In the stud-ies focusing on weight loss, treatment with liraglutide led to approximately 9% weight loss compared with 3% with placebo in patients completing 1 year of treatment. 63. As with all chronic medical conditions, effective management of obesity must be based on a partnership between a highly motivated patient and a committed team of health professionals. 2015. doi: 10.1007/ s11695-015-1974-2. The 5 As strategy, initially developed for smoking cessation counseling, has been adapted by several groups for behavioral therapy of obesity.37-39 The Society of Behavioral Medicine has developed a multidisciplinary 5As model in which the healthcare professional provides brief counseling and arranges additional care for patients with psychosocial issues or comorbid conditions.29 The components are: • Assess: Measurement of BMI, identification of comor-bid conditions known to interfere with weight loss (depression, sleep disorders, chronic pain, stress, binge eating), and discussion about readiness for change. Kushner RF, Butsch WS, Kahan S, et al. Naltrexone, an opioid receptor antagonist that has long been used for the treatment of addictions, leads to little weight loss on its own, as well. These were originally developed in the 1960s to provide a nutritionally complete intake in terms of protein, vitamins, and micronutrients, but provide as little as 1.4 MJ (350 kcal) daily. 2014;4(1):39-44. doi: 10.1111/cob.12038. An evidence-based guide for obesity treatment in primary care. Patients who respond to lorcaserin usually do so relatively quickly. The diet must be realistic – that is, based on dietary modification and practical changes in eating habits. Plans include a lower-calorie diet, increased physical activity, and ways to help you change your habits and stick with them. It consists of a surgically implanted, rechargeable electrical pulse generator and 2 wire electrodes that are placed in contact with the vagus nerve trunks near the junction of the stomach and esophagus. A silent response to the obesity epidemic: decline in US physician weight counseling. Jensen MD, Ryan DH, Apovian CM, et al. Management of obesity can include lifestyle changes, medications, or surgery. Randomized place-bo-controlled clinical trial of lorcaserin for weight loss in type 2 diabetes mellitus: the BLOOM-DM study. Eat Behav. Management. Ikramuddin S, Blackstone RP, Brancatisano A, et al. Responses should be evaluated after 12 weeks at this dose, and treatment should either be escalated to a higher dose or discontinued if patients do not achieve at least a 3% weight loss. Naltrexone/bupropion cardiovascular outcomes trial. Saxenda [package insert]. At 3 years out, there was nearly an 80% decreased progression to T2D compared with placebo.71 In a unique trial assessing weight maintenance, subjects initially engaged in a medi-cally monitored diet and lost approximately 6% of body weight within 12 weeks. Sherson EA, Yakes Jimenez E, Katalanos N. A review of the use of the 5 A’s model for weight loss counselling: differences between physician practice and patient demand. has requested noninferiority cardiovascular outcomes trials for each newly approved medication. This article reviews the standards of care and recommendations for the management of obesity. Many think of a ‘diet’ as a temporary change in eating habits (often extreme or quirky), a view encouraged by many of the diet books that hold out the promise of easy and instant success. Accessed January 10, 2016. Allison DB, Gadde KM, Garvey WT, et al. In 1 trial, preliminary treatment with the Orbera balloon led to decreased bariatric operative time, improved weight loss, and fewer AEs compared with patients who underwent gastric bypass without prior Orbera treatment.90, Orbera is approved for short-term use in patients with a BMI of 30 to 40 kg/m2 in the presence of at least 1 obesity-associated comorbid condition. PLoS One. An individual’s weight loss plan is often best addressed by enrollment in a bona fide weight loss program headed by a physician trained in obesity management. Weight loss per se is of no medical benefit unless it is maintained, and this will require the obese individual to adhere to a permanent change in eating habits. The diet should contain recommended daily intakes of vitamins, minerals, and electrolytes, if necessary by supplementation; 20–30 g daily of fiber should also be consumed. New tools and treatment approaches help clinicians provide these interventions and support weight management in the primary care setting. By itself, bupropion leads to little weight loss. 2013;37(11):1443-1451. doi: 10.1038/ijo.2013.120. clinicaltrials.gov/ct2/show/NCT0263812. Multicenter, placebo-con-trolled trial of lorcaserin for weight management. 