48 weeks, adults receiving semaglutide had lower risk for CVD events, HF endpoints, CV death and all-cause mortality than the placebo group.
Risk reductions were observed in adults with and without clinical HF. The reductions in risk were also observed among adults with HF with preserved ejection fraction and those with HF with reduced ejection fraction.
“These findings could facilitate prescribing and result in improved clinical outcomes for this patient group,” Eckel said.
Sarcopenia increases mortality risk
A cohort study published in JAMA Network Open found a link between sarcopenia — defined as a body composition with a high percentage of fat mass or low appendicular skeletal muscle mass plus low handgrip strength — and all-cause mortality.
Of 5,888 adults (mean age, 69.5 years), 11.1% had probable sarcopenia and 2.2% had confirmed sarcopenia. Both probable sarcopenia (HR = 1.29; 95% CI, 1.14-1.47) and confirmed sarcopenia (HR = 1.93; 95% CI, 1.53-2.43) were associated with higher risk for all-cause mortality compared with no sarcopenia.
Eckel said the study of sarcopenia is crucial with the increasing use of GLP-1 receptor agonists in obesity treatment.
“When we think about the prevalent use of GLP-1 receptor agonists, you lose a lot of body fat with those drugs, but you lose muscle mass also,” Eckel said. “When people regain the weight when they stop [GLP-1 therapy], they are gaining mostly fat mass back.”
Physical activity benefits differ by sex
A prospective study published in the Journal of the American College of Cardiology found physical activity conveys a greater reduction in all-cause and CV mortality risk for women compared with men. The study included 412,413 adults without coronary heart disease in the U.S. who reported physical activity from 1997 to 2019.
The maximal survival benefit with 300 minutes of moderate to vigorous physical activity per week was an HR of 0.81 for men and an HR of 0.76 for women. Leisure-time physical activity reduced the risk for all-cause mortality by 24% for women and 15% for men.
Read more of Healio’s coverage of the study.
Caffeine may benefit cardiometabolic health
In an analysis of data from the UK Biobank, researchers found drinking moderate amounts of caffeine daily could lower one’s risk for multiple cardiometabolic diseases.
In a study published in The Journal of Clinical Endocrinology & Metabolism, adults who drank 100 mg or more of caffeinated beverages such as coffee or tea each day had lower risk for cardiometabolic diseases, including type 2 diabetes, CHD and stroke, than those who drank less than 100 mg of caffeine daily. Those who consumed 2.6 to 3.5 drinks of coffee per day or 200 mg to 300 mg of caffeine daily had the largest reduction in cardiometabolic disease risk.
Read more of Healio’s coverage of the study.
A new definition for obesity
A report that is expected to be published in January could shed new light on how to define obesity as a disease.
Eckel said The Lancet Commission, a group of obesity experts formed by The Lancet Diabetes & Endocrinology and King’s Health Partners, was asked to come up with objective criteria for diagnosing obesity as a disease and for establishing a distinction between clinical and preclinical obesity based on obesity-related abnormalities in the function of tissues, organs or the individual as a whole. Eckel is one of the committee’s 56 members.
“The idea of obesity as a stand-alone disease entity remains highly controversial, both within and beyond medical circles,” Eckel said. “The question to recognize obesity as a disease is hindered by implicit limitations in the way we define and measure obesity today. BMI may under- or overestimate the condition.”
The commission’s report is expected to be published in The Lancet Diabetes & Endocrinology in mid-January, according to Eckel.
References:
Benz E, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.3604.
Deanfield J, et al. Lancet. 2024;doi:10.1016/S0140-6736(24)01498-3.
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Eckel RH. Late-breaking clinical trials: Obesity/Lifestyle. Presented at: Cardiometabolic Health Congress; Oct. 17-19, 2024; Boston.