Glucagon-like-peptide 1 (GLP-1) Receptor Agonists in Rheumatologic Disease

Obesity is a complex chronic disease that increases the risk of long-term medical complications and reduces lifespan due to excess body fat or adiposopathy. As of 2016, obesity affects 8.3 million (26.4%) of the Canadian population. Severe obesity, defined as a body mass index (BMI) >35 kg/m2, affects an estimated 1.9 million Canadians. The financial burden of obesity, including both direct and indirect costs, was estimated to be $7.1 billion in 2010. The pathophysiology of obesity is complex and involves a combination of genetic, metabolic, behavioural, and environmental factors. The hypothalamus regulates appetite and energy expenditure, while the mesolimbic area controls the emotional, pleasurable, and rewarding aspects of eating. The cognitive lobe is responsible for overriding the hedonic drive of the mesolimbic system. Adipose tissue itself contributes to its regulation through the release of leptin in proportion to fat mass. Leptin binds to receptors in the hypothalamus to reduce appetite and increase energy expenditure. Similarly, insulin binds to receptors in the arcuate nucleus of the hypothalamus also reducing appetite and increasing energy expenditure.