Medical Management Of Obesity Research Articles

Corrigendum to ‘‘Medical management of obesity as it affects reflux’’

Corrigendum to ‘‘Medical management of obesity as it affects reflux’’

Effect of surgical, medical, and behavioral weight loss on hormonal and sexual function in men: a contemporary narrative review.

This review explores the mechanisms and ramifications of weight loss achieved through lifestyle modifications, medical treatments, and bariatric surgery on testosterone levels and sexual health. Obesity significantly affects the hypothalamic-pituitary-gonadal axis in men, leading to diminished libido and erectile dysfunction. Here, we delve into the physiological disruptions caused by this imbalance and the intricate interplay of hormonal factors contributing to the dysregulation associated with obesity to comprehensively grasp the consequences of weight loss via diverse mechanisms. Lifestyle modifications involving dietary adjustments and regular exercise represent a widely employed and efficacious means of weight loss. While adherence demands discipline, our review scrutinizes various studies specifically investigating the impact of weight loss, attained through lifestyle modifications, on serum hormone levels and sexual function. Notably, several randomized controlled trials within the existing body of literature corroborate the enhancement of testosterone levels and sexual function consequent to weight loss through lifestyle modifications. The realm of medical management in addressing obesity is growing, notably propelled by the popularity of pharmacotherapy. Despite its prevalence, the current literature exploring the effects of weight loss medications on men remains insufficient. Nonetheless, we examine available studies on the medical management of obesity and its implications for sexual health, emphasizing pivotal avenues requiring further investigation. Bariatric surgery stands as an effective approach for individuals seeking substantial weight loss. Our review assesses existing literature that evaluates the impact of various surgical techniques on serum hormone levels, sexual function, and semen parameters. Despite certain limitations, the available body of evidence suggests enhancements in hormone levels and sexual function post-surgery, with semen parameters generally exhibiting minimal changes. This review critically evaluates the landscape of weight loss and its correlation with sexual function, while highlighting crucial areas necessitating future research endeavors.

Label-free quantitative proteomic profiling reveals differential plasma protein expression in patients with obesity after treatment with liraglutide.

Treatment and management of obesity is clinically challenging. The inclusion of GLP-1 receptor agonists (GLP1RA) in the medical management of obesity has proven to be efficacious. However, mechanisms underlying the molecular changes arising from GLP1RA treatment in patients with obesity remain to be elucidated. A single-center, prospective study was undertaken to evaluate the changes in the plasma proteins after liraglutide 3 mg therapy in twenty patients (M/F: 7/13) with obesity (mean BMI 40.65 ± 3.7 kg/m2). Anthropometric and laboratory parameters were measured, and blood samples were collected at two time points: baseline, before initiating treatment (pretreatment group, PT), and after three months of receiving the full dose liraglutide 3 mg (posttreatment group, PoT). An untargeted label-free LC MSMS mass spectrometric approach combined with bioinformatics and network pathway analysis was used to determine changes in the proteomic profiles. The mean age of the study participants was 36.0 ± 11.1 years. A statistically significant change was observed in weight, BMI and HbA1c levels between the PT and PoT groups (paired t-test, P < 0.001). A significant dysregulation was noted in the abundances of 151 proteins (31 up and 120 downregulated) between the two groups. The potential biomarkers were evaluated using receiver operating characteristic (ROC) curves. The top ten proteins (area under the curve (AUC) of 0.999 (95% CI)) were identified as potential biomarkers between PT and PoT groups and included Cystatin-B, major vault protein, and plastin-3, which were upregulated, whereas multimerin-2, large ribosomal P2, and proline-rich acidic protein 1 were downregulated in the PoT group compared with the PT group. The top network pathway identified using ingenuity pathway analysis (IPA), centered around dysregulation of MAPK, AKT, and PKc signaling pathways and related to cell-to-cell signaling and interaction, cellular assembly and organization, cellular compromise and a score of 46 with 25 focus proteins. Through label-free quantitative proteomic analysis, our study revealed significant dysregulation of plasma proteins after liraglutide 3 mg treatment in patients with obesity. The alterations in the proteomic profile between the PT and PoT groups demonstrated a decrease in levels of proteins involved in inflammation and oxidative stress pathways. On the other hand proteins involved in the glycolytic and lipolytic metabolic pathways as well as those participating in cytoskeletal and endothelial reorganization were observed to be increased. Understanding actions of liraglutide at a molecular and proteomic levels provides a holistic look into how liraglutide impacts metabolism, induces weight loss and improves overall metabolic health.

