The future of weight loss medications in GI care

Gastroenterologists are taking an increased interest in prescription weight loss medications and their impact on GI care. 

In June, the American Journal of Gastroenterology focused an entire issue on obesity in gastroenterology, discussing issues including population trends in obesity, food insecurity, how obesity affects predisposition to diseases and response to therapies, treatment and therapies and a multidisciplinary approach to obesity.

Benjamin Levy III, MD, a gastroenterologist at the University of Chicago Medicine, told Becker's that he has high hopes for the future of weight loss medications and their ability to improve gastroenterology care for patients. 

Dr. Levy: During clinic, I always evaluate patients for obesity by calculating their body mass index and then provide guidance and lifestyle modification tips. After documenting their BMI in the chart, I counsel each patient on nutrition recommendations and exercise. Lifestyle modifications should be used before jumping to medications. It's important for gastroenterologists to ask patients about specific food consumption over the past three days, so we can provide helpful nutrition advice. I also ask patients about their exercise habits over the past two weeks. I'm constantly encouraging patients to avoid eating fatty foods, fried foods, excess carbohydrates, sugary drinks and highly processed foods to help with weight loss.  

Over the past year, a huge surge of patients have been requesting weight loss medications - especially the GLP-1 receptor agonists. The CDC has estimated that the obesity prevalence in America was 41.9% between 2017 and 2020, so these new weight loss medications are very much needed. GLP-1 receptor agonists work by slowing gastric emptying, which helps patients feel full and consume less calories. As gastroenterologists, we need to keep track of patients on the GLP-1 agonists to help them prepare for colonoscopies, EGDs and other surgical procedures. Notably, the American Society of Anesthesiologists has suggested holding GLP-1 receptor agonists prior to procedures due to case reports of aspiration. It's super important for gastroenterologists, ASCs and hospitals to educate patients about specific recommendations for holding these new medications to prevent endoscopy cancellations.  

2024 is an amazing time in medicine because we now have the ability to significantly decrease rates of obesity without the need for invasive procedures - and hopefully prevent complications such as diabetes and heart disease. I encourage gastroenterologists to work with primary care physicians, endocrinologists and weight loss clinics to identify patients who might benefit from Ozempic, Wegovy or Zepbound. Over the next few years, hopefully these amazing new medications will help prevent metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis, liver conditions which are beginning to overwhelm our GI clinics. In addition, we hope that the GLP-1 receptor agonists decrease rates of obstructive sleep apnea nationally - a chronic condition which makes our EGD and colonoscopy procedures more difficult.   

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