Beverly G. Tchang, MD

#Endocrinologist. Passionate about #obesity as a medical disease and a social misunderstanding. Tweets are my own. | #health #medtwitter #weightloss #medicine |

[Beverly G. Tchang, MD @BevTchangMD]

Thankful to @JAMA_current for sharing my #Viewpoint on Primordial Care

👉https://t.co/KJajbzdABG

I've spent a long time wondering about where my patients are and who is taking care of those who are not my patients, especially when trust in medical and #publichealth institutions is fragile.

Primordial care has been taking care of us/you. It has emerged and grown in the vacuum left by disempowered medical systems. Everyone engages in primordial care as part of their personal health journey. I google (or ChatGPT) symptoms too and crowdsource advice from social circles. Is this good or bad? Primordial care allows us to self-direct care without traditional expertise, but it is also a space of high risk-tolerance innovation.

I think primordial care has been an unnamed force shaping #healthcare today and deserves attention and discussion.

[Beverly G. Tchang, MD @BevTchangMD]

I'm coining a new term: primordial care.

⭐️Primordial care is the stage when a person is actively engaging with their #health before their first contact with the #healthcare system. ⭐️

It is the individual-level equivalent of #publichealth primordial prevention.

Primordial care is person-centered. A person takes on all the risks and benefits of their beliefs, actions, or inactions, and they are the sole decision-maker.

A person in primordial care could be healthy or sick but thinks they are healthy or could be healthier.

Primordial care encompasses the #wellness industry but also AI engines and Google.

It is pre-healthcare but is sometimes disguised as healthcare.

It exists just before #primarycare, a person's first contact with the healthcare system.

It is a transition period for some and a permanent safe space for others.

Primordial care is neither negative nor positive.

If you've ever googled your symptoms or searched forums for answers related to your health or researched a new health trend to see if it were right for you or tried something new to improve your health--all without ever talking to a healthcare professional--you've engaged in primordial care.

#PrimordialCare

[Beverly G. Tchang, MD @BevTchangMD]

Congratulations to my graduating #obesity #medicine fellows Drs. Michael Bonafede and Aditi Rao who will be joining on as faculty at @WeillCornell!

I am so proud of their just published "Overview of Novel Mechanisms in Obesity Pharmacotherapy and Implications for Cardiovascular Disease: A Narrative Review" in Current Atherosclerosis Reports
👉https://t.co/7RP0Fax4f5

For this review, we explicitly chose to look at non-#GLP1 based mechanisms to explore what else the pharmacotherapy pipeline might be offering

Anyone else experiencing GLP-1 #research fatigue? It's hard to keep up with all of the data nowadays!😅

[Beverly G. Tchang, MD @BevTchangMD]

Nothing that compelling. "insulin resistance"? (hand waves)

My hypothesis is that diabetes is a "late-stage" complication of obesity, so we're basically treating a chronic disease (obesity) after significant pathophysiologic changes have already occurred (diabetes). The treatment still works, but the magnitude of response is attenuated.

This might be similar to HTN->CKD. Treat HTN before CKD and you get great BP response with one agent. Treat HTN after CKD stage 3, and you're probably using 3 agents for control.

[Beverly G. Tchang, MD @BevTchangMD]

This is revolutionary. Treatment of a patient with #obesity analogous to other "serious" chronic diseases where options are limited, like cancer

@EliLillyandCo 's compassionate use program allows access to retatrutide for one person, based on robust phase 2/3 data, prior to FDA-approval

👉 https://t.co/tv6EklMbUu @statnews

👏 @dr_muniyappa

[Beverly G. Tchang, MD @BevTchangMD]

@ZaherToumi @MichaelMindrum @AmarPut @AbdTahrani @MichaelAlbertMD @GoggleDocs @ConscienHealth @drpatrickholmes Yes i see it. We address environmental factors as possible but recognize too that obesity is a chronic *progressive* disease and medications have a limited durability too (as in diabetes). I am sure surgery is not permanent forever for everyone either?

[Annals of Int Med @AnnalsofIM]

A new living clinical guideline from @ACPIMPhysicians recommends #semaglutide and #tirzepatide as first-line options when initiating pharmacologic treatment with lifestyle modifications for weight management for nonpregnant adults with obesity. Read the full guideline: https://t.co/1Tbu4z60Kh

[Daniel J Drucker @DanielJDrucker]

Adiposity and #cancer Will use of GLP-1 medicines bend the curve? Is weight loss the potential mechanistic driver? https://t.co/y8gGtPgdyq

[Beverly G. Tchang, MD @BevTchangMD]

"47% of US adults say corporate health insurers ‘primary drivers’ of rising health costs"

https://t.co/KUtb3gd0P1 @FierceHealth

Ironic for an industry that claims its mission is #healthcare affordability

[Beverly G. Tchang, MD @BevTchangMD]

It's interesting that we researchers will examine observational data 20 years after an intervention and present its results as if attributable to the intervention 20 years ago

The landmark DPP trial established the idea of "metabolic memory"--early implementation of lifestyle (or metformin) changes a person's anticipated trajectory of disease burden

But this research finds no protection from metformin and durability from lifestyle--

🧐Does this mean metformin's protection runs out eventually?