FRI063 Effectiveness Of Liraglutide In Treating Obesity And Improving Hepatic Steatosis

Abstract Disclosure: A.A. Alfadda: None. A. Masood: None. B.M. Alsuwayni: None. A.M. Alhossan: None. Background: Obesity is a chronic relapsing disease with a multifactorial pathology. Chronic inflammation is an important underlying cause, that is also a reason for development of obesity associated comorbidities including metabolic associated fatty liver disease. Medical management of obesity using glucagon-like peptide 1 (GLP-1) agonists has been effective in achieving weight loss and improvements in glucose and lipid control but effects on liver steatosis occurring with persistence of treatment need to be further elucidated. Methods: A single center, prospective study was undertaken to evaluate the effectiveness of liraglutide in patients with obesity. Participants received daily subcutaneous liraglutide with dose escalation (initial dose of 0.6 mg to maximum of 3.0 mg) following the prescribed guidelines. Anthropometric and laboratory parameters were measured at baseline and after three months of receiving the full dose. Estimation of liver steatosis was performed by FibroScan, using controlled attenuation parameter (CAP), and the hepatic steatosis index (HSI) at baseline and at three months of therapy. Descriptive statistics were reported as percentage or mean ± standard deviation (SD) and P values below 0.05 were considered statistically significant. A sub-group analysis was carried out between patients classified as responders to treatment if they lost ≥ 5% of their initial weight, and non-responders, if they did not. Results: In total 28 patients, 18 females (64%) and 10 males (46%) with obesity, mean age 36 ± 11.6 years and BMI (42 ± 4.8) kg/m2, were recruited for the study. Six patients dropped out because of side effects. Twenty-two patients 8 (36.4%) males and 14 (63.6%) females comprised the study population followed for three months. Significant and clinically meaningful changes in weight (decreased by 5.03%), BMI (decreased by 4.71%), HbA1c (decreased by 5.44%), and CAP (decreased by 14.69%) (all P values &amp;lt; 0.05) were noted in all the patients after three months treatment. Sub-group analysis in responders, 16 patients (72.7%), and non-responders 6 patients (27.3%) at three months of treatment demonstrated decrease weight (from 119.64 ± 11.9 to 108.46 ± 11.6 kg; P &amp;lt; 0.001), BMI (from 42.08 ± 5.7 to 38.31 ± 5.7 kg/ m2; P &amp;lt; 0.001), HbA1c (from 5.80 ± 0.4 to 5.38 ± 0.3%; P &amp;lt; 0.001), and CAP (from 286.69 ± 68.6 to 260.69 ± 53.6 dB/m; P = 0.067) in the responders group. On the other hand, we noted a significant decrease in CAP in non-responders’ group (from 285.17 ± 29 to 242.33 ± 51.2; P = 0.041) with no significant changes were observed in anthropometric measures and laboratory markers. Conclusions: Treatment with liraglutide for a period of 3 months in patients with obesity produced significant weight loss and improvement in hepatic steatosis in most patients. Even though the non-responders did not show improvements in weight loss, they demonstrated significant improvements in hepatic steatosis. Presentation: Friday, June 16, 2023

Medical management of obesity

Obesity is a global epidemic that has worsened over the past few decades. It is strongly associated with multiple health conditions, including type 2 diabetes mellitus, cardiovascular diseases, obstructive sleep apnoea, certain malignancies and has an increased mortality risk. The annual cost of obesity to the NHS is around £6 billion, projected to increase to just under £10 billion by 2050. In 2020-2021, obesity was cited as a factor in over 1 million hospital admissions. An early and pragmatic approach to the management of obesity would reduce obesity-associated multiple health conditions and result in cost savings for the NHS. Here, we discuss current management strategies for obesity, including dietary intervention, pharmacological therapies and optimisation, and bariatric surgery.

