Obesity

We have discussed cardiovascular disease, rheumatoid arthritis, and depression. We should also mention obesity. Obesity increases the risk of many serious health conditions, like heart disease, type 2 diabetes, certain cancers, chronic kidney disease, sleep apnea and breathing problems, and deprssion.¹⁵⁰ The effects of obesity influence nearly every organ system in the body, caused mostly by a state of persistent, low-grade inflammation that begins in fat tissue and spreads systemically. The common thread is fat tissue, which is not a stagnant or passive storage space of energy. Adipose tissue, especially visceral fat, secretes inflammatory cytokines (IL‑6, TNF‑α) that stimulate the liver to produce CRP.¹⁵¹ This landmark study shows that adipose tissue acts as an endocrine organ. In obesity, especially central obesity, adipocytes and infiltrating macrophages release: IL‑6; TNF‑α; leptin; resistin; and free fatty acids. This creates a chronic low‑grade inflammatory state, often called metaflammation.¹⁵¹

Obesity is classified by the World Health Organization (WHO) as a chronic, relapsing disease arising from complex interactions between genetics, neurobiology, eating behaviors, access to healthy diet, market forces, and the broader environment.¹⁵⁰ Three out of five adults in the United States are expected to live with obesity by 2050.¹⁵² Due to serious health and other issues related to obesity, there has been a renewed interest in preventing it, and treating obesity as a chronic, relapsing disease. While core behaviors such as a healthy lifestyle and diet are important, this is not simply a self-discipline issue. Early diagnosis and screening and diagnosis of co-morbidities are vital. Pharmacotherapy, GLP‑1s and next‑generation agents, are transforming obesity care.¹⁵³ GLP-1 medications are not entirely new, hey were first developed for Type 2 diabetes, but recent oral formulations for weight loss represent a significant recent advancement. Over time, research revealed additional benefits, including weight loss, cardiovascular protection, kidney health, and liver disease management. These medications have been in use for several years, primarily as weekly injectable treatments. Let’s delve into these pharmaceuticals.

Glucagon-like peptide-1 (GLP-1) medications are FDA approved to treat Type 2 diabetes, help people lose weight, and lower the risk of serious cardiovascular problems.¹⁵⁴ GLP-1 medications simulate natural gut hormones that your body releases after eating. Most simulate the GLP-1 hormone. Some also simulate a second hormone called glucose-dependent insulinotropic polypeptide (GIP). Some GLP-1s are also approved to treat obstructive sleep apnea, chronic kidney disease, and a type of fatty liver disease. Potential future uses of GLP-1s include peripheral artery disease and heart failure.¹⁵⁴ Popular agents currently are in the graphic below. New mediacation are being introduced at a rapid speed. Note: Metabolic dysfunction-associated steatotic liver disease / Metabolic Dysfunction-Associated Steatohepatitis (MASLD/MASH).

Be aware that there are side effects of these medications. GLP‑1 medications can profoundly affect the mouth through xerostomia, altered eating patterns, reflux‑related erosion, nutrient‑linked mucosal changes, and shifts in periodontal inflammation.¹⁵⁵ None are universal, but they are increasingly relevant as more patients use semaglutide/tirzepatide. Be aware that sedation risks may be higher because of delayed stomach emptying, and blood sugar changes may happen during fasting without proper planning.^155,156 As there is a link between oral health/disease and systemic health/disease, oral health should be integrated into care for other related diseases. There is a current review that highlights the importance integrating oral health into chronic kidney disease care.¹⁵⁷ There the Oral–Kidney Collaborative for Advancing Research and Evidence (OK-CARE) is a multidisciplinary initiative focused on advancing evidence, clinical integration, and policy-relevant insights at the intersection of oral health and kidney disease. It aims to move beyond observational associations toward actionable integration of oral and renal care in clinical practice, payer strategy, and public health policy.¹⁵⁸