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Content Update

August 12, 2019

Oral, Nonsystemic Hydrogel Approved for Weight Management in Adults: In April 2019, the U.S. Food and Drug Administration (FDA) approved a first-in-class oral, nonsystemic, superabsorbent hydrogel (Plenity) to aid in weight management in overweight and obese adults. The product is classified as a device (not a drug) and was shown to be safe and effective when used in combination with diet and exercise, resulting in significantly greater weight loss vs. placebo in patients with and without type 2 diabetes. The incidence of adverse events in the treatment group was no different from placebo. Plenity is the only prescription product to be approved for weight management in adults with a BMI as low as 25 kg/m2, and there is no restriction on its duration of use.


Patient Care Process for the Management of Obesity



  • Patient characteristics (e.g., age, race, sex)

  • Patient history (past medical, family, social—dietary habits, tobacco use)

  • Obesity-related conditions (see Figure 144-1)

  • Current medications including prescription, nonprescription, and herbal product use

  • Weight loss history and prior attempts to lose weight

  • Objective data

    • Height, weight, BMI, waist circumference, and blood pressure

    • Labs (e.g., glucose, hemoglobin A1c, lipid panel)


  • Presence of secondary obesity (e.g., hypothyroidism, Cushing syndrome)

  • Current medications that may contribute to weight gain (see Etiology)

  • Presence of obesity-related comorbidities (e.g., hypertension, dyslipidemia, coronary artery disease, type 2 diabetes mellitus, sleep apnea, increased waist circumference; see Figure 144-3)

  • Class of overweight and obesity determined by BMI, waist circumference, and obesity-related comorbidities (see Table 144-3)

  • Readiness to engage in weight loss efforts and potential barriers to success

  • Candidacy for treatment with implantable medical devices, bariatric surgery, or pharmacotherapy


  • Nonpharmacologic lifestyle intervention including low-calorie diet, physical activity, and behavioral modifications

  • Pharmacotherapy (if appropriate) including specific medication, dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Table 144-4)

  • Initial weight loss goal of 5% to 10% over a 6-month time period

  • Monitoring parameters including efficacy (weight loss) and tolerability (medication-specific adverse effects)

  • Patient education (e.g., purpose of dietary and lifestyle modification, drug therapy)

  • Self-monitoring of weight—when and how to record results

  • Referrals to other providers when appropriate (e.g., physician, dietician, psychologist)


  • Educate patient regarding health risks associated with overweight and obesity

  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up (e.g., monthly for first 3 months and every 3 months thereafter)

Follow-up: Monitor and Evaluate

  • Determine weight loss goal attainment

  • Presence of adverse effects

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, and other health professionals


For the chapter in the Wells Handbook, please go to Chapter 58. Obesity.



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