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Fedor Kazakov
Fedor Kazakov

Clinical Management Of Overweight And Obesity: ...


Learn what the PACT Act means for your VA benefits "; $("body").append(alertMsg); }); Management of Adult Overweight and Obesity (OBE) (2020)The guideline describes the critical decision points in the Management of Adult Overweight and Obesity and provides clear and comprehensive evidence based recommendations incorporating current information and practices for practitioners throughout the DoD and VA Health Care systems. The guideline is intended to improve patient outcomes and local management of patients who are obese or overweight.




Clinical Management of Overweight and Obesity: ...


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Purpose: The purpose of this study was to reach consensus on the importance and feasibility of clinical practice guideline (CPG) recommendations for physiotherapy practice for the prevention and management of overweight and obesity in Canadian adults.


Before undertaking gynecologic surgery, an evaluation of underlying comorbid conditions that could affect intraoperative and postoperative care should be performed. Obese patients are at higher risk of coronary artery disease (CAD), hypertension, DM, obstructive sleep apnea, and venous thromboembolism. Preoperative consultation with an anesthesiologist should be considered for the obese patient in whom the possibility of obstructive sleep apnea is suspected on clinical grounds or who is at risk of CAD, has a difficult airway, or has poorly controlled hypertension. The oral airway in an obese patient is suboptimal because of decreased neck mobility and narrowing of the pharyngeal space due to the presence of increased soft tissue. There are no specific preoperative ancillary tests recommended for the obese patient. Tests should be ordered only if an abnormal outcome will change clinical management. Obese patients with metabolic syndrome undergoing noncardiac surgery are at increased risk of cardiovascular complications; thus, those with other risk factors for CAD may benefit from a 12-lead electrocardiogram and other tests based on physical examination findings. In obese patients with DM, blood glucose evaluation and counseling the woman on the importance of euglycemia to improve postoperative wound healing is important. Routine screening of the obese patient for diabetes before surgery is not recommended.


In June 2021, the FDA approved the use of the GLP-1 receptor agonist semaglutide for weight loss, in a 2.4-mg/week subcutaneous dose. The drug is indicated as an adjunct to diet and exercise for adults with an initial BMI of 30 kg/m2 or greater (obesity). It also indicated for BMI of 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbid condition (eg, hypertension, type 2 diabetes mellitus, dyslipidemia). The approval was based on four phase-3 clinical trials in the Semaglutide Treatment Effect in People With Obesity (STEP) program involving approximately 4500 patients. The STEP 1, 2, and 4 trials reported a 15-18% weight loss over 68 weeks in individuals with overweight or obesity who received the medication. [152, 153, 154]


Liraglutide is a GLP-1 analog. It is approved for chronic weight management as an adjunct to diet and exercise in adults with a BMI of 30 kg/m2 or higher (obese) or adults with a BMI of 27 kg/m2 or higher (overweight) who have at least 1 weight-related condition (eg, hypertension, type 2 diabetes, dyslipidemia). The dose for obesity differs from that of liraglutide (Victoza) that is used to treat diabetes. Saxenda is initiated at 0.6 mg SC once daily for 1 week, and is then increased by 0.6 mg/day in weekly intervals until a dose of 3 mg/day is achieved.


Approval was based on data from 3 clinical trials that included about 4800 obese and overweight patients with and without significant weight-related conditions. Results from a clinical trial that enrolled patients without diabetes or with diabetes showed that patients had an average weight loss of 4.5% and 3.7% from baseline respectively compared to treatment with a placebo at 1 year. Of those treated with liraglutide, 62% of persons without diabetes and 49% of persons with diabetes lost at least 5% of their body weight compared with 34% or 16% treated with placebo, respectively. [155]


Lorcaserin was approved by the FDA in June 2012 as an adjunct to a reduced-calorie diet and exercise for long-term weight management in individuals with an initial BMI of 30 kg/m2 or higher (obese) or 27 kg/m2 or higher (overweight) with at least 1 weight-related comorbid condition (eg, hypertension, dyslipidemia, type 2 diabetes mellitus). [158] Lorcaserin is a schedule IV substance, since it has potential for abuse. [159]


