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

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This educational program provides rapid clinical updates on the role of GLP-1 receptor agonists (GLP-1 RAs) and obesity management in hospital medicine, featuring expert speakers Drs. Marci Laudenslager and Lily Ackermann, moderated by Dr. Ebrahim Barkoudah. It emphasizes obesity as a complex chronic metabolic disease influenced by multifactorial etiologies including genetics, medications, hormonal changes, sleep disorders, and social determinants, beyond the simplistic “eat less, move more” model.<br /><br />Anti-obesity medications (AOMs), particularly GLP-1 RAs such as liraglutide, semaglutide, and tirzepatide, have transformed treatment by promoting substantial, clinically meaningful weight loss. These agents not only aid weight reduction but also improve cardiovascular outcomes—including reducing major adverse cardiovascular events (MACE) and heart failure hospitalizations—and slow diabetic kidney disease progression. Recent landmark trials (e.g., SELECT, SUMMIT) demonstrated 20% reductions in cardiovascular death, myocardial infarction, and stroke among patients with obesity and type 2 diabetes mellitus (T2DM). GLP-1 RAs also impact metabolic dysfunction-associated steatohepatitis (MASH), showing significant resolution of steatohepatitis and fibrosis in clinical trials.<br /><br />Hospitalists should be aware of inpatient and perioperative considerations: GLP-1 RAs delay gastric emptying, increasing risk of regurgitation and aspiration. Guidelines suggest holding these medications prior to elective surgery, typically for a week with weekly dosing, although evidence is evolving. Gastric ultrasound and liquid diets before procedures may help mitigate aspiration risk. Management of side effects (nausea, constipation) involves gradual dose escalation and lifestyle measures.<br /><br />Challenges include access barriers due to cost, insurance issues, and stigma. The presentation underscores the importance of reducing weight bias through language, environmental adjustments, and educating clinicians on obesity’s multifactorial pathophysiology to improve compassionate, evidence-based care.<br /><br />In summary, GLP-1 RAs are pivotal in managing obesity and its comorbidities, improving clinical outcomes beyond weight loss, but require careful perioperative management and efforts to enhance patient access and reduce stigma.

Keywords

GLP-1 receptor agonists

obesity management

hospital medicine

anti-obesity medications

liraglutide

semaglutide

tirzepatide

cardiovascular outcomes

perioperative considerations

weight bias