CRS 2017: Cardiometabolic Disease and Obesity: A Q&A With Dr Donna Ryan

Cardiometabolic risk reduction is at the core of nearly every clinician’s practice, given the prevalence of these conditions - hypertension, diabetes, dyslipidemia, and obesity - among the US population. Nearly 10% of American adults have diabetes, nearly 30% have hypertension, and nearly 35% are obese, meaning that helping patients manage their cardiometabolic health likely is one of the most common components of daily practice.

Consultant360 recently spoke with Dr. Donna H. Ryan, the executive director at Pennington Biomedical Research Center in Baton Rouge, Louisiana, about treating and managing patients with cardiometabolic disease.

Consultant360: What do you feel are the key issues contributing to the continued growth of the cardiometabolic disease epidemic in the US?

Donna Ryan: The cardiometabolic disease epidemic is actually a syndemic—2 or more epidemic diseases that are biologically related and have social and cultural underpinnings. The obesity epidemic is driving insulin resistance, dyslipidemia, and hypertension—essentially a prothrombotic and proinflammatory state—all of which culminate in diabetes and cardiovascular diseases. Obesity increases risk for stigma, stress, chronic pain, and depression.  These conditions and their treatment further exacerbate weight gain and cardiometabolic risk.  This vicious cycle is also exacerbated by poverty and personal violence. 

To successfully address cardiometabolic diseases, 2 approaches are essential. First, knowledgeable health care providers are needed who can address weight management and risk factor control. Second, the social support systems in our communities must create safe and supportive environments where healthy eating and active living are default conditions. 

C360: What is the biggest misconception about cardiometabolic disease?

DR: Cardiometabolic disease is THE public health challenge of the 21st century. It isn’t a collection of risk factors that lead to disease; it is a disease itself. 

C360: Why are primary care clinicians so critical in the management of patients with cardiometabolic risk factors?

DR: Primary care clinicians are the front line of defense in the cardiometabolic disease epidemic.  The prevalence is such that primary care clinicians must engage in this issue. We don’t have the manpower for a specialist approach!

C630: What do you feel is the greatest challenge for primary care clinicians in the prevention and treatment of obesity and overall cardiometabolic risk?

DR: Good weight management is not just the purview of the office physician. Obesity is a chronic disease and requires a team approach. An office team focused on helping patients with the lifestyle intervention approach to weight management is essential.

C360: If you could give primary care providers one piece of practical advice to improve the management of obesity and also overall cardiometabolic risk in daily practice, what would it be?

DR: Don’t make weight gain worse! Many of the drugs prescribed for other medical conditions (such as antidepressants, antipsychotics, progesterone, and other agents) are driving weight gain in susceptible patients. It is very important to understand and implement approved guidelines and recommendations appropriately in your practice.

C360: How can pharmacologic interventions help in weight loss management?

DR: Patients struggle to lose and maintain lost weight—because of the biology of the reduced obese state. Metabolic adaptation and physiologic changes in appetite regulation that accompany weight loss are the challenges. Some patients need medications that act centrally to help them adhere to the diet plan. However, weight loss response to pharmacotherapy is variable, and we can’t predict response in advance. We judge response at 12 to 16 weeks, and, if weight loss is 4% to 5%, we continue. The amount of weight loss achieved is related to the intensity of lifestyle intervention and the drug chosen. If patients succeed with weight loss, continue the medications for the long term.

C360: What are some of the more exciting recent pharmacologic developments in the clinical approach to, or our understanding of, obesity and cardiometabolic disease?

DR: Since 2012, we have 4 new medications that are approved for long-term use in chronic weight management. As never before, we have choices of medications to help with weight management and have reasonable confidence in their safety and efficacy. 

C360: What does the future hold in relation to emerging treatments for or approaches to the management of obesity?

DR: As the biology of body weight regulation and physiology of appetite regulation are elucidated, more targets are being identified and developed as future drugs. On the horizon is an oral GLP-1 agonist that shows the most weight loss to date. 

Dr. Ryan will be presenting "Incorporating Pharmacologic Intervention into Obesity Management Strategies" at our Cardiometabolic Risk Summit on October 22. For more information, visit www.CRSfall.com.