Use Of Weight Loss Medications Research Articles

Effective and appropriate use of weight loss medication in pediatric obesity: a narrative review.

Over the past few decades, there has been a notable increase in the incidence of pediatric obesity, which is a significant public health concern. Children who are obese have a greater risk of type 2 diabetes, hypertension, dyslipidemia, polycystic ovary syndrome, obstructive sleep apnea, and adult obesity. Lifestyle modification therapy is typically the initial approach to treat pediatric obesity. For patients who do not achieve success with lifestyle modification therapy alone, pharmacotherapy is the next logical treatment option. When selecting an anti-obesity medication (AOM), it is essential to first ascertain the medical background of the patient, including current medications and obesity-associated comorbidities. Evaluation of obesity phenotypes in patients may also be beneficial. AOMs for pediatric obesity include metformin, orlistat, glucagon-like peptide 1 agonists, phentermine, and the phentermine/topiramate combination. Sufficient lifestyle modification therapy should be administered before considering pharmacotherapy and continued after the initiation of AOM. To ensure healthy development, monitoring growth and puberty development during anti-obesity treatments is essential.

What is known about the use of weight loss medication in women with overweight/obesityon fertility and reproductive health outcomes? A scoping review.

Pregnancy during or soon after treatment with weight loss medication, particularly glucagon-like peptide-1 receptor agonists (GLP-1 RAs), is contraindicated due to potential teratogenicity. The aim of this scoping review is to investigate what is known about the use of weight loss medication in women of childbearing age in relation to reproductive health outcomes, focusing on the three medications licenced in the United Kingdom at the time of the search. A systematic search of studies that assessed reproductive health outcomes in women taking either orlistat, liraglutide or semaglutide was undertaken in July 2023 and updated in January 2024 across MEDLINE, Embase, CINAHL, Scopus, ClinicalTrials.gov, PROSPERO, Epistemonikos and OpenGrey. Studies focused on polycystic ovarian syndrome, diabetes or animals were excluded. Titles and abstracts were screened, and data from included articles were extracted. After removal of duplicates, 341 titles remained, of which 318 were excluded. Of the final 18 articles included, there were five interventional trials, one retrospective case-control study, six narrative reviews, two systematic reviews, three systematic review protocols and one registry protocol yet to start recruitment. All five interventional trials involved orlistat given preconceptionally, showing no improvement in live birth rate, despite improvement in reproductive hormone levels. There were no studies with primary data about GLP-1 RAs. There were no qualitative studies. There is an absence of primary data about the role of GLP-1 RAs on the reproductive health of women of childbearing age without polycystic ovarian syndrome. Future research should explore short- and long-term effects on reproductive health, pregnancy outcomes and experiences.

Consideration of Use of Semaglutide and Tirzepatide Prior to Pregnancy

In reproductive-age females with elevated body mass index (BMI), weight loss is often recommended independent of their reproductive and family planning goals. However, it is clear that lifestyle methods for losing weight often fall short of achieving and maintaining weight loss. As approaches to addressing obesity and weight optimization evolve beyond the simplistic notion of “eat less and move more,” there has been a growing acceptance of weight loss medications as part of comprehensive weight management strategies. It should also be noted that health optimization cannot be solely attributed to reducing BMI or kilograms of body weight. The objective of this paper is not to contribute to the well-established weight stigma in medicine, but rather to highlight a thoughtful approach to the use of weight loss medication in a cohort where the prevalence is expected to rise independent of the indication.

Utilization and perspectives of weight loss medications in pediatric metabolic dysfunction-associated steatotic liver disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing globally in pediatric populations. Currently, MASLD management primarily relies on lifestyle interventions, which pose challenges in sustaining long-term weight loss. This study investigated the use of weight loss medications in MASLD care through an international survey of 166 pediatric gastroenterologists and hepatologists. The results indicated a notable interest in weight loss medications, with 38% of practitioners considering or using them, particularly glucagon-like peptide-1 receptor agonists. However, the survey also revealed a tendency among clinicians to refer patients to specialists, emphasizing the potential gap between acknowledgment and prescription practices. Challenges include the lack of guidelines and uncertainty regarding side effects. The study highlights a pressing need for education, with over 90% of the respondents expressing an interest. Our study highlights the current management of MASLD, the potential role of pharmacotherapy, and highlights avenues for improved care and education in this dynamic field.

