In this article
- • What is comorbidity?
- • Type 2 diabetes and prediabetes
- • Hypertension and cardiovascular disease
- • Sleep apnoea and breathing problems
- • Osteoarthritis, PCOS and fatty liver
- • Treatment and the GLP-1 effect
What is comorbidity?
Comorbidity literally means: the simultaneous presence of several conditions in one person. In the context of obesity, it refers to chronic diseases that arise or worsen due to excess weight and that often occur together.
The most important comorbidities at a BMI of 30 or higher are: type 2 diabetes, hypertension (high blood pressure), dyslipidaemia (unfavourable cholesterol values), obstructive sleep apnoea, non-alcoholic fatty liver disease (MASLD), polycystic ovary syndrome (PCOS), osteoarthritis in weight-bearing joints, certain cancers and cardiovascular disease.
These conditions reinforce each other. Diabetes raises the risk of cardiovascular disease, hypertension worsens kidney disease, sleep apnoea increases the risk of arrhythmias. An integrated treatment that tackles weight, glucose and blood pressure at the same time is therefore the most effective.
Type 2 diabetes and prediabetes
Type 2 diabetes occurs in 60 to 90 percent of people with morbid obesity. At a BMI between 30 and 35, the risk is 3 to 4 times higher than at a healthy weight. Prediabetes (HbA1c between 42 and 47 mmol/mol) is a preliminary stage that is still reversible.
GLP-1 medicines (semaglutide, tirzepatide, liraglutide) act on both weight and glucose. In diabetes patients they lower HbA1c by 1 to 2 percentage points and sometimes even achieve diabetes remission (HbA1c back to <42 mmol/mol without medication) at 15 percent weight loss.
For people with type 2 diabetes, Ozempic and Mounjaro are prescribed via basic health insurance when other blood-sugar-lowering medicines work insufficiently. The reimbursement makes treatment financially accessible for this group.
Hypertension and cardiovascular disease
In obesity, hypertension is 2 to 3 times more common than at a healthy weight. Excess belly fat produces substances that constrict blood vessels and make the kidneys retain more sodium, which raises blood pressure.
The SELECT trial showed, in people with obesity without diabetes but with cardiovascular disease, that semaglutide 2.4 mg (Wegovy) lowers the risk of heart attack, stroke and cardiovascular death by 20 percent. Tirzepatide shows comparable signals in the SURMOUNT-MMO trial.
In patients with existing cardiovascular disease, GLP-1 is not only weight treatment but also cardiovascular prevention. This is one reason why guidelines increasingly name GLP-1 as first choice in obesity with comorbidity.
Sleep apnoea and breathing problems
Obstructive sleep apnoea occurs in 40 to 70 percent of people with obesity. Fat around the throat and tongue narrows the airway during sleep, leading to pauses in breathing, daytime fatigue and an increased risk of heart attack.
The SURMOUNT-OSA trial showed that Mounjaro 15 mg, in people with obesity and sleep apnoea, reduced the number of breathing pauses per hour by more than 50 percent and made CPAP treatment unnecessary for many. Clinically, this is a very important effect.
Other breathing problems such as obesity hypoventilation and asthma also usually improve with significant weight loss.
Osteoarthritis, PCOS and fatty liver
Osteoarthritis in knees and hips is 3 to 5 times more common in obesity due to the extra load plus low-grade inflammation from fat tissue. As little as 10 kilograms of weight loss reduces knee load by 40 kilograms per step.
Polycystic ovary syndrome (PCOS) affects 10 to 20 percent of women and is often worsened by insulin resistance and weight. GLP-1 improves the menstrual cycle, fertility and metabolic profiles in PCOS.
Non-alcoholic fatty liver disease (MASLD) occurs in 70 to 90 percent of people with obesity. GLP-1 therapy significantly reduces liver fat and liver inflammation, often within 6 to 12 months of treatment.
Treatment and the GLP-1 effect
An integrated approach to obesity and comorbidity delivers the greatest health gains. GLP-1 medication combines weight loss with direct effects on glucose, blood pressure, lipids, liver and sleep.
The choice between Ozempic, Wegovy, Mounjaro or Saxenda depends on your comorbidity, preference, history and budget. In diabetes, Mounjaro or Ozempic is preferred; without diabetes but with cardiovascular disease, Wegovy has the stronger evidence base.
At Go Leaner we assess all comorbidities at intake and tailor the treatment plan accordingly. Coaching, blood tests and consultations are part of the subscription, with no separate bills.
Frequently asked questions
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Comorbidity and treatment strategies are always assessed individually by a BIG-registered doctor.