An Interview with Dr. Arya Sharma
By Joseph Shivers, Vincent Wu, Alasdair Wilkins, Adam Brown, and Kelly Close
As Chair of Obesity Research and Management at the University of Alberta in Edmonton, Dr. Arya Sharma oversees a program of over 30 healthcare practitioners treating several thousand patients per year — including hundreds that he sees personally. He has also led development of the Edmonton Obesity Staging System (EOSS), a rubric for classifying obese patients based on the severity of weight-related complications rather than BMI or body weight. Dr. Sharma is also an outspoken advocate both for better obesity treatments and for better societal ‘treatment' of individuals with obesity. He was in the spotlight most recently at the FDA's Advisory Committee meeting on Qsymia, where he spoke compellingly about the absence of good anti-obesity drugs today and the enormous related costs. And then of course there's a blog that he updates daily (!) with his take on new research and other obesity-related news.
Dr. Sharma provided valuable perspective on the recent approval of Vivus' Qsymia, highlighting that it has the most convincing weight loss data for any obesity drug to date. He also emphasized the under-recognized benefits of simply maintaining one's current weight, a significant achievement given our weight-loss culture and the expectations of patients. Dr. Sharma also discussed the prospects of using mobile apps for weight loss and maintenance, described why obesity is not merely an issue of personal responsibility, and highlighted the importance of long-term treatment of obesity.
Joseph Shivers: Thank you so much for agreeing to speak with us, Dr. Sharma. What factors do you believe contributed to the approval of Qsymia?
Dr. Arya Sharma: A couple special circumstances surrounded Qsymia's situation. First, because it's a combination of two drugs that are already generic and are probably already being used off-label by physicians, there was a certain urgency in approving Qsymia that may not exist for other drugs. When drugs are being used off-label, you then have virtually no control over who's prescribing it or who's using it. Even more importantly, you would never have a long-term efficacy or safety study because nobody would conduct it.
In terms of weight loss, the data for Qsymia is probably the most convincing we've seen from any obesity drug so far. The issues of hypertension, which you've seen in previous drugs, clearly do not exist for this drug. There is a very clear blood-pressure-lowering effect. As to the small increase in heart rate — nobody really knows what that means, and most cardiologists would tell you that it's probably not very relevant, given that the drug has all these other positive effects.
Both circumstances — the fact that you have a very effective drug, and you have a drug that is the best composite of two drugs that are freely available as generics — make Qsymia's situation special.
Yesterday was pretty horrible. Today is better. So far … Yesterday morning’s Dexcom graph was Mount Kilimanjaro. Today we have a dorsal fin, jutting out of the water at about 200 before descending into a connect-the-dots shark. He appears to be 63 at lunchtime versus three-hundred-something yesterday. Not perfect, but it never is. Charlie’s teacher and the nurse mentioned that he didn’t look like himself yesterday. He had taken too many body blows from diabetes...