The Use of Weight Loss Medication in Korea: An Analysis of Prescriptions Voluntarily Posted Online

The Use of Weight Loss Medication in Korea: An Analysis of Prescriptions Voluntarily Posted Online

Further Research on Internet Searches for On- and Off-Label Use of Weight-Loss Medications.

Further Research on Internet Searches for On- and Off-Label Use of Weight-Loss Medications.

Use of weight loss medications in relation with prostate, colorectal and male breast cancers among older men: SEER-Medicare 2007-2015.

The association of weight loss medications with prostate (PCa), colorectal (CRC) or male breast cancers, including assessment of these cancers combined (HRCs, hormone-associated cancers) remain poorly understood. Testosterone replacement therapy (TTh) is reported to be inversely associated with obesity, PCa and CRC, but it is unclear whether TTh modifies the association of weight loss medications with HRCs. In 49,038 men (≥ 65years) of SEER-Medicare, we identified 15,471 men diagnosed with PCa, 4836 with CRC, and 141 with male breast cancers. Pre-diagnostic prescription of weight loss medications and TTh was ascertained for this analysis. Weighted multivariable-adjusted conditional logistic and Cox proportional hazards (mortality) models were conducted. We found an inverse association between use of weight loss medications and incident PCa (OR 0.59, 95% CI 0.57-0.62), CRC (OR 0.86, 95% CI 0.80-0.92), and HRCs (OR 0.65, 95% CI 0.62-0.68). Similar associations were observed for advanced stage at diagnosis of PCa and CRC. Effects of weight loss medications on PCa and HRC remained significant irrespective of the use of TTh but were only suggestive with CRC with positive TTh use. No associations were observed with male breast cancer and HRCs mortality. Pre-diagnostic use of weight loss medications reduced the incidence of PCa, CRC, and HRCs. These associations persisted in the same direction irrespective of the history of TTh use. Future studies are needed to confirm these findings and to identify underlying biological mechanisms of weight loss medications and TTh on the risk of cancer.

Analysis of body mass and food consumption of university students of the male sex in Brazil

This study aimed to characterize food intake, body weight and self-perception about weight among university men of a Higher Education Institution in Brazil. Cross-sectional study, conducted in 2019, with a representative sample of 375 university students, using a validated questionnaire. Regarding nutritional assessment, most of them were classified as eutrophic (61.3%). It is noteworthy that 31.5% were overweight (overweight and obesity). Although most (42.6%) of the students realized that they were at normal weight, when the other categories (below or overweight) are added, 57.4% indicated these options. Asked about attitudes towards the current weight, 33.9% answered that they were not doing something and 14.3% indicated that they were trying to maintain them. Adding to the other options, 48.2% tried to lose or win. Most of them did not diet, exercise, use of weight loss medications in the 30 days prior to the research. Regarding physical activity in the week prior to the survey, 37.1% did not practice. On food intake the previous day, most consumed fruits, vegetables or boiled vegetables at least once. On the consumption of fast food (hamburger, coxinha, snacks or french fries), 53.9% did not make consumption in the previous week. Regarding biscuits, cakes or sweets, 40.8% ate once. It was observed that the interviewees presented good eating habits, however, part of them perceived their weight as not ideal. Although a small frequency indicates that you have done something (diet, exercises, use of medications) to lose weight, attention should be paid to these situations in order to monitor possible risk behaviors, highlighting universities as important spaces for help and promotion of men's health.

