Biotechnology revolutionizes advances against obesity: enhanced understanding, more accurate diagnosis, and development of innovative drugs

The World Health Organization (WHO) warns that in 2022, around 2.5 billion adults worldwide were overweight. Of these, 890 million people were living with obesity. The current picture shows that one in eight people globally suffer from obesity. Since 1990, obesity has more than doubled among adults worldwide and has quadrupled among adolescents. In 2022, 37 million children under the age of five were overweight. This number rises to 390 million among those aged five to nineteen, of which 160 million are obese.

In most cases, obesity is a multifactorial disease due to an obesogenic environment, psychosocial factors, and genetic variants. Obesity and overweight can increase the risk of type 2 diabetes and heart disease, affect bone health, reproduction, and increase the risk of certain types of cancer. In this regard, WHO data indicates that in 2019, a body mass index (BMI) higher than recommended caused more than five million deaths worldwide due to non-communicable diseases (cardiovascular diseases, diabetes, cancer, neurological disorders, chronic respiratory diseases, or digestive disorders).

In recent years, significant scientific advances have been made in areas such as prevention, management, or treatment of obesity, in which biotechnology is playing a crucial role through new medications and/or treatments, the development of functional and healthier foods; advances in fields like gene therapy or gene editing are being investigated as possible treatments for obesity; the study of the gut microbiome; or research in cell therapy are some examples of how biotechnology is revolutionizing the fight against obesity through new approaches and tools that allow it to be tackled from various perspectives, both preventive and therapeutic.

To address how biotechnology is enabling progress in combating obesity from various perspectives, and in celebration of European Obesity Day, we interviewed Miriam Rubio de Santos, Medical Director of the Diabetes and Obesity Division at Lilly Spain.

AseBio: What is obesity?

Miriam Rubio de Santos: Obesity is a disease based on the dysfunction of adipose tissue. Additionally, it is a complex, multifactorial, chronic, and recurrent disease associated with the onset of multiple complications. Obesity is the origin of more than 200 diseases, which often become more complicated in the presence of obesity.

AseBio: We are facing a complex disease in which multiple factors, sometimes beyond the control of the person suffering from it, are involved. What are the main factors in its development?

Miriam Rubio de Santos: The origin of obesity involves multiple factors, including genetic, endocrine, environmental (endocrine disruptors, an obesogenic environment…), stress, sleep disturbances, behavioral, and sociocultural factors. These factors ultimately contribute to an imbalance in energy balance, leading to a progressive increase in adipose tissue that exceeds its storage capacity and generates dysfunction and inflammation of various organs and systems at all levels. The complexity is defined by the alteration in the signaling of multiple body systems that regulate hunger-satiety balance and energy expenditure. These processes involve the central nervous system, the intestine, the pancreas, and the adipose tissue itself, which we know is an endocrine organ that produces multiple hormonal signals to regulate this balance.

AseBio: Why should the approach to obesity be carried out with a comprehensive care perspective?

Miriam Rubio de Santos: As a chronic, complex, and recurrent disease, the optimal approach must be multifactorial: intervention on healthy eating (knowing what to eat, when to eat, and how to eat), physical exercise, both aerobic and anaerobic, psychological and behavioral aspects, and if this is not enough, offering treatment alternatives. As a chronic, complex, and recurrent disease (meaning there can be many relapses).

But the starting point is to make a good diagnosis of obesity, and to achieve this, the stigma in society, including among healthcare professionals, must be overcome, and knowledge and resources available to doctors treating these patients must be increased.

AseBio: What advances against obesity has biotechnology enabled?

Miriam Rubio de Santos: Biotechnology is helping us a lot in all areas, as significant advances are being made that allow us to better understand the disease, make a more accurate diagnosis of obesity, going beyond the patient’s BMI (body mass index), and of course, it is helping us in the development of innovative drugs.

Biotechnological research and advances in the area of obesity aim to offer personalized medicine, for example, through appropriate phenotyping of people living with this disease, developing more precise diagnostic tools.

AseBio: Lilly works to deepen the understanding of obesity with the goal of developing treatment alternatives that provide health solutions to people living with obesity. What advances are you achieving?

Miriam Rubio de Santos: Lilly has been researching obesity for years, since we saw the impact on weight that one of our type 2 diabetes medications had. Since then, more than a decade ago, various alternatives and mechanisms of action have been studied to allow weight loss that generates positive health consequences. This has led to a wide range of molecules being investigated for both obesity and many of its complications.

Another line of work is to share the results of these advances with the scientific and medical community. In this case, in addition to the lack of alternatives, people with obesity have had to face false beliefs, stigma, and myths, which science is now confronting.

This dissemination of the knowledge generated by science will also help to make a more accurate diagnosis and approach for people with obesity, which will help them intervene more effectively.

AseBio: What benefits do these types of medications bring to healthcare systems in a context where obesity is already a serious public health problem?

Miriam Rubio de Santos: The World Obesity Federation has estimated the economic impact of overweight and obesity. According to their data, in 2019, it had an impact of 2.09% of GDP in Spain, which amounted to a total of 29.14 billion dollars. Based on their estimates of prevalence increase, it is expected that by 2060, the cost will triple, representing 2.4% of GDP.

Returning to 2019 data, obesity had a direct medical cost in Spain of 9.51 billion dollars, in addition to the cost of premature deaths, absenteeism, and presenteeism costs.

Therefore, we believe that these medications to treat obesity could be of great help in addressing it. It should be noted that we are talking about a disease that until now was only treated with lifestyle changes—which alone were not effective in people with obesity—or with surgery—which is a very invasive alternative with high relapse rates.