Chapter 161: Obesity

KEY CONCEPTS

• Two clinical measures of excess body fat, regardless of sex, are the body mass index (BMI) and the waist circumference (WC). BMI and WC provide a better assessment of total body fat than weight alone and are independent predictors of obesity-related disease risk.

• Excessive central adiposity increases risk for development of type 2 diabetes, hypertension, and dyslipidemia.

• Weight loss of as little as 5% of total body weight can significantly improve blood pressure, lipid levels, and glucose tolerance in patients with overweight and obesity. Sustained, large weight losses (ie, after bariatric surgery) are associated with a lower risk of cardiovascular events and death and long-term improvements in many of the complications associated with obesity.

• Clinicians should consider the weight-altering effects of medications used to treat comorbid conditions (eg, antidepressants, antipsychotics, antiepileptics, and antidiabetics) and select medications that promote weight loss or are weight-neutral.

• Bariatric surgery is reserved for patients with extreme obesity having a BMI more than or equal to 40 kg/m² or BMI more than or equal to 35 kg/m² with a significant comorbidity.

• Pharmacotherapy may be considered an adjunctive treatment in patients with a BMI more than or equal to 30 kg/m² or BMI of 27 to 30 kg/m² with a comorbidity if comprehensive lifestyle modifications (eg, diet, exercise, and behavioral modification) fail to achieve or sustain weight loss.

• Weight regain occurs with a high probability when pharmacotherapy for obesity is discontinued.

• Pharmacotherapy should be discontinued if weight loss of at least 5% is not achieved after 12 weeks of maximum-dose therapy with phentermine–topiramate or bupropion–naltrexone because significant weight loss is unlikely to be achieved despite continued therapy. Liraglutide should be discontinued if weight loss of at least 4% is not achieved after 16 weeks of therapy.

• The Food and Drug Administration (FDA) does not regulate labeling of herbal and food supplement diet agents, and content is not guaranteed.

Preclass Engaged Learning Activity

Access the Centers for Disease Control and Prevention (CDC) Overweight & Obesity website found at https://tinyurl.com/w9847zx. Review the latest obesity statistics and recommended strategies to prevent and manage obesity. This website is useful to enhance student awareness of the significant public health impact of overweight and obesity and provides tools to assist in the IMPLEMENT step of the patient care process.