Beyond GLP-1s: Q&A with Sandeep Makkar

Sandeep Makkar
Global president of endomechanical
and energy
Johnson & Johnson MedTech

The rise in popularity of GLP-1s has shined a spotlight on the need for obesity treatment. Sandeep Makkar, global president of endomechnical and energy for Johnson & Johnson MedTech spoke with Pharmaceutical Executive about how these medications should just be one method used by doctors and patients.

Pharmaceutical Executive: What are the most effective strategies for treating obesity on all fronts?
Sandeep Makkar: Obesity has emerged as one of the most pervasive and complex health challenges of the 21st century. Yet, there are still misconceptions around how it is diagnosed and treated.

Physicians, scientists, and major health organizations agree that obesity is a chronic metabolic disease caused by environmental and genetic factors. With over 54% of adults projected to experience high BMI globally by 2035, obesity has taken—and will continue to take—a massive toll on individual, societal, and economic wellbeing with outsized impacts on marginalized and lower-income populations. Like other chronic diseases, obesity requires comprehensive and long-term management by a diversified care team that is committed to understanding the unique circumstances of each patient.

For example, the approach to cancer care through multidisciplinary teams (MDT)s utilizing complementary therapies and surgical intervention has been shown to promote continuity of care, increase confidence in medical decisions and expand access to potentially life-saving trials and treatments. However, despite significant advances this approach has demonstrated in other disease areas, MDTs have not yet been widely applied in the treatment of obesity.

Combatting obesity on all fronts, including the stigma it carries, begins with raising awareness about the prevalence and causes of the disease and showing the same compassion we would to anyone living with a chronic disease. In that regard, it’s critically important that we continue to support and drive innovation in this disease area so we can offer patients a full breadth of effective treatment options. At J&J MedTech, we develop innovative surgical technologies that help address some of the most pressing health challenges of our time, including metabolic disease and obesity. Our mission to tackle this problem head on has driven us to create surgical and interventional solutions that center on the unique journey of every patient, as patient care is never one-size-fits-all.

PE: What are the common roles that a patient will have on their care team? How important is each member of the team?
Makkar: Due to the complex nature of obesity and the wide range of associated comorbidities, such as diabetes, heart disease, stroke, and depression, partnership among clinicians is paramount for any care team treating a patient with obesity. In the ideal scenario, a patient’s care team might include any combination of their primary care physician, bariatricians and/or bariatric surgeons, endocrinologists, gastroenterologists, dieticians, mental health professionals, and exercise physiologists. Ultimately, the ability to take a collaborative approach and operate as one cohesive unit has a tremendous positive impact on helping to improve a patient’s quality of life.

For patients who qualify for bariatric surgery as a means of treatment, the role of a bariatric surgeon is uniquely consultative, as the pre- and post-op care involves a comprehensive approach to treating obesity and comorbidities and ensuring sustainable outcomes. Bariatric surgeons must consider many factors throughout a patient’s care journey such as the stigma obesity carries and the overall impact it has on a patient’s lifestyle and mental health.

While this multidisciplinary team approach may be recommended, it’s important to note that barriers to initiating and accessing treatment remain a considerable challenge, especially for populations most impacted by the disease. Though not yet a reality for most, a comprehensive and individualized approach to care is the vision and goal for treating patients living with this chronic disease.

PE: At what point does a patient need to get a care team involved to treat obesity?
Makkar: Living with obesity can significantly decrease a patient’s quality of life. Individuals with a body mass index (BMI) above 25 may experience weight-related problems such as joint pain, high blood pressure, high cholesterol, depression, and type 2 diabetes. These comorbidities cause discomfort and pose health risks that may warrant the involvement of an obesity care team. However, it’s important to remember that seeking treatment for obesity can be a challenge for patients due to factors like stigma and shame; competing responsibilities, such as full-time employment and caring for others; and inaccessibility of healthcare due to geographical or financial constraints.

If an individual is experiencing adverse health effects due to obesity, they may benefit from seeking and establishing a care network. In fact, studies have shown that multidisciplinary care teams are conducive to increased weight loss success rates; improved blood glucose, blood lipid and adipokine levels; relief of negative emotions such as anxiety and depression; and enhanced sense of general self-efficacy for obese patients. Primary care physicians can be extremely helpful in assembling multidisciplinary care teams, as patients may not be aware of the benefits they could receive from other specialists or know how to connect with them. Establishing trust through honest, non-judgmental dialogue is a strong start to embarking on a successful treatment journey with each patient.

PE: What roles should medications like GLP-1s play in treating obesity?
Makkar: The cultural and clinical significance of the obesity crisis creates an opportunity for a well-rounded discussion on the science of obesity, its societal impact on patients and appropriate treatment. Our Johnson & Johnson MedTech division is actively partnering with clinical societies and experts to explore the role of different obesity treatment options, such as surgery and pharmacotherapy, with the goal of providing multiple evidence-based options that offer patients long-term benefits and maximize their quality of life.

Therapies that deliver sustainable outcomes don’t have to be mutually exclusive. Depending on the patient, a GLP-1 may be useful on its own or in combination with a bariatric procedure. Alternatively, pharmacotherapy might not be recommended, and another treatment option may be more suitable.

While achieving weight loss necessitates a multidisciplinary approach involving healthcare providers, patients, and caregivers, empowering patients to actively participate in their health journey is at the heart of successful care management. By emphasizing a medically informed, customized care plan and adopting a patient-centered approach, the integration of these strategies can pave the way for sustainable results and improved overall well-being.