Severe and complex obesity will soon be consigned to medical history due to new drugs and improved treatments, the Irish Medical Organisation’s annual conference has been told.
Most young doctors now starting their training will almost never encounter the kind of obesity seen today, but the high cost of the new medicines, however, will mean governments have to provide additional funding, according to Prof Donal O’Shea, the HSE’s national clinical lead for obesity.
Prof O’Shea said the transfer this month of the HSE’s obesity section from the health service’s Healthy Eating, Active Living programme to its chronic disease management one was symptomatic of the wider shift in attitude that has yielded better funding for treatment and outcomes for patients.
Drugs like Ozempic, he said, had represented a major breakthrough, producing hugely beneficial results for around 30 per cent of patients and positive ones for as many again. Clinical testing, already underway, of the next generation of drugs suggests they are much better and will benefit more people with far less severe side effects.
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The World Health Organisation says roughly a quarter of Irish adults are suffer from obesity and the condition is linked to illnesses like cancer, heart disease and type 2 diabetes.
“It’s an incredibly exciting time to be working in the field of obesity,” Prof O’Shea told IMO members in Killarney, Co Kerry, on Friday. “Obesity is going to be an historical phenomenon. It’s mad.”
He quickly qualified the statement, acknowledging the cost of the new drugs would mean the need for additional funding if those who could not afford to pay themselves were to benefit before the patent on branded drugs expired and generics became available. However, he said the economics of obesity and related health conditions meant paying for the treatments would make sense from the point of view of governments.
Widespread changes in attitude, including among politicians who had found obesity “an easy thing not to fund”, have come “after 25 years of work on the issue,” he said.
He credits current Minister for Health with a much more enlightened take than some of his predecessors, something he has backed with improved funding.
“If you look back historically there have been diseases that were stigmatised, poorly understood, and then the understanding got better and the treatment got better,” he said. “Epilepsy was demonic possession. Peptic ulcer disease was an inability to handle stress and smoking and then they discovered the helicobacter pylori infection that causes peptic ulcer disease.
“So, with obesity the simplistic narrative is ‘eat less, move more, and just go away and lose weight’. But we know that that doesn’t work for 90 per cent of people. And now we have treatments that are effective for obesity and our understanding of the disease of obesity is improving. It is being recognised as a chronic disease, and that has important implications for treatment.”
A particular leap forward, he said, was the result of “healthcare providers listening to the patient voice and then the advent of treatment, the emergence of Ozempic”. That has in turn changed attitudes because “if it’s treatable, the view is it must be a disease”.
New drugs will take time to hit the market but ultimately “Ozempic will be regarded like the early blood pressure treatments we had; crude, lots of side effects, effective for some people but ultimately obsolete”.
The impact will, he anticipates, be on a similar scale to the one already seen in the treatment of type two diabetes, with patients experiencing hugely improved outcomes.
“My hope is that because Ireland is going to be a demonstration platform for the WHO, the drug companies will look to have the pharmacotherapy available in Ireland as a priority country because other countries would be looking at us,” he says. “I’m hoping to use the WHO’s interest to leverage the pharma companies to come in early to Ireland and then to leverage the Department of Health and the Minister for Health to fully fund our model because our model of care is currently 50 per cent funded. To work properly it needs to be fully funded.”
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