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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

Patient Care Process for the Management of Obesity

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Collect

  • 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)

Assess

  • 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

Plan*

  • 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)

Implement*

  • 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

CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

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

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. Two clinical measures of excess ...

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