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鈥淧atients come to see us for the medication. And the issue is, as doctors, we don鈥檛 have the time 鈥� or expertise, necessarily 鈥� to talk about everything else,鈥� says Dr. Dimitre Ranev, a family physician who practices in both Ottawa and Gatineau. Fewer than of U.S. patients on GLP-1 RAs receive any kind of behavioural or lifestyle therapy, and this lack of support undermines treatment: A 2024 study by Blue Cross Blue Shield found that 30 per cent of patients who were prescribed GLP-1 RAs stopped taking them within the first month, and were still on the medications at the 12-week mark.

鈥淲e still struggle with the delivery of basic care around obesity,鈥� says Dr. Puneet Seth, the 海角社区官网physician and entrepreneur behind , an AI-powered support platform trained on a proprietary knowledge base. Launched last year, Nymble provides structured ongoing support via text-based messaging.

The tool helps patients anticipate and manage side effects including nausea, constipation and fatigue 鈥� a major barrier to adherence 鈥� by offering timely tips about what to expect, dose adjustment guidance and check-in messages, says Seth. It also helps users integrate behavioural changes, such as adjusting meal sizes and building consistent movement into their routines, as well as prepare questions for followup appointments. Nymble even scans social media platforms to assess what comments influencers are making about obesity management, with the aim of helping dispel misinformation.

Ranev has used Nymble in his practice for a few months. While the tool is not a replacement for an actual therapist or a doctor, he says, it provides in-between support that鈥檚 鈥渁vailable all the time. And that鈥檚 important.鈥� Nymble is already expanding beyond Canadian clinics through a with Shoppers Drug Mart and an evidence-based obesity management practice in , suggesting broadening interest in patient-centred support that meets people where they are.

Obesity care has also been hindered by an overreliance on body-mass index as a diagnostic tool. Originally established in 1832 by a Belgian astronomer, BMI was introduced to the mainstream in the 1970s by an American physiologist as a for studying weight at a population level. But when it comes to evaluating an individual鈥檚 health, it鈥檚 far too crude a measure, according to Dr. Jean-Pierre Despr茅s, a leading researcher with Universit茅 Laval who has been studying metabolic health since the 鈥�80s.

One of the biggest shortcomings of BMI is that it doesn鈥檛 account for fat distribution, which is often a stronger predictor of health risks than overall body weight. Critically, BMI fails to measure visceral adipose tissue (VAT), also known as abdominal obesity, a harmful type of fat that surrounds and infiltrates internal organs. According to Statistics Canada, of Canadians have VAT. 鈥淭his 鈥榟idden fat鈥� is a lot more dangerous to your health than excess body weight,鈥� explains Despr茅s. Subcutaneous fat (the kind that sits just beneath the skin) is largely inert. VAT, on the other hand, is , and releases hormones and substances that can wreak havoc on the body鈥檚 internal systems, promoting systemic inflammation and insulin resistance, damaging blood vessels, contributing to the buildup of artery-clogging plaque and increasing the risk of heart attacks and strokes.

Although GLP-1 RAs can be effective in reducing VAT, they鈥檙e prescribed primarily based on BMI thresholds 鈥斅爓hich means someone with elevated VAT whose BMI falls in the 鈥渘ormal鈥� range won鈥檛 qualify for pharmacological intervention, despite facing potential metabolic risks. (Conversely, someone with a high BMI but low VAT may not have any metabolic issues at all.) This disconnect is especially baffling given that GLP-1 RAs have long been used to treat and reduce the risk of Type 2 diabetes and cardiovascular disease. Despr茅s believes there鈥檚 likely a link between those clinical benefits and a reduction in patients鈥� VAT. 鈥淏ut we don鈥檛 have that evidence because, as of now, the only end point reported in the clinical trials is weight loss,鈥� he says.

This highlights a fundamental problem in the conventional framing of obesity treatment: weight loss, rather than metabolic improvement, is presented as the goal. Physicians are also conditioned to see the number on the scale as the outcome, overlooking the more meaningful markers 鈥� insulin sensitivity, inflammation levels and cardiovascular function 鈥� which more accurately reflect a person鈥檚 risk of chronic diseases such as Type 2 diabetes and heart disease.

Understanding GLP-1 RAs as metabolic health tools rather than diet drugs could help shift the focus. Nymble tries to avoid focusing solely on weight by integrating various domains, including behavioural therapy, nutrition and physical activity, the science of appetite and how therapeutics work. 鈥淲e won鈥檛 see the net benefit of these medications until we address obesity as a complex chronic disease,鈥� says Seth.

Dr. Dan Drucker and Dr. Puneet Seth are speaking at the conference on May 7 & 8. Check out the full program .

Caitlin Walsh Miller writes about technology for . Torstar, the parent company of the 海角社区官网Star, has partnered with MaRS to highlight innovation in Canadian companies.