Five-year Weight Loss Maintenance With Obesity Pharmacotherapy.

Long-term treatment of obesity with lifestyle changes alone is unsustainable for most individuals because of several factors including adherence and metabolic adaptation. Medical management of obesity has proven efficacy for up to 3 years in randomized controlled trials. However, there is a dearth of information regarding real-world outcomes beyond 3 years. This work aimed to assess long-term weight loss outcomes over a 2.5- to 5.5-year period with US Food and Drug Administration (FDA)-approved and off-label antiobesity medications (AOMs). A cohort of 428 patients with overweight or obesity were treated with AOMs at an academic weight management center with an initial visit between April 1, 2014, and April 1, 2016. Intervention included FDA-approved and off-label AOMs. The primary outcome was percentage weight loss from initial to final visit. Key secondary outcomes included weight reduction targets as well as demographic and clinical predictors of long-term weight loss. The average weight loss was 10.4% at a mean follow-up duration of 4.4 years. The proportions of patients who met the weight reduction targets of 5% or greater, 10% or greater, 15% or greater, and 20% or greater were 70.8%, 48.1%, 29.9%, and 17.1%, respectively. On average, 51% of maximum weight loss was regained, while 40.2% of patients maintained their weight loss. In a multivariable regression analysis, a higher number of clinic visits was associated with more weight loss. Metformin, topiramate, and bupropion were associated with increased odds of maintaining 10% or greater weight loss. Clinically significant long-term weight loss of 10% or more beyond 4 years is achievable in clinical practice settings with obesity pharmacotherapy.

Improving the Physical Health of Psychiatric Hospital Residents: An Evaluation of an Obesity Education Program for Mental Health Professionals.

Background: People living with mental health disorders are at increased risk for developing obesity due to poor diet, physical inactivity, and antipsychotic medications. In the United States, the obesity rate is 36% in the general population and more than 50% for people living with mental health disorders. Although mental health clinicians concentrate on managing psychiatric disorders, they seldom recognize the gradual increase in body mass index of their patients. The result is a disconnection between the clinical management of psychiatric disorders and the medical management of obesity. Purpose: This study assessed the effectiveness of an evidence-based education program for improving the obesity management practices of mental health clinicians caring for residents at a state psychiatric hospital. Methods: This was a quasi-experimental study design with a pretest and posttest evaluation. Convenience sampling was used to recruit mental health professionals, or clinicians, at a large psychiatric hospital in the Southern region of the United States. Data was collected with the Advising and Treating Overweight and Obese Patient questionnaire (17 items). Data analysis included descriptive and inferential statistics. The findings were reported in accordance with the TREND and GREET guidelines. Results: The education program was completed by 50 MHCs. The pretest indicated that 76% of MHCs were not involved in helping obese residents manage their weight, but the posttest indicated 90% were involved. There was a significant increase in MHC knowledge about obesity management and reported actions 90-days after the program. MHCs were unable to arrange follow-up visits for residents, a task not directly within their control. Conclusions: Mental health clinicians reported increased knowledge and improved clinical practice after an education program. Because the outcomes were reported at 90-days after the program, further research needs to evaluate the longitudinal impact of this type of program, where the reported behaviors are correlated to process and clinical outcome measures for obesity.

Exploring a Need for a Cardiometabolic Disease Staging System as a Computerized Clinical Decision Support Tool: Qualitative Study.