61. Obesity management 1. Connect. soard.2015.08.496. Clinicians can be reimbursed for a maximum of 22 visits (15 minutes each) over one year, with reimbursement in the second 6 months contingent on patients achieving at least a 3-kg weight loss.29 Educational resources to help PCPs acquire obesity counseling and management skills have expanded, as well. Talk to your doctor or therapist about improving your coping skills and consider these tips to cope with obesity and your weight-loss efforts: 1. sity management. Kissileff HR, Carretta JC, Geliebter A, Pi-Sunyer FX. Obesity, particularly upper body obesity, is a well-documented risk factor for OSA and is reported to be present in 60% to 90% of OSA patients evaluated in sleep clinics.2 Additionally, the severity of OSA is directly related to increasing body weight. 2013;51(2):186-192. doi: 10.1097/ MLR.0b013e3182726c33. Post RE, Mainous AG 3rd, Gregorie SH, Knoll ME, Diaz VA, Saxena SK. Patients must modify their eating habits; consuming smaller amounts, more slowly. Stay focused on your goals. What is the role of the pharmacist in obesity management? 2014;8(2):e131-e139. 27. Safety and effectiveness of the intragastric balloon for obesity. Gudzune KA, Bennett WL, Cooper LA, Bleich SN. Weight loss and the development of a healthy lifestyle is the cornerstone in the treatment of the obese hypertensive patient. Smith SR, Weissman NJ, Anderson CM, et al; Behavioral. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Few commercial programs had long-term data available.46, Very low calorie diets (<800 kcal/day) are viable options in some patients but should be provided only within the context of a high-intensity lifestyle interven-tion and close medical monitoring.3,32 Patients should be supervised by trained practitioners in a medical care set-ting because rapid weight loss has the potential for medical complications, such as gallstones and electrolyte distur-bances.3,32,47 Total meal replacement with a very low calorie diet over 3 months has the potential to achieve 10% to 15% weight loss, but it may result in substantial weight regain, especially in the absence of a maintenance program.3 These diets are typically prescribed in medical settings, but several commercial options are also available.46. ReShape Integrated Dual Balloon System [instructions for use]. Effects of bariatric surgery on mortality in Swedish obese subjects. Alli [package insert]. A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight. doi: 30. The term ‘reducing diet’ has been coined to describe such diets used to treat the obese. Cet aliment diététique complet, à l'efficacité cliniquement prouvée, favorise la perte de poids chez les chats obèses. Obesity Algorithm, presented by the Obesity Medicine Association, 2014-2015. Obes Surg. Patients treated with the medication also had improved cardiometabolic markers, including reduced blood pressure and lipids, and many were able to decrease or discontinue blood pressure or T2D medications. 2.12. J Am Coll Cardiol. 2013;36(12):4022-4029. doi: 10.2337/ dc13-0234. 2012;20(2):330-342. doi: 10.1038/oby.2011.330. The latter approach is preferable for Americans, whose typical diet is too high in fat. Other contraindications include glaucoma, use of monoamine oxidase (MAO) inhibitor medications, and hyperthyroidism. Dietary management of obesity aims to reduce fat stores by changing eating habits to reduce energy intake below that required for weight maintenance. R. Rajendram, V.R. 20. 3. Although there is an inevitable fall with weight loss, 0.8 g per kg of body weight per day+1.75 g per 100 cal deficit of protein (approximately 44 g daily for women and 56 g daily for men) should be consumed, and fat restricted to less than 30% of total energy. Iverson C, Christiansen S, Flanagin A, et al. Only bariatric surgery achieves sufficient sustained weight loss to reduce the burden of obesity-associated diseases. Physician weight loss advice and patient weight loss behavior change: a literature review and meta-analysis of survey data. There is a warning of sui-cidal thoughts in patients younger than 24 who are taking antidepressants, including bupropion, which also applies to naltrexone-bupropion SR. Other contraindications include uncontrolled hypertension, seizure disorders, chronic opioid pain medication use, and MAO inhibi-tor use. Protein intake must be adequate to maintain lean body mass. Finding exercises that fit individual limitations, abilities, and preferences and/or supervision by an experienced fitness instructor with a prescribed exercise program can help improve adherence.22, Commercial weight-loss programs that have evidence to support their efficacy and safety are an option to pro-vide a comprehensive lifestyle program.1,3 However, the amount of weight loss that patients can expect to achieve with these programs is likely less than they expect.45 A recent meta-analysis of 13 randomized controlled trials (RCTs) found that, among the most popular programs, weight loss at one year compared with controls ranged from 2.6% for Weight Watchers to 4.9% for Jenny Craig. Moon Township, PA: GlaxoSmithKline; 2014. Il est formulé avec : • Une teneur élevée en protéines, ce qui a une efficacité cliniquement prouvée pour la perte de poids chez les chiens obèses. 