In Brief:
- The medication can reduce risk of cardiovascular disease and improve quality of life for those living with CVD.
- Nutrition and physical exercise remain the first recommended treatments for obesity and weight management.
Tammy Merton has struggled with obesity for much of her adult life.
She cycled through periods of weight loss and gain — and tried to seek help.
"You turn up at the doctor's and ask for some help — you're pretty much shamed," she said.
After suffering sudden cardiac arrest, which left her with a hypoxic brain injury and a defibrillator, Merton fell into the "cardiac blues" and her weight rose again.
"It was really hard to keep it off, to stay motivated," she said.
"My body didn't want to do all the things I used to do to help me lose weight again.
"I didn't want to go to the doctors and ask for help."
Merton's lived experience has informed Australia's first Clinical Consensus Statement on Obesity and Cardiovascular disease, which has endorsed the use of Semaglutide or GLP-1 medications for weight management in those at risk of cardiovascular disease (CVD).
"This is a huge step forward," Merton said.
"We'll find that more people suffering from more than one issue are going to get far better help now."
Launched at the World Heart Summit in Geneva, Switzerland, the statement was designed by a national task force of experts, healthcare practitioners and lived experience advocates.
"It's really the gold standard for managing obesity in people who already have heart disease or are at high risk of developing it," said taskforce co-chair and the Heart Foundation's chief medical advisor Professor Garry Jennings.
The statement recommends four pillars of management, starting with nutrition and exercise.
"Nutrition is very important and has been the core way in which we've addressed obesity in the past," Jennings said.
"We recommend the national recommendation of 30 minutes of moderate to vigorous physical activity ... but any physical activity is better than none."
Semaglutide medications are the third pillar of treatment.
Designed for diabetes management, the drugs were "incidentally found" to reduce risks of cardiovascular disease and improve "quality of life and symptoms in certain types of heart failure".
Studies have shown that people living with established heart disease saw a 20 per cent reduction in future cardiovascular events when taking the medications.
For those for whom diet, exercise and medication were not effective, surgery remains the final pillar of treatment.
Treating the 'interconnectedness' of obesity and CVD
GLP-1 medications are gaining popularity in Australia.
"Manjaro, Wegovy, and Ozempic are widely available, and many patients come to talk to their clinicians about the use of these medications," endocrinologist and director of the Australian Centre for Accelerating Diabetes Innovations, professor Elif Ekinci, said.
She said clinical trial data is being compiled to understand how the medication affects the cardiovascular system.
"This evidence is building up, and it's important for patients to be aware of the potential benefits and also the potential side effects of these medications," she said.
"The guidelines really provide that important information for both patients and their families, as well as clinicians."
General practitioner and task force member, Dr Mark Mellor, sees up to 30 patients a day, many of whom are living with weight concerns.
He said the statement emphasises the connection between obesity and CVD.
"There is this inter-connectedness between them, and actually not treating the obesity in a person with cardiovasular disease misses an opportunity to improve the health of that person."
He said the statement provides a "clear pathway" for health practitioners to escalate their treatment of obesity and prioritises the need for life-long care.
"Obesity is a chronic-relapsing, lifelong condition, and short-term measures might not really be the way to go. We need to be thinking longitudinally and be patient-centred about it," he said.
Currently, no TGA-indicated medicines for weight management are listed on the Pharmaceutical Benefit Scheme (PBS), according to Natalie Raffoul, The Heart Foundation's senior manager for healthcare programs and clinical strategy.
"These medications are effective, and they also help protect people at high risk of heart disease or living with heart disease to improve their future heart health. So, we certainly hope that they become available," she said.
Jennings said the task force hopes the medications can be made "available to people that need them, hopefully at minimal cost".
Australia's 'widespread problem'
The rate of obesity is rising in Australia.
In 2022, the National Health Survey found that 34 per cent of adults were classified as overweight, and 31.7 per cent were clinically classified as obese.
In 2007, only 24.4 per cent of Australian adults were classified as obese.
"It's a widespread problem ... We need to heighten our efforts as far as prevention is concerned," Jennings said.
"It's not just to do with drugs and medicines, it's about the environment in which we live, the availability of particular cheap and high-fat, high-sugar, high-salt foods, ultra-processed foods, making it more difficult for people to get physical activity, encouraging school children and others to develop lifelong healthy heart habits — it's all part of a big story."
Jennings acknowledged the impact of 'weight stigma' on those seeking help.
"For far too long, the public narrative has always been that obesity is an individualised problem, it is an issue around willpower and motivation," he said.
"Now, the clinical understanding is that it's a chronic condition beyond the choice of the individual. The determinants for obesity and, to some degree, cardiovascular disease, are complex and not within the direct control of the individual."
For support with eating disorders or body image concerns, call Butterfly National Helpline on 1800 ED HOPE (1800 33 4673) or visit www.butterfly.org.au to chat online or email, 7 days a week, 8am-midnight (AEST/AEDT).
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