BackgroundAlthough cardiometabolic diseases are leading causes of morbidity and mortality in the United States, computerized tools for risk assessment of cardiometabolic disease are rarely integral components of primary care practice. Embedding cardiometabolic disease staging systems (CMDS) into computerized clinical decision support systems (CDSS) may assist with identifying and treating patients at greatest risk for developing cardiometabolic disease.ObjectiveThis study aimed to explore the current approach to medical management of obesity and the need for CMDS designed to aid medical management of people living with obesity, at risk of being obese, or diabetic at the point of care.MethodsUsing a general inductive approach, this qualitative research study was guided by an interpretive epistemology. The method included semistructured, in-depth interviews with primary care providers (PCPs) from university-based community health clinics. The literature informed the interview protocol and included questions on PCPs’ experiences and the need for a tool to improve their ability to manage and prevent complications from overweight and obesity.ResultsPCPs (N=10) described their current approaches and emphasized behavioral treatments consisting of combined diet, physical activity, and behavior therapy as the first line of treatment for people who were overweight or obese. Results suggest that beneficial features of CDSS include (1) clinically relevant and customizable support, (2) provision of a comprehensive medical summary with trends, (3) availability of patient education materials and community resources, and (4) simplicity and ease of navigation.ConclusionsImplementation of a CMDS via a CDSS could enable PCPs to conduct comprehensive cardiometabolic disease risk assessments, supporting clinical management of overweight, obesity, and diabetes. Results from this study provide unique insights to developers and researchers by identifying areas for design optimization, improved end user experience, and successful adoption of the CDSS.

Medical Management of Obesity as it Affects Reflux

Gastroesophageal reflux disease (GERD) is common among the American population and increasing in prevalence, with obesity being implicated as one of the strongest risk factors for its development. Little is known about the effects of currently prescribed anti-obesity medications on GERD symptoms. This review aims to explore the current literature on FDA-approved and off-label anti-obesity pharmacotherapy with respect to their influence on GERD and interactions with commonly prescribed GERD medications.

85. Weight Management in Adolescents and Young Adults: An Educational Intervention for Integrated Clinical Teams at School-Based and Family Planning Clinics

Obesity affects nearly 20% of adolescents in the United States. To enhance equitable access to evidence-based obesity management, an educational intervention targeting Advanced Nurse Practitioners (ANPs) and Social Workers (SWs) was implemented at a nine clinic system that provides primary care and family planning services to > 10,000 low-income adolescents and young adults (AYA) annually. The goal of this intervention was to improve providers’ knowledge, attitudes, and behaviors in the following domains: medical management of obesity, use of motivational interviewing (MI) for behavior modification, avoiding weight-related stigma, and addressing social determinants of health.

Management of Obesity During Pregnancy and Periconception: Case-Based Learning for OB/GYN Clerkships.

IntroductionMedical students lack knowledge about the effects of bariatric surgery on pregnancy and medical management of obesity as it relates to reproductive health. Additionally, there is bias toward obese patients among clinicians and learners. Our goal is to improve knowledge and make students aware of the possibility of bias in their management of obese patients.MethodsWe designed a flipped classroom learning experience focused on teaching students about the impacts and management of obesity and bariatric surgery on pregnancy and reproductive health. Before the seminar, students took the Implicit Attitude Test (IAT) and read two articles. During the 60-minute seminar, students worked in small groups discussing clinical vignettes, IAT results, and how bias affects patient care. One faculty preceptor oversaw the work and led discussions. We evaluated pilot seminars using Kirkpatrick levels 1 (reaction) and 2 (knowledge) outcomes. We measured change in knowledge after the seminar (using pre- and postseminar quizzes) and assessed students’ feedback using a postseminar survey.ResultsThis module was piloted with one in-person group (n = 9) and one virtual group (n = 11) of third-year medical students. Students’ knowledge improved (48% vs. 84% correct, p < .001), and they displayed statistically significant improvements in quiz scores postseminar.DiscussionEducators striving to teach learners about the management of obesity in pregnancy using evidence-based medicine should integrate this module into their medical student clerkship curricula.

