Advocating For Weight Loss Medication: Q&A with Jeanne Blankenship

Jeanne Blankenship, MS, RDN
Vice president, policy initiatives and advocacy
The Academy of Nutrition and Dietetics

While anti-obesity medications (AOMs) may be having a big moment, it’s important to remember that they should play only a single part of a larger healthy lifestyle. Jeanne Blankenship, MS, RDN, vice president of policy initiatives and advocacy at The Academy of Nutrition and Dietetics, discussed the roles AOMs should play in the healthy lifestyle ecosystem.

Pharmaceutical Executive: What is the Academy’s stance on anti-obesity medications?
Jeanne Blankenship: The Academy supports comprehensive access to obesity care. Medications have the potential to play a significant role in addressing the obesity epidemic, but they should be one piece of a larger strategy that involves an evidence-based, collaborative, interprofessional approach to disease management and weight loss. To enhance the efficacy and safety -- and minimize side effects of these medications, we must remove barriers to the tools and support needed from registered dietitian nutritionists. Health care providers and obesity management specialists should refer individuals for medical nutrition therapy delivered by an RDN in conjunction with pharmacological interventions. Every person should have access to lifestyle interventions that sustain medication results and encourage long-term health.

PE: What involvement should RDNs have in optimizing AOM results
Blankenship: Individuals taking obesity medication must have access to evidence-based lifestyle interventions to achieve optimal results and improve health. Managing obesity through medications includes efforts to reduce inflammation, curb cravings and facilitate weight loss.While weight loss is desirable, it is important to the extent possible that muscle mass and nutrition status are conserved. Medical nutrition therapy delivered by RDNs helps individuals optimize and sustain health outcomes and address the many facets of obesity.

Personalized nutrition care delivered by an RDN is a critical part of comprehensive obesity management. Regardless of the approach—lifestyle intervention, obesity medication, metabolic surgery, or a combination of therapies—nutrition is imperative to optimizing and maintaining results.

PE: What are the risks to patient safety when it comes to AOMs?
Blankenship: It is important that the provider and individual consider the risks and benefits of medications used to treat obesity. Experienced providers can work with individuals to mitigate side effects with dosage, timing, and other considerations. If one medication is not effective, there are options for alternatives that might better match the needs of the patient and tolerance though access may be limited due to insurance coverage or cost. Overall risks to patient safety can be mitigated by prescribing medications as part of treatment plan that includes interprofessional care from RDNs and practitioners specializing in obesity. These professionals provide other resources—such as side effect prevention and reduction strategies—that can enhance patient experience, improve safety and that foster sustainable results in the management of obesity as a chronic disease. When individuals are not able to tolerate medications and metabolic surgery is not an option, lifestyle interventions such as MNT can improve health.For those who transition off medications due to intolerance, MNT is important to ensure that weight regain is minimized and behavioral strategies and eating patterns that support health are employed.

PE: How important is it to advocate for issues like insurance coverage in the AOM space?
Blankenship: More than 40% of Americans have obesity, and a lack of meaningful action is costing millions of lives and billions of dollars. Bipartisan legislation, such as the Treat and Reduce Obesity Act (H.R. 4818/S.2407), would expand the selection of providers and programs that deliver intensive behavioral counseling and increase coverage for obesity medications for seniors on Medicare. The Medical Nutrition Therapy Act (H.R.6407/S.3297) would help more people receive nutrition services from RDNs and qualified practitioners by covering the costs of evidence-based and clinically effective MNT for a wider range of conditions, including prediabetes, obesity, hypertension, dyslipidemia, malnutrition, eating disorders, cancer, gastrointestinal diseases, HIV/AIDS, cardiovascular disease and illnesses related to unintentional weight loss. These bills offer real opportunities for change by removing financial barriers to services that help save lives, the Academy calls on policymakers to take action to increase access to comprehensive care for those living with chronic diseases such as obesity.