Questioning Medicine

Episode 400: 408. CME Obesity and MASH

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  • GLP1 drugs work but they likely need lifestyle modifications


  • No convincing evidence GLP1 cause thyroid cancer in humans BUT contraindication if family history exist


  • Stopping therapy usually results in weight gain


  • Insurance coverage for weight loss is limited and variable 


  • Semaglutide for type 2 diabetes max dose is 2.0 mg weekly Semaglutide for weight loss has a goal dose of 2.4 mg weekly
  • Diagnose steatotic liver disease with imaging and 1 metabolic risk factor (or biopsy)


    • After diagnosis check FIB-4:
    • Low risk, continue to monitor with FIB-4 every 2-3yrs 
    • Intermediate risk, order VCTE and consider referral if >F1 
    • High risk order a VCTE and referral (20% end with SLD)


      • 2 FDA approved medications for liver fibrosis are not cheap, expect insurance push back


      ...more
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