Relationships among Child Eating Behaviors and Household Food Insecurity in Youth with Obesity.

Background: Food insecurity may trigger eating behaviors that contribute to pediatric obesity. The aim of this study is to identify eating behaviors among a pediatric population with obesity and household food insecurity. Methods: A cross-sectional study analyzed Child Eating Behavior Questionnaire (CEBQ) and household food insecurity screener responses, and BMI measurements from pediatric participants with obesity (BMI ≥95th percentile) from a weight management clinic between 2013 and 2017. Multivariate linear regression was performed to evaluate associations between CEBQ eating domains [Food Responsiveness, Emotional Overeating, Enjoyment of Food, Desire to Drink (DD), Satiety Responsiveness, Slowness in Eating, Emotional Undereating (EUE), and Food Fussiness] and household food insecurity, adjusting for age, sex, race/ethnicity, SNAP participation, and BMI percentile. A sub-group analysis was performed on participants from food insecure (FI) households to evaluate the associations between SNAP participation and eating domains. Results: Eight hundred twenty-two participants were included in the final analysis. Participants from FI households had significantly higher BMI percentiles even after adjustment for age, sex, race/ethnicity, and SNAP status (p = 0.000). Household food insecurity was associated with increased DD beverages (p = 0.000). Among participants from FI households, SNAP participation was significantly positively associated with the EUE (p = 0.009). Conclusions: Youth from FI households have higher BMIs even among a population with obesity. DD is positively associated with household food insecurity and may contribute to obesity in this population. Results suggest that providers treating pediatric patients with obesity should consider regularly screening for household food insecurity and associated eating behaviors as part of their medical management of obesity.

Obesity in Kidney Transplantation: Impact on Transplant Candidates, Recipients, and Donors.

Obesity is now common among children and adults who are kidney transplant candidates and recipients. It is associated with an increased risk of cardiovascular disease and kidney failure. This also pertains to potential living kidney donors with obesity. Obese patients with end-stage renal disease benefit from transplantation as do nonobese patients, but obesity is also associated with more risk. A complicating factor is that obesity is also associated with increased survival on maintenance dialysis in adults, but not in children. The assessment of obesity and body habitus should be individualized. Body mass index is a common but imperfect indicator of obesity. The medical management of obesity in renal failure patients is often unsuccessful. Bariatric surgery, specifically laparoscopic sleeve gastrectomy, can result in significant weight loss with reduced morbidity, but many patients do not agree to undergo this treatment. The best approach to manage obese transplant candidates and recipients is yet unresolved.

Prevalence and Determinants of Engagement with Obesity Care in the United States.

ObjectiveMedical management of obesity can result in significant weight loss and reduce the burden of obesity‐related complications. This report employs a new conceptual model to quantify engagement with obesity care and associated determinants in the US adult population.MethodsEngagement with obesity care was conceptualized as a cascade comprising 5 successive steps: perceiving oneself as overweight, desiring to lose weight, attempting weight loss, seeking care from a health care professional for obesity, and seeking care from a physician specifically.ResultsAmong adults with obesity, 7.3% did not perceive themselves as overweight, 1.5% perceived themselves as overweight but had no desire to lose weight, 29.9% wanted to lose weight but did not try in the last year, 51.3% tried to lose weight but did not consult a health professional, and 6.4% sought help for weight loss from a health professional but not a physician, implying that 96.4% of the population with obesity had an unmet need for obesity care.ConclusionsThis analysis provides new insight into the most common points along the cascade at which disengagement occurs and can inform efforts to improve uptake of obesity‐related health care services.

Review of post bariatric surgery effects on common genitourinary physiology.