LBODP002 Phase II Open-label Pilot Trial Of Liraglutide In Adolescents With Obesity After Vertical Sleeve Gastrectomy: Interim Results From 8-weeks Of Treatment

Abstract Background Metabolic and bariatric surgery (MBS) is currently the most effective weight loss treatment in adults and children with severe obesity. However, up to 50% of adolescents continue to have obesity three years post-MBS. Vertical sleeve gastrectomy (VSG), the most common MBS performed in adolescents, causes an increase in post-prandial glucagon-like peptide 1 (GLP-1) post-operatively, but the duration of this incretin hormone response is unclear. Liraglutide, a GLP-1 analogue, may supplement the physiological increase in GLP-1 following VSG and promote weight loss via appetite suppression. We hypothesized that daily liraglutide treatment would significantly reduce body weight in adolescents who had previously undergone VSG but who continued to have insufficient weight loss. This abstract reports interim data from our prospective clinical trial of liraglutide in adolescents with obesity after VSG (ClinicalTrials.gov Identifier: NCT04883346). Methods This trial is an active, open-label, phase II pilot study to investigate the efficacy of daily subcutaneous liraglutide to promote reduction of BMI in adolescents with persistent obesity 1 year or more after VSG. The primary objective is to determine the effect size for the change in BMI of liraglutide 3. 0 mg daily at 16 weeks in study participants to calculate the sample size of a subsequent randomized controlled trial. Inclusion criteria are age 12 to 20.99 years, good general health, BMI≥30 kg/m2, and a personal history of VSG ≥1-year prior. Exclusion criteria include major medical illnesses, use of medications associated with weight gain, or use of weight-loss medications within the last 3 months of screening. Liraglutide is initiated at 0.6 mg daily and escalated by 0.6mg weekly to 3 mg/d for the last 12 weeks of treatment. Participants receive monthly nutrition counseling throughout the study. Results At time of interim analysis (3/24/22), 26 participants (baseline age 18±1.9y, mean±SD; 65% female; 55% black; baseline BMI 42. 0±7. 0 kg/m2) were screened and 20 started liraglutide. Among 17 participants who reached 8 weeks of treatment, mean absolute change in weight was -3.9±2.6 kg, percent change in weight was -3.6±2.6%, absolute change in BMI was -1.4±0.9 kg/m2, and percent change in BMI was -3.6±2.6%. There were no serious treatment-emergent adverse events (TEAEs) reported; 16/20 participants reported non-serious TEAEs including low energy (40%), nausea (40%), and vomiting (20%). In this interim analysis of an open-label phase II pilot study, the mean weight change from baseline was -3.6% after 8 weeks of liraglutide treatment in adolescents with persistent obesity after VSG. No new TEAEs were identified. Completion of this study will help determine if weight reduction with liraglutide suggests value to carry out a randomized placebo controlled study using liraglutide. Presentation: No date and time listed

Prevalence and Clinical Determinants of Obesity in Adults With Type 1 Diabetes Mellitus: A Single-Center Retrospective Observational Study

ObjectiveTo determine the prevalence of obesity and assess the cardiometabolic risk profile and treatments associated with obesity management in the type 1 diabetes mellitus adult population. MethodsWe reviewed the records of all patients with type 1 diabetes mellitus seen in our institution’s outpatient endocrinology clinic between 2015 and 2018. We stratified the patients into 4 weight categories on the basis of body mass index (BMI) (normal, overweight, obesity class I, and combined obesity class II and III) and evaluated their associated clinical characteristics and relevant medications. ResultsOf 451 patients, 64% had a BMI of >25 kg/m2, and 25% had a BMI of ≥30 kg/m2. Over 40% of patients with a BMI of >30 kg/m2 had a history of cardiovascular disease. The off-label use of the glucagon-like peptide 1 receptor agonist was 12% and the sodium glucose cotransporter 2 inhibitor use was 5% in those with obesity. Only 2 patients were prescribed phentermine and 3 had undergone bariatric surgery. Hemoglobin A1C and low-density lipoprotein did not significantly differ between the normal weight and obesity groups. The obesity groups had significantly higher levels of median triglycerides and lower high-density lipoprotein than the normal weight group. ConclusionObesity was prevalent in a population of patients with type 1 diabetes mellitus seen in a specialty clinic. Those with obesity had a higher prevalence of cardiovascular disease than their normal weight counterparts. The use of weight loss medications was scarce. Studies exploring the safety and efficacy of obesity-targeted therapy in the type 1 diabetes mellitus population are needed.

