Australia's First Clinical Consensus on Obesity and CVD Unveiled Amid GLP-1 Safety Concerns

"The consensus statement aims to provide clinicians with practical tools to address obesity in patients with or at high risk for CVD." – Professor Garry Jennings AO

Clinical Consensus Statement on Obesity and CVD

Development and Launch

The National Heart Foundation of Australia has released the country's first Clinical Consensus Statement on Obesity and Cardiovascular Disease, providing guidance on the use of Glucagon-Like Peptide-1 (GLP-1) therapies for weight management and cardiovascular risk reduction.

The statement was developed over 12 months by a 22-person task force of experts, healthcare practitioners, and lived experience advocates. It was launched at the World Heart Summit in Geneva, Switzerland, and presented at the WHO World Health Assembly, where it received international recognition.

Key Recommendations

The statement addresses obesity as a risk factor for cardiovascular disease and outlines a four-pillar management approach:

• Nutrition and physical activity
• Lifestyle modifications
• GLP-1 pharmacotherapy (including semaglutide, liraglutide, and tirzepatide)
• Metabolic bariatric surgery

The statement notes that incretin-based medicines have "changed the landscape of obesity management" and that high-quality trials have shown they improve cardiometabolic risk factors and reduce the risk of major adverse cardiovascular events in some cohorts. Studies cited indicate a 20% reduction in future cardiovascular events among those with established heart disease taking these medications. The statement emphasizes that pharmacotherapy should complement, not replace, behavior modifications.

Expert Statements

Professor Garry Jennings AO, Heart Foundation Chief Medical Advisor and taskforce co-chair, stated that the consensus statement aims to provide clinicians with practical tools to address obesity in patients with or at high risk for CVD. He noted that obesity rates have plateaued in Australia at a high level, while rates are still accelerating in many low- and middle-income countries.

Professor Elif Ekinci stated that clinical trial data is being compiled to understand how the medication affects the cardiovascular system.

Dr. Mark Mellor, a GP on the taskforce, stated that there is an inter-connectedness between obesity and CVD, and that not treating obesity in a person with CVD misses an opportunity to improve health.

Background Data

According to the 2022 National Health Survey, 34% of Australian adults were overweight and 31.7% were obese, up from 24.4% in 2007.

Access and Regulatory Status

Pharmaceutical Benefits Scheme (PBS)

No TGA-indicated weight management medications are currently listed on the Pharmaceutical Benefits Scheme (PBS). The Pharmaceutical Benefits Advisory Committee (PBAC) has recommended listing semaglutide (Wegovy) on the PBS for patients with established cardiovascular disease and obesity, with a subsequent report recommending prioritizing high-risk groups. The listing has not been confirmed.

Natalie Raffoul of the Heart Foundation stated the organization hopes these medications become available on the PBS. The task force aims to make these medications available at minimal cost.

International Reception

The WHO recognized the statement as a world first, and the World Heart Federation acknowledged its practical approach. Several other countries have requested to adapt the statement for their own healthcare systems.

Concerns Regarding GLP-1 Medications and Eating Disorders

"A 'starved brain' can lead to increased food-related thoughts, anxiety, fear, and a drive for control, forming the basis of typical anorexia cognitions." – Josephine Money, Dietitians Australia

Patient Experiences

Multiple patient accounts have raised concerns about the prescribing of GLP-1 medications to individuals with eating disorder histories.

Case 1: Kacey Martin
A 33-year-old with a history of bulimia and binge/restrictive eating reported an initial reduction in food preoccupation when starting weight-loss medication. She later experienced a return of problematic behaviors, including purging, increased body-checking, and heightened psychological preoccupation with weight.

Case 2: Claire Munch
In 2023, Ms. Munch sought weight-loss drugs through the telehealth provider Juniper. She completed an online questionnaire, disclosing her history of an eating disorder and mental health conditions, including severe depression and post-traumatic stress disorder. Based on her body mass index, she was prescribed the medication without a video consultation. Her general practitioner had previously refused the same medication due to her eating disorder history.

Following the prescription, Ms. Munch stated that her eating disorder relapsed, leading to approximately five months of hospitalization. She clarified that the medication did not directly cause the hospitalization but acted as a trigger.

Expert Concerns

Atypical Anorexia
Dr. Terri-Lynne South of the Royal Australian College of General Practitioners (RACGP) noted concerns about patients developing "atypical anorexia"—a condition involving individuals with a history of larger body sizes becoming excessively preoccupied with weight, dieting, and exercise while using these medications. South emphasized the need to prevent unhealthy relationships with food and potential shifts between eating disorder types.

Nutritional Impact
Josephine Money, a spokeswoman for Dietitians Australia, indicated that GLP-1 medications can make it difficult for many individuals to consume adequate nutrition. She warned that a "starved brain" can lead to increased food-related thoughts, anxiety, fear, and a drive for control, forming the basis of typical anorexia cognitions.

Regulatory and Telehealth Actions

AHPRA Actions
The Australian Health Practitioner Regulation Agency (AHPRA) has taken regulatory action against doctors, pharmacists, and nurses for inappropriate prescribing of GLP-1 medicines, particularly through telehealth. These instances have been linked to suppressing the hunger of patients with anorexia, resulting in emergency hospitalizations. AHPRA stated that practitioners must conduct comprehensive assessments to identify patient vulnerabilities, such as disordered eating or body image concerns, before prescribing weight-loss medication.

Juniper Response
Following Ms. Munch's recovery, she contacted Juniper to express concerns about their prescribing processes. The company's Clinical Director, Dr. Matt Vickers, apologized and offered a refund for the medication, which was processed promptly. Several months later, Ms. Munch began receiving discount codes and promotional emails from Juniper.

Dr. Vickers later sent a letter apologizing again and outlining changes made by the company, including improved staff training and mandatory video calls for all consultations, implemented in September 2023, to align with AHPRA Medical Board guidelines.

Dr. Vickers stated Juniper's commitment to patient safety, regular review of safeguards, and implementation of mandatory training on patient risk factors and audit processes for risks such as eating disorders. He also noted a review of marketing processes to prevent communications from reaching inappropriate patients.

Broader Concerns
Dr. Michael Wright, RACGP president, stated that Ms. Munch's case highlights communication breakdowns among some medical telehealth providers. He emphasized patient safety over access or convenience and raised concerns about providers operating outside Medicare not being held to the same standards.

Eating disorder groups report that patients can easily exaggerate their Body Mass Index (BMI) during online questionnaires to obtain medication via telehealth, sometimes without direct doctor screening. The Butterfly Foundation's helpline has received numerous calls from individuals using these medications who have eating disorders, as well as from concerned caregivers.

Regulatory Findings

The Therapeutic Goods Administration (TGA), in conjunction with federal Health Minister Mark Butler, stated there is no evidence of an increase in eating disorders linked to GLP-1 drugs, but they are aware of some reports. The TGA has received five reports of eating disorders linked to GLP-1 medications since 2012.

The Department of Health, Disability, and Ageing is aware the Butterfly Foundation has received calls regarding GLP-1 drugs. The TGA is in discussions with regulatory bodies to strengthen integration between prescribing platforms and primary care.

The Eating Disorder Alliance and other bodies have also expressed concerns that marketing for weight-loss treatments, including promotional sales, could target vulnerable individuals. Dr. South highlighted concerns about some telehealth companies potentially exploiting loopholes in advertising laws.