ABSTRACT Background: Obesity is a worldwide challenging health problem. Weight loss through medical management of obesity has not always been successful, thus, giving rise to the need for surgical intervention. Bariatric surgery has been shown to be helpful for morbidly obese patients. However, studies have also shown the effect of surgery on stone formation, fertility and erectile function. This review summarizes the main findings of several studies that analyze stone formation and fertility in men as well as erectile function post bariatric surgery. The underlying pathophysiologic alterations post bariatric surgery include increased absorption of oxalate leading to hyperoxaluria, hypocitraturia and increased urinary calcium oxalate supersaturation. Contradicting data exist on the effect of bariatric surgery on fertility and erectile function. Further studies are needed to analyze the mechanisms.

Medical Management of Obesity

Medical Management of Obesity

Medical Management of Obesity

Obesity has reached epidemic proportions, accounting for increased morbidity, disability, health care expenditures, and mortality. Certain metabolic and comorbid conditions disproportionately affect women. Unfortunately, nonsurgical options for treatment are limited. Knowledge accrued over the past 2 decades regarding physiological and hormonal determinants of weight regulation has contributed to growing evidence regarding efficacious behavioral, dietary, and pharmacologic treatments. In this review, the biology of excess adiposity is summarized in the context of a shifting paradigm, approaching obesity as a chronic metabolic disease. Relevant updates are discussed regarding long-term lifestyle approaches and novel drug therapies, with attention to some issues specific to women.

Is bariatric surgery an option for women with gynecologic cancer? Examining weight loss counseling practices and training among gynecologic oncology providers

ObjectiveThe objective of this study was to evaluate gynecologic oncology provider (GOP) practices regarding weight loss (WL) counseling, and to assess their willingness to initiate weight loss interventions, specifically bariatric surgery (WLS). MethodsMembers of the Society of Gynecologic Oncology were invited to complete an online survey of 49 items assessing knowledge, attitudes, and behaviors related to WL counseling. ResultsA total of 454 participants initiated the survey, yielding a response rate of 30%. The majority of respondents (85%) were practicing GOP or fellows. A majority of responders reported that >50% of their patient population is clinically obese (BMI≥30). Only 10% reported having any formal training in WL counseling, most often in medical school or residency. Providers who feel adequate about WL counseling were more likely to offer multiple WL options to their patients (p<.05). Over 90% of responders believe that WLS is an effective WL option and is more effective than self-directed diet and medical management of obesity. Providers who were more comfortable with WL counseling were significantly more likely to recommend WLS (p<.01). Approximately 75% of respondents expressed interest in clinical trials evaluating WLS in obese cancer survivors. ConclusionsThe present study suggests that GOP appreciate the importance of WL counseling, but often fail to provide it. Our results demonstrate the paucity of formal obesity training in oncology. Providers seem willing to recommend WLS as an option to their patients but also in clinical trials examining gynecologic cancer outcomes in women treated with BS.

Corpulence and Correspondence: President William H. Taft and the Medical Management of Obesity

This article analyzes the letters exchanged as part of the clinical weight management of President William H. Taft, one of the first public figures in U.S. history to be defined popularly in terms of his pathologic obesity. In 1905, Taft hired Dr. Nathaniel E. Yorke-Davies, an English diet expert, to supervise a weight-loss plan. Taft corresponded extensively with Yorke-Davies over the next 10 years, receiving and responding to courses of treatment via post. This correspondence is one of the few archival collections documenting physician and patient perspectives on the treatment of obesity, and it took place at the precise moment when obesity began to be framed as both a serious and medically manageable condition. This intimate clinical history of the 27th president and 10th chief justice of the Supreme Court offers a unique opportunity to examine in detail the history of the obesity experience in the United States, and it sheds light on the almost-timeless challenges of creating and maintaining long-term treatment courses for conditions like obesity.

Medical Management of Obesity in the Community Setting - Efficient Strategies

Medical Management of Obesity in the Community Setting - Efficient Strategies