Dr Ruben Nogueiras

Good morning, I'm Ruben Nogueiras. I work at the University of Santiago de Compostela in Spain, and I will be talking about the new treatments for obesity.

What are the most significant advances in obesity management as of 2025?

Well, there is currently a revolution in the treatment of obesity. And in 2025, at the end of this year it is supposed to be approved a new drug. It is a dual agonist so it's a GLP-1, which is an intestinal hormone, plus GIP, another intestinal hormone.

So this molecule puts together these two hormones, and this drug has been approved for the treatment of type 2 diabetes and it is supposed to be approved very soon for the treatment of obesity. And on the top of that, we have new drugs and more clinical trials that are supposed to give some beneficial results to patients with obesity.

How has the medical definition of obesity evolved in recent years, and what does it mean to now classify it as a chronic disease?

Historically, obesity has been a risk factor for other diseases like cardiovascular diseases or type 2 diabetes. Nowadays we assume that obesity is a real chronic disease. So in addition to that, I must say that the classification has evolved because in the past the body mass index was the only one factor to take into account.

But now there are other aspects that are being considered and one very important is how the excess of adipose tissue may affect the function of other organs. So right now we can classify obesity in preclinical obesity, if the excess of adipose tissue does not affect the function of other organs, or clinical obesity, when the excess of fat mass affects other organs.

What role do nephrologists play in multidisciplinary obesity care, and how can collaboration be improved?

We must think that obesity is a multifactorial disease. This means that for the treatment it should be considered as a work from multidisciplinary areas. And of course, nephrologists should be one of those specific experts in this network, because it is impossible to treat obesity efficiently only if one particular area of experts are involved in the diseases.

To improve the collaboration, I would say that it would be important: one, to integrate nephrologists in the discussion of patients with obesity, how the treatment should be, the doses and so on. And second, probably will be important to improve the training of a nephrologist for allowing them to have the information on the new treatments and how are they working in real life.

Are newer obesity drugs safe and effective for patients with moderate to severe CKD?

So yeah, there are some studies indicating that these new drugs are efficient for chronic kidney diseases. Actually, it has been reported that they ameliorate the progression of kidney diseases.

And actually this year in 2025, one of the drugs, semaglutide, has been approved for the treatment of chronic kidney diseases and type 2 diabetes. So patients who have these two diseases can be treated with this drug. And apparently, according to the clinical trials, [illegible] working quite well.

Are there any promising emerging therapies that you believe will become mainstream?

Yeah, as I said in the beginning, there are new drugs coming, actually, there are new clinical trials coming every week, I would say. And some of the drugs apparently can improve to the current drugs that have been approved by the FDA for the treatment of obesity.

So I think that we can be optimistic in this way. And this new generation of drugs putting together two or even three different hormones in the same molecule can have a superior effect to the current drug.