Pulmonary Hypertension in Hispanics: An Update on Treatment Options and Possible Causes

Pulmonary arterial hypertension, a form of pulmonary hypertension (PH), is a rare but serious disease. This condition carries significantly increased risk of morbidity and mortality, associated with progressive elevations of pulmonary pressures and the subsequent development of right heart failure. PAH can also be very difficult to diagnose primarily because the initial symptom of shortness of breath can be very nonspecific and similar to other diseases. There are certain medications used to target obesity that have been associated with the development of pulmonary hypertension. Aminorex, commonly used in Europe in the 1960s, has been grossly tied with PAH. Additionally, Flenfluramine both on its own and used in combination with Phentermine, as appetite-suppressant medications, were associated with Primary Pulmonary Hypertension and valvulopathies. We believe the widespread use of weight loss medications in Latin America remains a risk factor for PH development in the Hispanic population. The NIH and the REVEAL registries in the United States provide the most information for different races/ethnicities in patients with the diagnosis of PAH. Both NIH and the REVEAL registries in the United States show a lower prevalence of PH than the expected prevalence of 11.5% in the Hispanic population. The underdiagnosis of PH in the Hispanic population can be explained by several causes such as lack of awareness of disease, access to healthcare, and tolerance to symptoms. Remarkable efforts in medicine have been made to better treat patients with this condition in the past few years, with the introduction of combination therapy in treatment-naive patients, which has changed the guidelines for treatment of PAH. Furthermore, recent clinical trials have shown promissory results with initiation of dual or even triple therapy instead of a step up approach in therapeutics. However, the majority of these therapies are indicated for PAH and PH related to connective tissue disease and come with a high financial burden to patients, especially minority patients such as Hispanics.

S2978 A Case of Severe Ischemic Duodenitis Secondary to Weight Loss Medication

Introduction: Diethylpropion hydrochloride (Diethylpropion HCL) is a sympathomimetic similar to amphetamine. It acts centrally to suppress appetite. We report a case of severe ischemic duodenitis in a male patient three weeks after starting diethylpropion HCL. Case Description/Methods: A 42-year-old white male with a medical history of obesity, hypertension and nonalcoholic fatty liver disease presented to the hospital due to four hours of epigastric pain and intractable nausea and vomiting. One week prior to presentation, he started taking diethylpropion HCL75 mg daily for weight loss. The physical exam was normal except for moderate epigastric tenderness. There was no guarding or rebound. Bowel sounds were normal. Murphy sign was negative. The laboratory tests white cell count 12.7x 109/L, hemoglobin 18.2 mg/dl and hematocrit 52.2%. Troponin, liver enzymes, total bilirubin and pancreatic enzymes were normal. An electrocardiography revealed no acute ischemic changes. Computed tomography of the abdomen revealed thickening of the gastric walls. An esophagogastroduodenoscopy (EGD), performed within 24 hours of hospitalization, demonstrated mild diffuse erythema in the antrum suggestive of mild gastritis. The duodenal bulb was normal. Distal to the ampulla, there is severe patchy erythema with ulcerations and edema suggestive of severe duodenitis (figure1, B). The biopsy revealed an ulcerated duodenal mucosa and villous atrophy. There was hemorrhage along with hyalinization of the lamina propria and atrophy of the deep aspects of the glands (figure1, A). These features suggest ischemic-type mucosal injury. The etiology was deemed to be secondary to phentermine. The patient was treated with intravenous fluids and was discharged home after 2 days of inpatient care. Four weeks later, he was asymptomatic, did not resume diethylpropion HCL and EGD revealed resolution of the ischemic duodenitis. Discussion: This case describes an association between the use of diethylpropion HCL and ischemic duodenitis. There are no published reports about the association between diethylpropion HCL and ischemic duodenitis. However, there are two case reports linking the use of phentermine, to ischemic colitis. As the use of weight loss medications has been increasing over the last few years, clinicians should be aware of potential ischemic duodenitis when prescribed.Figure 1.: Biopsy shows ulcerated duodenal, villous atrophy, hemorrhage and hyalinization of the lamina propria (A), severe patchy erythema with ulcerations and edema in the second part of the duodenum (B).

