Rapid Clinical Updates: GLP-1 and Obesity Management for Hospital Medicine-Handout

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This document provides a clinical update on obesity and incretin therapeutics for hospitalists. Obesity is a complex, chronic metabolic disease influenced by multiple factors beyond excess caloric intake and inactivity, including medication effects, stress, and sleep disorders. Clinicians are encouraged to avoid weight-promoting medications when alternatives exist. Despite cost and insurance coverage barriers, several FDA-approved and affordable off-label therapies for weight loss, including incretin-based drugs, are available.<br /><br />Lipedema, often misdiagnosed as lymphedema or obesity, is highlighted as important to recognize. Certain incretin therapies, particularly GLP-1 receptor agonists (GLP-1RAs), now promote weight loss comparable to metabolic surgery. GLP-1 exerts diverse effects beyond slowing gastric emptying, with ongoing research expanding understanding.<br /><br />In the context of cardiometabolic disease, GLP-1RAs should be prescribed to reduce cardiovascular (CV) death risk regardless of glucose control (A1C). Diabetes is a major CV risk factor; GLP-1 therapies reduce CV risk in obese patients both with and without type 2 diabetes. Recent randomized controlled trials show cardiovascular benefits of GLP-1 and GLP-1/GIP dual agonists in chronic kidney disease (CKD), nonalcoholic steatohepatitis (NASH/MASLD), heart failure with preserved ejection fraction (HFpEF), obstructive sleep apnea (OSA), and CKD related to diabetes. Large trials for heart failure with reduced ejection fraction (HFrEF), NASH, and cirrhosis are forthcoming.<br /><br />Perioperative management notes uncertain aspiration risks with incretins; shared decision-making is advised regarding drug interruption, balancing symptom control and procedure risk. Longer fasting and rapid sequence intubation are recommended for urgent procedures in patients on these agents.<br /><br />The update includes a table outlining medications associated with weight gain via various mechanisms (e.g., antihistamines, antipsychotics, beta-blockers, corticosteroids, insulin, SSRIs), emphasizing that weight-neutral alternatives should be considered.<br /><br />Overall, the document underscores expanding roles for incretin therapies in obesity and related cardiovascular and metabolic diseases, while acknowledging practical considerations like medication choice and peri-procedure management.

Keywords

Obesity

Incretin therapeutics

GLP-1 receptor agonists

Weight loss

Cardiometabolic disease

Cardiovascular risk reduction

Diabetes mellitus type 2

Chronic kidney disease

Nonalcoholic steatohepatitis

Perioperative management