2005;13(4):703-709. doi: 10.1038/oby.2005.79. 2015;16(4):304-318. doi: 10.1111/obr.12264. Brazilian multicenter study of the intragastric balloon. Ann Intern Med. 2010;11(2):74-78. doi: 10.1016/j.eat-beh.2009.09.007. Hospital complication rates with bariatric. Childhood obesity: a plan for action, chapter 2 Statistics on Obesity, Physical Activity and Diet, England 2019 Childhood obesity plan: interactions between modelled policies v7.i9.847. Expected improvement of a comorbid condition can be a potent motivator for behavioral change and weight loss.29 As little as 3% sustained body weight loss improves glycemic control, triglycerides, and risk of T2D.1 Weight loss of 5% to 10% further reduces hyperglycemia and triglycerides, and it improves blood pressure, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol ranges, as well as liver function and fatty liver disease; it also reduces functional limitations, chronic pain, and the need for hypertension, T2D, and lipid medications in most patients.1,2,32 Many other conditions, such as obstructive sleep apnea and osteoarthritis, along with the risk for several cancers, can also be improved, reversed, or prevented with moderate sustained weight loss.1,2 T2D is a particularly relevant example. Managing obesity is similar to managing high blood pressure or diabetes—left unmanaged, these conditions get worse and when treatments stop, the problem comes back. When possible, more frequent and intensive multidisciplinary interaction, ideally with a range of clinical providers such as pharmacists, physicians, nurses, dieticians, psychologists, and obesity medicine specialists, leads to greater improvements than less intensive or less frequent counseling. November 2-6, 2015; Los Angeles, CA. 31. It appears that withdrawing all solid or ‘proper’ food helps the patient to define himself or herself as ‘not eating,’ in the same way that some quitting smokers find it easier to abstain completely from cigarettes rather than to cut down. 2012;22(6):896-903. doi: 10.1007/s11695-012-0607-2. Zerrweck C, Maunoury V, Caiazzo R, et al. Pharmacists can be actively involved in weight-man-agement counseling,48 which can include collaboration among physicians, dietitians, and other healthcare pro-viders, and referring patients to providers for care as needed; monitoring of vital signs; motivational behav-ioral counseling and education; nutrition and exercise support; and medication monitoring. A randomized, con-trolled trial of 3.0 mg of liraglutide in weight management. It is applicable in every case. 22. All rights reserved. Components of behavioral therapy include goal setting, self-monitoring, addressing barriers, problem-solving, positive reinforcement, and ongoing support.20 Motivational interviewing can improve behavioral counseling in patients who are ambivalent about behavior change and has been shown to improve weight-loss outcomes.34-36 This technique is a collaborative, patient-centered process that focuses on assisting and guiding patients to build internal motivation and supporting personalized problem-solving to achieve behavior change.28. 85. Endocr Pract. Secher A, Jelsing J, Baquero AF, et al. Adams TD, Gress RE, Smith SC, et al. Additionally, warnings for this medica-tion include a risk for mood disorders, suicidal thoughts, hypoglycemia in patients on some diabetes medications, cognitive impairment, metabolic acidosis, and sleep difficulty. Don't become isolated. Aliment médicalisé pour chat en surpoids. Int J Obes (Lond). • Advise: Counseling about the benefits of weight loss and behavioral changes. Imaz I, Martinez-Cervell C, Garcia-Alvarez EE, Sendra-Gutiérrez JM, González-Enriquez J. Available resources could be better utilised in the management of obesity. Among 265 balloon insertions, there were 1 failure and 2 replacement procedures, and 24 patients required early retrieval due to nonulcer intolerance. Further, few pharmacists or physicians have formal training in obesity treatment and counseling. Early removal of the balloon was required in 4.2% of patients; fewer than 1% developed severe