Approach to Obesity in the Older Population.

Until recently, weight loss in older obese people was feared because of ensuing muscle loss and frailty. Facing overall increasing longevity, high rates of obesity in older individuals (age ≥ 65 years) and a growing recognition of the health and functional cost of the number of obesity years, abetted by evidence that intentional weight loss in older obese people is safe, this approach is gradually, but not unanimously, being replaced by more active principles. Lifestyle interventions that include reduced but sufficient energy intake, age-adequate protein and micronutrient intake, coupled with aerobic and resistance exercise tailored to personal limitations, can induce weight loss with improvement in frailty indices. Sustained weight loss at this age can prevent or ameliorate diabetes. More active steps are controversial. The use of weight loss medications, particularly glucagon-like peptide-1 analogs (liraglutide as the first example), provides an additional treatment tier. Its safety and cardiovascular health benefits have been convincingly shown in older obese patients with type 2 diabetes mellitus. In our opinion, this option should not be denied to obese individuals with prediabetes or other obesity-related comorbidities based on age. Finally, many reports now provide evidence that bariatric surgery can be safely performed in older people as the last treatment tier. Risk-benefit issues should be considered with extreme care and disclosed to candidates. The selection process requires good presurgical functional status, individualized consideration of the sequels of obesity, and reliance on centers that are highly experienced in the surgical procedure as well as short-term and long-term subsequent comprehensive care and support.

Pharmacotherapy for Weight Loss in Cirrhosis and Liver Transplantation: Translating the Data and Underused Potential.

Thirty percent of patients with cirrhosis are obese and the prevalence of obesity increases after transplant to >40% post-transplant. There are currently four weight loss medications approved by the FDA for treatment of obesity (orlistat, phentermine-topiramate, naltrexone-bupropion, and liraglutide). The aim of this review was to investigate the data on the use of these weight loss medications and alternative medicines in patients with cirrhosis and in liver transplant recipients (LTRs). While there is paucity of data for these medications in patients with cirrhosis and LTRs, Liraglutide appears to be generally safe in view of its pharmacokinetic properties. Phentermine-topiramate seems to have the highest weight loss potential but special consideration should be given to neuropsychiatric disorders, cardiovascular comorbidities, and drug interactions. There are emerging data on use of alternative medicines for weight loss but more data are needed. The use of weight loss medications is feasible in this patient population but the decision of which medication to prescribe should be individualized based on the degree of renal and hepatic impairment, other co-morbidities, and concomitant medications.

Use of Weight Loss Medications in Patients after Bariatric Surgery.

Weight regain after bariatric surgery is unfortunately a common occurrence. In this article, we have reviewed the data addressing this clinical problem focusing on pharmacological management of weight regain. Data from several small, non-randomized, retrospective, and prospective studies provide evidence that a number of pharmacological options, both FDA approved and off-label, are effective in mitigating and managing weight regain after bariatric surgery. There is a suggestion that the optimal time to initiate weight loss medications may be at the time of weight plateau, rather than after weight regain. Adjuvant pharmacotherapy can help treat weight regain after bariatric surgery. Future studies should investigate the optimal timing for starting weight loss medications, as well as the best medication or combinations of medicines, for managing postoperative weight regain in different patient groups, including those who have undergone different types of bariatric surgeries.