Liraglutide is approved for chronic weight management as an adjunct to diet and exercise in adults with a BMI of 30 kg/m2 or higher (obese) or adults with a BMI of 27 kg/m2 or higher (overweight) who have at least 1 weight-related condition (eg, hypertension, type 2 diabetes, dyslipidemia). The dose for obesity differs from that of liraglutide (Victoza) that is used to treat diabetes. Saxenda is initiated at 0.6 mg SC once daily for 1 week, and is then increased by 0.6 mg/day in weekly intervals until a dose of 3 mg/day is achieved.


The combination of phentermine and extended-release topiramate (Qsymia) was approved by the FDA in July 2012 as an adjunct to a reduced-calorie diet and exercise for long-term weight management in individuals with an initial BMI of 30 kg/m2 or higher (obese) or 27 kg/m2 or higher (overweight) with at least one weight-related comorbid condition (eg, hypertension, dyslipidemia, type 2 diabetes mellitus). [163] Use during pregnancy is contraindicated.


A systematic review and meta-analysis by Vilsbøll et al found that treatment with GLP-1 receptor agonists results in weight loss among overweight or obese patients with or without type 2 diabetes. [168] GLP-1 agonist regimens reviewed included exenatide twice daily, exenatide once weekly, and liraglutide once daily at clinically relevant doses for at least 20 weeks.


The diabetes drug pramlintide (Symlin), which is a synthetic analogue of the pancreatic hormone amylin, does not have an FDA indication for obesity management. However, this drug is clearly associated with variable weight loss in people with type 1 or 2 diabetes, while improving overall glycemic control. Higher doses (240 mcg before main meals) than those approved for the management of type 2 diabetes (60-120 mcg before main meals) have produced modest weight loss in obese or overweight patients with and without diabetes. [175]


Inpatient evaluations of obese patients are important in the immediate postoperative period after antiobesity surgery. In addition, hospitalization may be required for the management of major complications, such as clinically significant respiratory or cardiac compromise.


General practitioners are often the first healthcare providers to identify overweight or obesity. Treatment should be individualised with careful consideration given to the severity of the problem and associated complications using the 5As approach for weight management: Ask and Assess, Advise, Assist and Arrange (Table 2).7


The National Institutes of Health has several resources related to screening, diagnosis, prevention, and management of prediabetes and type 2 diabetes available at -information/professionals/clinical-tools-patient-management/diabetes.


In addition to biological effects, obesity can lead to difficulties in screening and management. For example, women with overweight or obesity have an increased risk of cervical cancer compared with women of healthy weight, likely due to less effective cervical cancer screening in these individuals (38).


The rapid economic growth in China has been accompanied by alarming rise in obesity. Recent National survey data suggest that more than half of Chinese adults are now living with overweight and obesity, with obesity rates likely to increase.This three-paper Series provides an examination of the epidemiology, highlights the advances and future directions of the clinical management and treatment, and discusses current health policies and public health implications of obesity in China. China now faces important choices. Only by understanding the challenges of obesity in China can successful prevention and management strategies and policies be devised and implemented.


Her research focuses on primary-care weight management in children and adults. Her goal is to identify specific ways that primary-care providers can improve the weight status and health of patients with overweight and obesity. She currently is supported by a five-year (2014-18) career-development award through the National Heart, Lung, and Blood Institute to examine pediatrician clinical practices and communication strategies associated with weight-status improvement among overweight children. Her publications address complications of and treatments for pediatric and adult overweight and obesity.


Patients with type 2 diabetes or other health conditions that are associated with overweight or obesity can also benefit from our unique collaboration with Rewind, combining proven science with expert clinical care, coaching and team support.


Abdominal obesity and the endocannabinoid system: from basic aspects to clinical management of related cardiometabolic risk. Edited by Jean-Pierre Despres, Vincenzo Di Marzo. New York, Informa Healthcare, c2009. 265 p. Includes bibliographical references. RC628.A233 2009 041b061a72


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