GLP-1 therapies key to Australia’s new obesity and CVD treatment guide

The National Heart Foundation of Australia presented Australia’s first clinical consensus statement on obesity and cardiovascular disease (CVD) at the WHO World Health Assembly in Geneva. 

The statement is the first to provide clear advice for the use of Glucagon-Like Peptide-1 (GLP-1) therapies for the treatment of obesity and CVD.

InSight+ spoke to Prof Garry Jennings AO, Heart Foundation Chief Medical Advisor and Co-chair of the consensus statement task force from Geneva, where he said the appetite for a practical approach to obesity and cardiovascular disease (CVD) was universal.

“There are a lot of commonalities, and of course it's very different in high-income countries like Australia, where we've got very high rates of obesity that have plateaued. We've got to get them down,” said Prof. Jennings.

“There are also a lot of low- and middle-income countries where the pace is still accelerating. We’ve got to blunt that acceleration and bring it down again. In both cases, there are two levels to it,” he said.

“One is that we live — around the world — in an obesogenic environment. As obesity rates have increased in the last 20-30 years, it’s not that people have changed; the world around them has changed. That's been an important theme at this World Assembly: what we can do about it.”

“This Consensus Statement is about what clinicians can actually do. What health professionals do with the person in front of them who's at high risk already, who has cardiovascular disease, or whose overweight is contributing to their risk.”

“It's timely, because we've got GLP-1 therapies available for the first time, which not only help people control their weight, but also have consequences in terms of reducing cardiovascular events and improving outcomes.”

Australia leading the world in GLP-1 guidance

Prof. Jennings said that GLP-1 therapies (including semaglutide, liraglutide and tirzepatide) are changing the game.

“They have changed what is possible in obesity care. This statement shows how to use them safely and appropriately to improve heart health.”

“This is a line-in-the-sand moment for cardiovascular care in Australia. Obesity must be addressed early, seriously, and as part of lifelong heart health.”

Prof. Jennings said that the WHO recognised the Consensus Statement as a world first, and asked the task force to present at Geneva.

“The WHO has recently issued a statement about the availability of GLP-1 treatments around the world. The World Heart Federation had produced a roadmap for obesity. Both organisations saw our consensus statement as the first that took a practical view of these very broad and general statements, to put them into action in a clinic.”

“We got a very encouraging reception and many, many requests from other countries to adapt to their own systems.”

The Consensus Statement: a practical guide

The Consensus Statement provides practical recommendation for the management of obesity and CVD, with many guides available on the Heart Foundation website. 

It recommends managing obesity and CVD risk via four pillars:

1. Nutrition;
2. Physical Activity;
3. Clarity on the use of weight loss drugs, which carry some heart health benefits beyond just weight loss; and
4. And when and how to recommend weight loss surgery (metabolic bariatric surgery).

Cardiometabolic health is a key pillar of the National Heart Foundation’s 25-year vision to reduce heart disease across Australia, Health for Every Heart.

An industry-wide approach

Prof Jennings said that the statement is a positive one, but that there is a lot of work to do.

“We are optimistic, because it's a new world, with more pathways to help people at high risk for CVD with obesity or overweight. It's positive. But we’ve still got to get all our ducks in a row.”

“We've got to deal with the food supply. We've got to deal with the increasingly sedentary lifestyle, and then we've got to work out how to fit these new therapeutics into the health system.”

“The one thing we already knew was that this is not something one particular medical specialty can deal with. It needs to be a broad variety of disciplines, within the health profession, from allied health to clinicians to specialists.”

“This is a postcode condition, like a lot of non-communicable diseases, and there's a very real risk with new treatments that they can be expensive.”

“The people who need them the most are going to get the least access. So we're very concerned about those who have experienced a disproportionate burden of overweight and obesity.”

“And of course they include culturally and linguistically diverse communities, First Nations people, people in rural and remote areas, people with other kinds of socioeconomic disadvantage, people with mental health conditions, and women.”

“First nations people often have a double whammy if they're disadvantaged by being in rural and remote communities, without access to the specialised care, which comprehensive obesity clinics can provide. And of course they suffer a disproportionate burden with not just cardiovascular disease, but also type 2 diabetes, chronic kidney disease, and other medical conditions.”

“Aboriginal led health care is key, here. It’s much more likely to be culturally appropriate and tailored to the environment, the situation in which people find themselves.”

“So we are trying, in this statement, to be cognisant that they're going to need greater emphasis in management.”

“This needs to be a holistic approach to the patient, not specialty by specialty.” 

GPs key to long-term health management 

Prof Jennings said that GPs are key to the long-term success of the strategy. 

“Hopefully we've given them a guide to the here-and-now. This is a rapidly changing field with many, many new pharmaceuticals under development which might change the scene. At the moment, we're in a transition as far as regulation and reimbursement is concerned.”

Prof Jennings said that while some treatments are not currently listed on the PBS, it is a fast-paced environment. 

“The very first Glutide is now generic. It's now off patent.”

“There are also many companies developing other agents in different forms. And one thing that will bring prices down, and help with availability, and help the PBS in making its decision based on cost benefits, is competition.”

“Whatever happens, the important thing will be the recognition that this is a chronic, relapsing condition.”

“It's not the individual's fault, but the individual is suffering the consequences. That it needs a comprehensive care program, not just a prescription, but nutrition, physical activity, testing for comorbidities.”

“It’s GPs who will be at the centre of this, and those who can support GPs through well-oiled health expertise.”