complications, such as bowel obstruction or perforation.84-86 Outcomes improve significantly when use of the balloon is combined with ongoing dietary and lifestyle modifica-tion counseling.87 Orbera has also shown durability of weight loss after balloon removal and has been studied for repeated use after removal of the initial balloon.88,89, This device has also been studied as a bridge to gastric bypass surgery. jacc.2013.11.004. The energy expenditure greater than 24 h can be estimated by multiplying by a factor related to activity levels (1.3, sedentary; 1.5, moderate activity; 1.8, physically very active). Diet prescription for weight management involves a caloric deficit to promote weight reduction. Am J Clin Nutr. Physician practice patterns of obesity diagnosis and weight-related counsel-ing. Plus de détails . Gudzune KA, Doshi RS, Mehta AK, et al. 2003;285(5):R992-998. Contrave [package insert]. Référence : 1812750. • Overweight refers to increase body weight in relation to height , when compared to some standard of acceptable or desired weight. Robert F. Kushner, in Sleep Apnea and Snoring, 2009, Evaluation and management of obesity is an essential step in the treatment of patients with obstructive sleep apnea (OSA) and snoring based on three important facts. Mayo Clin Proc. Effects of naltrexone sustained-release/bupropion sustained-release combination therapy on body weight and gly-cemic parameters in overweight and obese patients with type 2 diabetes. Accessed January 10, 2016. American College of Cariology/American Heart Association Task Force on Practice Guidelines; Obesity Society. Pi-Sunyer X, Astrup A, Fujioka K, et al; SCALE Obesity and Prediabetes NN8022-1839 Study Group. 2010. The REDUCE pivotal trial: a prospective, random-ized controlled pivotal trial of a dual intragastric balloon for the treatment of obesity. Arutchelvam Vijayaraman MD, FRCP, in Practical Guide to Obesity Medicine, 2018. Obes Surg. Glucagon-Like Peptide 1 and Human Obesity, Ananthi Anandhakrishnan (MBBS, IBSC, BMEDSCI), Márta Korbonits MD, PHD, in, Journal of the Academy of Nutrition and Dietetics, Journal of the American College of Cardiology, Approximately 2 MJ (500 kcal) per day with >50 g high-quality protein; usually liquid, 5–7.5 MJ (1200–1800 kcal) per day often from menus, recipes, Nutritionally balanced, individually tailored to produce fixed-energy deficit (e.g., 2 MJ or 500 kcal day, Greater than 40% protein, thus low in carbohydrate and fat, Effectively low fat, may be high in fiber, Limits carbohydrate to maximum <50 g daily, Choice from lists of macronutrients to encourage intake of foods high in complex carbohydrates, Liquid formula meals of approximately 1.7 MJ (400 kcal) to replace 1–2 meals daily, Varied; e.g., food combining diets that require macronutrients to be eaten separately and separated by time. doi: 10.1371/journal. 2011;19(1):110-120. doi: 10.1038/oby.2010.147. 33. The ReShape dual balloon device, approved in July 2015, uses 2 connected balloons, filled with 750 to 900 mL of saline, to displace gastric volume and increase satiety.12 In the REDUCE trial, which included 326 patients with obe-sity and at least 1 comorbid condition, subjects treated with ReShape who completed the trial lost twice as much weight as completers who received a sham control (7.6%/15.9 lbs vs 3.6%/7.8 lbs, respectively).91 As expected, several risk factors and comorbid conditions improved, including blood pressure, A1C, and lipids, and treated patients experienced significant improvements in quality of life domains. A low-glycemic load diet facilitates greater weight loss in overweight adults with high insu-lin secretion but not in overweight adults with low insulin secre-tion in the CALERIE Trial. 86. Nausea and vomiting are the most common AEs; however, they can be managed with antiemetic and antispasmodic medications. Screening for obesity in adults: recommendations and rationale. Obes Surg. O’Neal KS, Crosby KM. Pâtée médicalisée pour chat adulte, spécialement formulée pour la perte de poids. Early weight loss while on lorcaserin, diet and exercise as a predictor of week 52 weight-loss outcomes. High-carbohydrate diets are composed of complex carbohydrates and are thus of low-energy density, which may aid management of hunger. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Moreover, progression to T2D was reduced by 76% compared with placebo in patients treated with the high dose of the medication.59, In the EQUIP trial, patients with severe obesity (BMI ≥35 kg/m2) who completed one year of treatment with phentermine-topiramate ER 15/92 lost 14.4% of body weight compared with 2.1% in the placebo group; 83.5% lost at least 5% of body weight, compared with 25.5% in the placebo group, and 67.7% lost at least 10% of body weight compared with 13.0% of those completing placebo treatment.60 Sub-analysis in patients with extreme obe-sity (BMI >45 kg/m2), a population that is rarely studied for nonsurgical weight-loss interventions, showed even greater benefits, with more than 50% of patients who completed the trial losing more than 15% of initial body weight and 28% of patients losing more than 20% of initial body weight.61, Notably, the maximum approved dose of phenter-mine is 37.5 mg and the maximum approved dose of topiramate is 400 mg; therefore, the doses of each medication in this combination treatment are quite low and well tolerated.7 Treatment is initiated at 3.75 mg phentermine/23 mg topiramate ER and escalated to 7.5/46 mg after 2 weeks. In pharmacother-apy, the FDA has approved the newer medications for long-term use, and the standard of care is to continue treatment, as long as patients are receiving benefit. In addition, people with type 2 diabetes and ndigenous people are eligible for additional care plan I Gastric ulcers may occur, as well.91 In another clinical trial that evaluated durability of lost weight, 98% of weight lost at the time of balloon removal was maintained at 6 months.92 Also, like Orbera, ReShape is approved for short-term use in patients with a BMI of 30 to 40 kg/m2 in the presence of at least 1 obesity-associated comorbid condition and is indicated in patients without previous gastric surgery who do not have active gastric disease (eg, gastritis, ulcers, hiatal hernia); patients should avoid using NSAIDs or other gastric irritants during the course of treatment.12 An improvement that may be seen with the next generation of gastric balloon devices includes the ability for placement by swallowing rather than endoscopic insertion.93, The Maestro Rechargeable System is an electrical neurostimulator that blocks vagus nerve activity between the stomach and the brain. 2013;8(7):e70048. the Comprehensive implementation plan on maternal, infant and young child nutrition 3 sets a target of no increase in childhood overweight by 2025. Many diets prescribe an energy intake that is based on a generalized rather than an individualized assessment of energy needs. Patients should also be encouraged by the dietitian to self-monitor their food intake, which may include measuring portion sizes and recording and calculating calories, fat grams, and/or carbohydrate grams. Ne pas donner à des chiennes en gestation ou allaitante, aux chiots ou aux chiens qui ont des affections associées à des états hypercataboliques (insuffisance rénale chronique de stade 3 et 4, insuffisance cardiaque avancée) 2012;157(5):373-378. doi: 10.7326/0003-4819-157-5-201209040-00475. Belviq [package insert]. Wilkinson ML, Brown AL, Poston WS, Haddock CK, Jahnke SA, Day RS. Kumar N. Endoscopic therapy for weight loss: gastroplasty, duodenal sleeves, intragastric balloons, and aspiration. Referral options include dieti-tians, hospital-based programs, behavioral medicine providers, and evidenced-based commercial weight-loss programs.29, The primary target for behavior change is to create an energy deficit by addressing caloric intake and energy expenditure.1 A caloric reduction of 500 to 750 calories per day can achieve weight loss of approximately 1 to 1.5 lb/week in the short term, with the rate of weight loss decreasing asymptotically over time.41 This typically translates to a rule-of-thumb caloric intake goal of 1200 to 1500 calories/day for women and 1500 to 1800 calories/day for men.1,3 Clinically meaningful weight loss can occur across a broad range of macronutrient compositions.19-21 For example, in one study that exam-, ined 4 diets that varied in content of fat (20%-40%), pro-tein (15%-25%), and carbohydrates (35%-65%), there was similar weight loss and no difference in hunger or satiety ratings among the interventions over 2 years. 2009;94(12):4898-4906. doi: 10.1210/jc.2009-1350. On average, topiramate leads to relatively little weight loss by itself. Proplan Veterinary Diets OM Obesity Management. These programs frequently stress behavioral modification techniques that have had documented success at achieving long-term weight loss.31-33 A reasonable initial goal for weight loss is about 10% of total body weight. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. A study to evaluate the effect of long-term treatment with BELVIQ (Lorcaserin HCl) on the incidence of major adverse cardiovascular events and conversion to type 2 diabetes mel-litus in obese and overweight subjects with cardiovascular disease or multiple cardiovascular risk cactors (CAMELLIA-TIMI).

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