Treatment of obesity in spinal cord injury with tirzepatide: a case report

IntroductionIndividuals with spinal cord injury (SCI) experience alterations in metabolism that result in increased central obesity, insulin resistance, and dyslipidemia placing them at elevated risk for developing cardiometabolic disease (CMD). Increased exercise and dietary modifications are the primary interventions for preventing CMD. However, people with SCI face unique challenges that prevent them from increasing their physical activity and easily modifying their nutritional intake. Tirzepatide is a medication that has been approved by the Food and Drug Administration to be used in conjunction with lifestyle changes to treat obesity in adults with type 2 diabetes mellitus.Case presentationA male in his 40's with C6 American Spinal Injury Association Impairment Scale B SCI 15 years prior with a body mass index of 32 presented to his primary care provider for treatment of obesity. He previously worked with multiple dietitians and increased his physical activity to lose weight. Despite these interventions, he was unable to reduce his weight. He was started on tirzepatide. After 3 months of treatment, he lost 31 pounds and saw improvements in his lipid profile. The only adverse effect reported was heartburn.DiscussionThe metabolic dysfunction associated with SCI and barriers to adequate exercise for weight loss place individuals with SCI at increased risk for obesity and developing CMD. Tirzepatide may be an effective adjunct therapy to lifestyle interventions to help prevent CMD in those with SCI. Further research is indicated to examine the long-term efficacy, benefits, and adverse effects that may be associated with tirzepatide.