Or we are seeing a "survivorship"-type bias favoring lifestyle, common in long term observational studies?

[Eric Topol @EricTopol]

In a randomized trial of people with prediabetes, lifestyle improvement vs metformin or placebo, lifestyle was best for prevention of chronic conditions
@JAMA_current
https://t.co/sELQFMcKiG

[Beverly G. Tchang, MD @BevTchangMD]

One of the classic findings in #neuroscience: intermittent amphetamine exposure increases their effects over time (sensitization), while continuous exposure blunts the effects (tolerance).

It makes me wonder...

Should longer-acting #GLP1s be the goal?

Is continuous receptor agonism what we need? Have we fully explored what intermittent GLP-1 receptor stimulation might do?

@DanielJDrucker @MatthiasTschop @EricTopol

[Beverly G. Tchang, MD @BevTchangMD]

"If we deny free will when it comes to the worst of our behaviors, the same must also apply to the best." - Robert Sapolsky

HT @juliaoftoronto @KevinH_PhD, Food Intelligence

#obesity #food #science

[Michael Weintraub, MD @MWeintraubMD]

📢 The diagnosis of obesity is expanded, based on the new ADA Standards of Care Screening and Diagnosis Chapter published last week. 📋

⚖️ BMI > 30 = obesity (unchanged)
📏 BMI >25 + waist-to-height ratio >0.5 = obesity
🌏 BMI >27.5 with Asian background = obesity
🌏📏 BMI >23 with Asian background + waist-to-height ratio >0.5 = obesity

https://t.co/SbKUn1MtkS

[OAC @ObesityAction]

ARE YOU READY?🚦On July 1, the Medicare GLP-1 Bridge program launches, creating a new pathway that may help eligible Medicare patients access obesity treatment.

Join @ObesityAdvocacy, @ObesityAction, @AmDiabetesAssn, @OMAsocial, @ASMBS and @ObesitySociety on June 18 to learn what this could mean for you. Sessions are available at 12 PM or 7 PM ET

RSVP: https://t.co/2UKCvdHCIT

[The Lancet Diabetes & Endocrinology @TheLancetEndo]

Beyond weight loss: multisystem benefits of #obesity medications https://t.co/IFPyEU8bKn
#GLP-1 receptor agonists #weightloss

[Ted Kyle @ConscienHealth]

Controversy swirling around ADA leadership at the #ADASciSessions deepened today as the President-Elect and Scientific Sessions Planning Committee Chair resigned.
https://t.co/ZeykqiLlGu

[Beverly G. Tchang, MD @BevTchangMD]

The latest in #obesity #medicine optimization was published today in @NaturePortfolio

⭐️ Phase 2 trial of apitegromab + tirzepatide vs placebo + tirzepatide over 24 weeks 👉 https://t.co/PfR6i8pOQu

🔹Lean mass loss was less with apite: -1.6 vs -3.5 kg
🔹Fat mass loss were similar: -8.5 kg vs -8.0 kg
🔹No skeletal muscle mass reported, but possible signal for functional improvement in hand-grip strength (if you're really squinting)
🔹Subgroup analysis suggests more pronounced benefit in men ♂
🔹Same signal in mitigation of LDL-improvements that we've seen with other myostatin inhibitors

Was this shared at @ADA_DiabetesPro ? @MWeintraubMD @doctorjny

[Nature Portfolio @NaturePortfolio]

A drug called apitegromab may help to preserve lean body mass during weight loss with tirzepatide, a GLP-1 receptor agonist, according to a phase 2 clinical trial published in Nature Medicine. https://t.co/e7ItpI7ajh

[Beverly G. Tchang, MD @BevTchangMD]

Interesting opinion article on @statnews on #obesity in horses--a population you would imagine we humans have full "control" over with respect to lifestyle--and yet, the disease persists:

Equine metabolic syndrome 👉 https://t.co/m1qjOdIDAZ

[Michael Weintraub, MD @MWeintraubMD]

💉 Survodutide the dual GLP1/glucagon weekly agonist demonstrated 16.6% weight loss after 76 weeks in its phase 3 SYNCHRONIZE-1 trial. 📉

However, the placebo arm had more than expected weight loss. Why? 🤔 Some of those patients were taking a GLP1!

Over 15% of patients in the placebo arm were obtaining GLP1s outside the trial. 👀 This is a signal placebo controlled trials will be more challenging in the space going forward. ⚠️

[Beverly G. Tchang, MD @BevTchangMD]

The science around #GLP1 drugs and #cancer is suddenly getting a lot more interesting https://t.co/8JM3aQa6Bx

[Michael Weintraub, MD @MWeintraubMD]

Retatrutide in adults with obesity over 104 weeks in the highest dose group had 30.3% weight loss.

Nearly 2/3 reached BMI < 30

1 in 3 reached BMI < 25