Weight Lowering Medications to Alter Morphological Indices: A Cross-Sectional Study among Saudi Females

Introduction: Obesity has become a large health problem globally and a major risk factor contributing to a number of diseases. It is suggested in Saudi Arabia for obese adults to use Orlistat and Metformin; in addition to dieting and doing physical activity. However, there are limited studies on the regular practices of weight-loss among Saudi people especially with the aid of weight lowering medication. Objectives: The aims of this study are to evaluate the practice of using weight lowering medications and to describe self-reported side effects of using these medications among Saudi females. Methods: A cross-sectional study carried out on Saudi females whom were approached to answer a set of self-administered questionnaires. The survey covers several aspects that will aid the study’s topic such as the demographic data, previous or current use of weight loss medication and any side effects from using the medication. The collected data were then analyzed using SPSS program. Results: There were 820 participants (647 electronic submissions and 173 by paper). The results showed that among them 21.3% were using weight lowering medication, while dieting and exercising were the main methods used to lose weight (64.1% and 61.5% respectively). In addition, the most common drug used for losing weight was Orlistat (26.4%). Furthermore, the most frequent self-reported side effect for using these kinds of drugs was oily spotting (25.9%). Interpretation and conclusion: Saudi females were found to use weight lowering medications and it was related to several factors such as the BMI and the ages of participants, however dieting and exercising were the main methods reported for weight loss.

722 ENDOSCOPIC REVISION OF LAPAROSCOPIC SLEEVE GASTRECTOMY IS SAFE, EFFECTIVE, AND DURABLE: A MULTI-CENTER STUDY

The laparoscopic sleeve gastrectomy (LSG) is an effective bariatric surgery that facilitates approximately 60% excess body weight loss at five years; however, surgical revision for weight regain has been reported in over 10% of cases. Given the evolving role of endoscopic suturing as a therapeutic bariatric intervention, there is growing interest in endoscopic revision of LSG as a minimally-invasive alternative to surgical revision for weight recidivism. This study examined the procedural elements, outcomes, and safety associated with endoscopic revision of LSG. Seventy-seven adults at seven centers who experienced weight regain from post-LSG weight nadir underwent endoscopic revision to further restrict the surgical gastric sleeve using an endoscopic suturing device (OverStitch; Apollo Endosurgery, Austin, TX). Total body weight loss (TBWL) was followed (Figure 1). Univariate and multivariate analysis for TBWL >15% at 6 months post-revision was performed on inputs of age, weights, time to revision, use of weight loss medications, number of sutures, and presence of dilated stomach on baseline imaging (Table 1). Seventy-seven subjects (baseline mean age 42.27 years ± 10.73 years, 92% female) who had mean pre-LSG weight of 151.66 kg ± 71.00 kg and post-LSG weight nadir of 98.61 kg ± 41.94 kg experienced 21.35 kg ± 33.25 kg weight regain from post-LSG weight nadir, prompting endoscopic revision of LSG. At time of revision, mean weight was 117.90 kg ± 47.79 kg. The revisions occurred at a median of 5 (IQR 4-7) years after LSG and used median of 4 (IQR 3-4) sutures over a mean procedural duration of 46.90 min ± 19.28 min. After revision, TBWL was 5.85% ± 3.50% at one month (n = 63), 10.60% ± 4.58% at 3 months (n = 57), 13.68% ± 7.63% at 6 months (n = 47), and 12.75% ± 12.80% at 12 months (n = 38). At 3 month follow up, the 31% of subjects on weight loss medications at time of revision experienced 12.30% ± 4.41% TBWL compared to 9.06% ± 4.08% TBWL for those not on weight loss medications (p = 0.013). By 6 months, those on weight loss medications at time of revision experienced 14.50% ± 8.19% TBWL compared to 11.95% ± 6.92% TBWL for those not on weight loss medications (p = 0.32). Univariate analysis for association with TBWL > 15% at 6 months post-revision was significant for older age (OR 1.07, p = 0.038), and presence of dilated stomach on baseline imaging (OR 4.33, p = 0.026). There were no reported adverse events from the endoscopic revisions. Endoscopic revision of LSG is a safe and effective means of facilitating weight loss in those with weight regain after LSG and should be considered prior to pursuing more invasive surgical revision options. Concurrent use of weight loss medications with the revision appears to provide short term improvement in TBWL but this difference was not sustained at 6 months.Table 1Univariate and Multivariate Analyses. Factors associated with endoscopic revision of LSG to achieve TBWL > 15% at 6 months after post-revision were subjected to univariate and multivariate analyses. Statistically significant p values and odds ratios are bolded. Older age and presence of dilated stomach on baseline imaging prior to revision were associated with TBWL > 15% on univariate analysis. On multivariate analysis, greater weight at time of endoscopic revision was most correlated with achieving TBWL > 15% at 6 months.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Prevalence and Management of Adult Obesity in a Large U.S. Academic Health System

