The Future of Obesity Treatment with Martha Gulati, MD

At the 9th Annual Heart in Diabetes Conference in Philadelphia, PA, Martha Gulati, MD, associate director of both Barbra Streisand Women’s Heart Center and the Preventive and Cardiac Rehabilitation Center at Smidt Heart Institute, presented her discussion on the challenges and advancements in the management of obesity.1

Obesity’s connection to cardiovascular disease has been well documented. Affecting millions of adults and children worldwide, it is associated with several adiposity-related complications, including hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea, cancer, and cardiovascular disease.2

Recent treatments, such as glucagon-like peptide-1 (GLP-1) receptor agonists and incretin therapies, have allowed for the medical treatment of obesity and other adiposity-related diseases. This, in turn, has led to a new degree of intervention surrounding the maintenance and treatment of its resulting complications.

Gulati praised recent studies and medications for highlighting the connection between obesity and a variety of life-threatening complications, indicating significant progress in the last few years.

“Obviously these medications started out as treatment for diabetes, and we’ve had that well established for a number of years,” Gulati told HCPLive. “But the idea that we could use these medications for more than that, and particularly for obesity, was the first step, showing that they were effective at weight loss.”

Gulati also noted that the renewed focus on incretin therapies has also resulted in a much broader application for similar medications, potentially moving far beyond diabetes and obesity.

“We’ve looked at people with kidney dysfunction and we’ve seen the improvement in the kidney function,” Gulati said. “We’ve seen these drugs proven to be effective in reducing fibrosis of the liver, and so for our patients with MASH, that also gives us a therapy that we’ve really not had for that important disease, which was often advancing to both end stage liver disease and increased risk of liver cancer.”

In addition to a broader spectrum of treatable diseases, Gulati noted that incretin therapies are also capable of forestalling cardiovascular events by eliminating their precursors, such as sleep apnea.

“And for cardiac patients, I think that’s incredibly important because we know if you have obstructive sleep apnea, you’re putting yourself at a greater risk for heart disease of many different forms, including things like atrial fibrillation,” Gulati said. “So being able to stop these risk factors is a compelling clinical indication, and I think it has the potential to really change the effect that obesity has had on these rising rates.”

Gulati agrees with the pressing concern of figuring out how to consistently get these medications to patients in need; however, she also notes the comparative importance of focusing on prevention in addition to treatment.

“If we don’t keep focusing on prevention, we’re just going to continue the same way of treating advanced cardiovascular disease. Let’s keep putting in stents, let’s do ablations for atrial fibrillation, let’s do all these big expensive procedures because we aren’t able to provide these advanced therapies early enough,” Gulati told HCPLive. “And I think that we have to change the medical paradigm of how we treat patients and how we think about prevention and how we invest in prevention at the forefront.”

Gulati also expressed excitement at the forward momentum of obesity studies, commenting on ongoing research and the drugs currently in the pipeline. She notes the necessity of expanding the mechanisms and methods of treatment in addition to new medications, in an effort to maintain cost-effectiveness and allow for the largest number of patients to receive care.

“And I think the other point is, can we change how we deliver it, too? And the reason that that’s important is not because it’s an injection, but it’s the reason these drugs have become so costly; they’re injectable, and they have to stay cool, and we have to deliver them in a mechanism that they built around it.”

Gulati reports the following disclosures: Boehringer Ingelheim Pharmaceuticals, Lilly, Medtronic, Merck & Co., New Amsterdam, Zoll, and others.

References

1. Gulati M. Obesity Management Role of Medical Management in CVD. Presented at the 9th Annual Heart in Diabetes Conference in Philadelphia, PA, June 6-8, 2025.

2. Christensen S, Nelson C. Chronicity of obesity and the importance of early treatment to reduce cardiometabolic risk and improve body composition. Obes Pillars. 2025;15:100175. Published 2025 Apr 2. doi:10.1016/j.obpill.2025.100175