GLP-1 Agonist Safety Risks and Obesity Stigma with Kevin Peterson, MD, MPH

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Peterson reviews the gastric and hormonal events linked to drugs like tirzepatide, before considering whether incretin therapies will help to finally embrace obesity as the medical condition it is.

In a previous interview with HCPLive during the American Academy of Physician Associates (AAPA) 2024 Conference & Expo in Houston, TX, this week, Kevin Peterson, MD, MPH, had notably high praise for incretin therapies in his fields of care.1

Peterson, a professor in the department of family medicine and community health at the University of Minnesota and vice president of the American Diabetes Association (ADA), said he believed incretin therapies would “change the whole paradigm” of diabetes therapy. As has been continually covered by HCPLive, he’s not necessarily alone in that assessment.2

However, there are underlying details of incretin therapies that may be under-addressed during an era of peaked public interest in agents like semaglutide and tirzepatide. In the second segment of an interview with HCPLive during AAPA 2024, Peterson discussed the potential shortcomings and clinical risks associated with incretin therapies.

“I'm sure that it's easy enough to get to get an exaggerated expectation (of these drugs),” Peterson said. “I think we have to moderate those until we have evidence. You know, you see people making all sorts of claims on the internet. And honestly, they just don't have science behind them.”

Peterson explained that while in particular the GLP-1 receptor agonist drug class comes with few notable adverse event risks, it’s not necessarily perfectly safe. Gastrointestinal complications—including nausea, vomiting, constipation and gastroesophageal reflux—can frequently occur.

“The idea that people might eat less or drink less, become dehydrated—that could cause problems with acute kidney injury,” Peterson said. “I think one of the side effects that we see with tirzepatide that's probably not all that well known is that it decreases the effectiveness of birth control pills. We see if we have young women that are taking this, we have to be careful, because the likelihood of pregnancy will increase if they are using an oral birth control agent.”

Overall, however, the incretin therapies carry a robust benefit-risk profile, and possess the potential to achieve the paradigm-shifting effect that Peterson predicted for cardiometabolic disease. The drug class may be efficacious enough to even help change discourse surrounding obesity medicine itself—helping to improve messaging around obesity and overweight being treatable, biologically-driven condition and not indictments on patient lifestyle.

“I think that one of the impacts is that we see that this is a chemical thing. This isn't a character thing,” Peterson said. “People are genetically predisposed to a disease, and this is a chronic condition. And I hope that it helps us decrease that stigma and that discrimination.”

References

  1. Kunzmann K. Kevin Peterson, MD, MPH: Incretin Therapy's Potential. HCPLive. Published May 18, 2024. https://www.hcplive.com/view/kevin-peterson-incretin-therapy-potential
  2. Kunzmann K. The 6 Biggest Stories in Medicine in 2023. HCPLive. Published December 1, 2023. https://www.hcplive.com/view/6-biggest-stories-medicine-2023
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