The Challenge of Treating Obesity and Overweight Proceedings of a Workshop (2017) / Chapter Skim
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2 Treatment of Obesity and Overweight in Adults
2 Treatment of Obesity and Overweight in Adults
Pages 7-16
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From page 7... ...
• Bariatric surgery leads to the largest and most sustained weight reduction, although different procedures result in different av erage weight losses, and patients undergoing each procedure vary in weight loss and its maintenance. Health care providers encourage patients with obesity to lose weight to prevent or ameliorate obesity-related diseases and conditions and to improve the way they feel and function, said Susan Yanovski, co-director of the Office of Obesity Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.
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From page 8... ...
as "an approach used to help individuals develop a set of skills to achieve a healthier weight. It is more than helping people to decide what to change; it is helping them identify how to change." She explained that components of behavioral treatment include self-monitoring of food intake, physical activity, and other behaviors; stimulus control, such as keeping unhealthy foods out of the house or making fruits and vegetables more available; goal setting, which may encompass not only weight goals 1 In responding subsequently to a question, Yanovski asserted that the training is what is important, and it does not need to be delivered by a physician or other health professional.
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From page 9... ...
The intensive lifestyle intervention included diet, physical activity, and behavioral strategies delivered in group and individual sessions weekly for 6 months, and then three times a month for the next 6 months. Yanovski noted that this intervention met the gold standard approach to treating obesity with behavioral modification.
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From page 10... ...
"There may be less weight loss initially," observed Yanovski, "but perhaps slower regain." The results from this study are encouraging, Yanovski asserted, but FIGURE 2-1 Percent reduction in initial weight in the Look AHEAD study's intensive lifestyle intervention group at years 1, 4, and 8 according to race/ethnicity. SOURCES: Presented by Susan Yanovski on April 6, 2017 (data from Look AHEAD Research Group, 2014)
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From page 11... ...
In fact, she pointed out, phentermine is by far the most prescribed weight loss drug despite being approved only for short-term use. TABLE 2-1 Drugs Approved by the Food and Drug Administration for Obesity Treatment Generic Trade DEA Approved Year Price per Name Names Schedule Use Approved Month Benzphetamine Didrex III Short term 1960 $20–$50 Phendimetrazine Bontril, Prelu-2 III Short term 1961 $6–$20 Diethylpropion Tenuate IV Short term 1973 $47–$120 Phentermine Adipex, Ionamin IV Short term 1973 $6–$45 Orlistat Xenical, Alli None Long term 1999 $45–$520 Lorcaserin Belviq IV Long term 2012 $240 Phentermine + Qsymia IV Long term 2012 $140–$195 Topiramate-ER Bupropion-ER + Contrave None Long term 2014 $180–$210 Naltrexone ER Liraglutide Saxenda None Long term 2014 $900–$1,000 NOTE: ER = extended release.
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From page 12... ...
For example, depending on the medication used and the intensity of the lifestyle intervention, between 25 percent and more than 50 percent of treated patients may not achieve a 5 percent reduction after 12 weeks of therapy, which means they are exposed to the risks and costs of a drug but have little prospect of benefits. In that case, Yanovski said, guidelines call for consideration of discontinuing the drug and reevaluating treatment options, including the intensification of behavioral strategies, referral to a dietician or lifestyle interventionist, a medication with a different mechanism of action, reassessment and management of medical or other contributory factors, and referral for bariatric surgery in appropriate patients.
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From page 13... ...
The second procedure Yanovski described was the laparoscopic adjustable gastric band, an inflatable silicone device placed around the top portion of the stomach that slows and limits food consumption. She explained that it results in less weight loss compared with the Roux-en-Y gastric bypass, but the procedure is reversible.
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From page 14... ...
-- an observational cohort study of adults who underwent their first bariatric surgery at 10 U.S. hospitals between 2006 and 2009 and 70 percent of whom underwent Roux-en-Y gastric bypass, 25 percent gastric band, and 5 percent other -- those who underwent the gastric bypass procedure had lost more than 30 percent of their initial weight at 1 year and maintained a fair amount of that weight loss on average at 3 years (Courcoulas et al., 2013)
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From page 15... ...
These results indicate that baseline variables have limited predictive value for an individual's chance of a successful weight loss outcome after bariatric surgery." KNOWLEDGE GAPS Yanovski concluded by listing some of the knowledge gaps with respect to the efficacy of obesity treatment in adults: • the efficacy of drug and surgical treatments in racial and ethnic minority groups and other populations subject to health disparities, such as rural populations and those of low socioeconomic status; • the effectiveness of newer modes of delivery for lifestyle interven tion (such as Web-based and telephonically delivered interventions) in large and diverse populations; • predictors of response beyond initial weight loss for all obesity treatments, encompassing genetic and phenotypic characteristics (including behavioral and metabolic characteristics)
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