Both medication and surgical interventions can be used to treat obesity, yet their use and effectiveness in routine clinical practice are not clear. This study sought to characterize the prevalence and management of patients with obesity within a large U.S. academic medical center. All patients aged ≥18 years who were seen in a primary care clinic within the Duke Health System between 2013 and 2016 were included. Patients were categorized according to baseline BMI as underweight or normal weight (<25 kg/m2), overweight (25-29.9 kg/m2), Class I obesity (30-34.9 kg/m2), Class II obesity (35-39.9 kg/m2), and Class III obesity (≥40 kg/m2). Baseline characteristics and use of weight loss medication were assessed by BMI category. Predicted change in BMI was modeled over 3 years. All data were analyzed between 2017 and 2018. Of the 173,462 included patients, most were overweight (32%) or obese (40%). Overall, <1% (n=295) of obese patients were prescribed medication for weight loss or underwent bariatric surgery within the 3-year study period. Most patients had no change in BMI class (70%) at 3 years. Despite a high prevalence of obesity within primary care clinics of a large, U.S. academic health center, the use of pharmacologic and surgical therapies was low, and most patients had no weight change over 3 years. This highlights the significant need for improvement in obesity care at a health system level.

Use of Weight Loss Medication for Weight Regain after Bariatric Surgery

Use of Weight Loss Medication for Weight Regain after Bariatric Surgery

Incorporating Weight Loss Medications Into Hepatology Practice for Nonalcoholic Steatohepatitis.

There is an urgent need for practical approaches to patients with nonalcoholic steatohepatitis (NASH). Total body weight loss (TBWL) is an important approach, as its effects are amplified in the liver, with 10% TBWL resulting in a 50% loss of liver triglycerides and improvement in all aspects of NASH histology. Lifestyle changes are the first step in addressing TBWL, but uncommonly result in the range required to improve liver histology in NASH (7%-10%). Weight loss medications (WLMs) are an effective additional tool because they can provide TBWL in the 7%-10% range, have a well-characterized clinical profile, have clear guidelines, and meet approved criteria for their use (body mass index greater than 27 kg/m2 ) for most NASH patients. Use of WLMs requires shared decision making with the patient, which hepatologists, due to their understanding of the natural history of NASH, are uniquely positioned to provide. WLMs do present the challenge of incorporating new medications into the hepatology clinic, but this will be necessary with all medications to manage NASH. WLMs provide a practical intervention that can be incorporated into hepatology clinics and can be offered to most NASH patients. NASH-specific medicines in clinical trials offer partial histological responses, and TBWL will likely enhance this. Conclusion: WLMs provide the hepatologist with effective and welcome clinical intervention beyond the diagnosis and staging of NASH and provide patients with a sense of empowerment about the treatment of their liver disease.