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Welcome to the Pulse finale. Data meets the clinic floor, brought to you by Medall. I'm your host, and today we are bridging the gap between raw clinical trial data and the everyday conversations you have with your patients. This activity will discuss clinical trial data and guidelines and how these are translated into empathetic, patient-centered consultation language. The podcast will also examine real-time management of treatment escalations, side effects, and patient hesitancy under standard consultation time constraints. Before we begin, please review the faculty information, disclosure statements, and learning objectives using the link in the episode description. And remember to claim your CME credit by completing the evaluation linked there as well. This podcast is a continuing education activity managed and accredited by Partners for advancing clinical Education in collaboration with Medall and supported by an independent medical education grant from Lilly. Joining me today to help translate the latest emerging science from the 2026 ECO, ADA and EASD congresses into practice is our expert, Doctor Patrice Forner. Doctor Forner, it is fantastic to have you here. Let's jump right into our first segment, looking at a simulated high tension obesity consultation based on a common primary care presentation. Let's meet Melissa. She's a 48-year-old school administrator with a BMI of 36, pre-diabetes, and knee osteoarthritis that actively limits her mobility. She has made multiple prior attempts with diet-based weight loss, only to regain the weight repeatedly, and she clearly feels defeated. What I'm hearing from Melissa is a patient who blames herself. How do you use bias aware communication to shift her mindset? And how do the latest ECHO and ADA guidelines change our approach to initiating her treatment? The first thing I would do is try and take blame out of that conversation. So she's just told us she's tried repeatedly to lose weight and she's experienced weight regain and we really, really need to recognize that this can be incredibly demoralizing, particularly when people have been led to believe that weight is simply a matter of willpower. It's not. Um, weight regulation is very complex and our biology will actively respond to weight loss in ways that can make maintaining that loss quite difficult. We have excellent treatment options available now and we can work together with patients to find an approach that really supports their health and quality of life. The language that we use matters too, uh, and I generally use first person language such as, you know, a person living with obesity rather than defining someone by their weight. So I would ask permission before discussing weight, for example, you know, would it be OK if we talked about your weight and how that might be affecting your blood sugar and your knee pain, and that gives the patient some sense of control over the conversation. Uh, but we also really need to be careful not to use language that implies blame, such as, you know, non-compliant or failed weight loss, and instead ask open questions like, What, what approaches have you tried previously, or what made those approaches quite difficult to sustain, or what matters to you in, in terms of your health? And these questions can help us understand her circumstances, her preferences, and her barriers to treatment. Now from a treatment perspective this means moving away from the idea that patients must repeatedly demonstrate their ability to lose weight through lifestyle change before they deserve medical treatment. We know that obesity is a chronic relapsing disease with complex biological, psychological, social, and environmental determinants, and we wouldn't expect someone with any other chronic disease to manage it through willpower alone, so we shouldn't approach obesity any differently. Actually, the 2026 ADA standards of care support offering obesity pharmacotherapy as part of initial treatment for adults with obesity who have or are at high risk of obesity related complications. So our patient has a BMI of 36, she has pre-diabetes and knee osteoarthritis that's limiting her mobility. This is a great time to discuss treatment options rather than waiting for her to develop type 2 diabetes or for her mobility to deteriorate further. But I think it's important that we also change how we define success, so we often focus on percent body weight loss, but that doesn't always tell us whether an individual has achieved the health improvements that matter most. So we should consider things like waist circumference, glycemic control, BP, physical function, and quality of life. We're also seeing research explore how we can complement percent weight loss with more meaningful anthropometric targets. For example, there was a secondary post hoc analysis of redefined one that was presented earlier this year, and that examined two targets, or BMI of less than 27 and a weight waist to height ratio of 0.53. And at 68 weeks, around 30% of patients receiving Cadryema achieved both targets, and those who did were more likely to have favorable cardio metabolic outcomes. And while these targets aren't yet established as universal treatment goals, the findings illustrate how we might look beyond percent weight loss alone to better understand the health benefits of treatment. It's ultimately though, success needs to be individualized, so I'd have a chat to Melissa about what matters most to her, and it might mean reducing the risk of diabetes or walking more comfortably, you know, returning to activities that she enjoys or feeling less distressed by repeat weight gain, but we can combine these personal goals with appropriate metabolic and anthropometric measures to guide treatment and review the process together, so, I guess that the overall message is that we should treat the person and not just the number on the scales, and we should offer effective treatment early with the aim not only of reducing weight, but also of improving cardio metabolic health, physical function and quality of life. That completely changes the framing from a willpower issue to a targeted medical strategy. Let's look at another patient, Christopher. He is a 47-year-old architect with a BMI of 32, pre-diabetes, and a family history of type 2 diabetes. He has been diligently following a lifestyle program, but after two months, he has only lost 2.2% of his body weight. He tells you, I've made some progress, but it's slower than I hoped. What should I do next? We know that therapeutic inertia is a huge barrier. How does early weight loss velocity help us precision escalate his treatment? And what emerging therapies across the ADA and EASD Congresses might fit into his long-term plan? This is a pretty typical clinical scenario, so 2.2% weight loss over a two month period, we're looking at around 1.1% weight loss per month. If we think back to the ADA data presented earlier this year, there was a retrospective cohort analysis of over 8000 adults with obesity who were prescribed a Mediterranean diet and they modeled 24 month trajectories. They identified a weight loss velocity threshold of 1.5% per month to distinguish high risk non-responders from responders. Now participants with less than 1.5% weight loss per month in the early treatment period were classified as high risk. Non-responders and this group benefited significantly from rescue treatment with a very low calorie ketogenic diet or incretin-based pharmacotherapy. So it would make sense to escalate Christopher's treatment now rather than waiting another six months or so. In terms of emerging therapies, our treatment options are expanding well beyond conventional GLP-1 or dual agonists. So emerging data from ADA, ECO, and EASD have highlighted therapies targeting multiple hormonal pathways. Retatritide is a particularly interesting example, that's our GIP, GLP-1, and glucagon receptor agonist. Uh, in the phase three Triumph One trial, people with obesity without diabetes lost an average of up to 28.3% of their body weight at 80 weeks at the highest dose. In triumph two among people with overweight and obesity and type 2 diabetes, weight loss reached an average of 20.8% alongside improvements in glycemic control, and this is the best weight loss we've seen to date. Savodatide that takes a different approach, it combines glucagon and a GLP-1 receptor agonist. It has shown promising effects on liver fat and histological features of metabolic dysfunction associated steatohepatitis or MASH. Uh, this is in phase two studies, and it's particularly relevant when we think about obesity as a multi-system disease. Uh, another interesting direction is petrolintide, that's a long-acting emylin analog. Emmelin acts on pathways involved in satiety and food intake, so this offers a mechanism that is distinct from GLP-1 based treatment. Uh, in the phase two Zuprene trial, petrolintide produced mean weight reductions of up to 10.7% by week 72, and it generally had favorable gastrointestinal tolerability. So, I guess the key message here is that we really need to avoid therapeutic inertia and move away from the idea.