Treatment of obesity starts with comprehensive lifestyle management (i.e., diet, physical activity, behavior modification), which should include the following:
- Self-monitoring of caloric intake and physical activity
- Goal setting
- Stimulus control
- Nonfood rewards
- Relapse prevention
Weight-Loss Maintenance
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Self-monitoring of weight
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Consumption of a low-fat diet
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Daily physical activity of approximately 60 minutes
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Minimal sedentary “screen time”
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Consumption of most meals at home
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Water Drinking
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Energy Expenditure
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Behavioral Changes
Pharmacological Management
Currently, the 3 major groups of drugs used to manage obesity are as follows:
- Centrally acting medications that impair dietary intake
- Medications that act peripherally to impair dietary absorption
- Medications that increase energy expenditure
Orlistat (Xenical)
- Orlistat is a gastrointestinal and pancreatic lipase inhibitor that induces weight loss by inhibiting dietary fat absorption.
- Orlistat should be taken during or up to 1 hour after a meal containing fat. Its effectiveness in producing weight loss does not depend on systemic absorption.
- Orlistat may reduce absorption of some fat-soluble vitamins (A, D, E, K) and beta carotene.
- Administer a multivitamin supplement containing fat-soluble vitamins orally daily, 2 hours before or 1 hour after a meal.
- Orlistat may also affect the absorption of some medications.
- In particular, patients on warfarin need closer monitoring because of the potential for malabsorption of vitamin K.
CNS Stimulants, Anorexiants
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Indications include weight loss and maintenance of weight loss, in conjunction with a reduced-calorie diet, specifically in patients who have an initial body mass index (BMI) of 30 or more (obese) or a BMI of 27 or more (overweight) and other risk factors (e.g., diabetes mellitus, dyslipidemia, hypertension).
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Lorcaserin
- Lorcaserin is indicated as an adjunct to a reduced-calorie diet and exercise for long-term weight management in patients with an initial BMI of ≥30 (obese) or in those with a BMI of ≥27 (overweight) who have at least 1 weight-related comorbid condition (e.g., hypertension, dyslipidemia, type 2 diabetes mellitus).
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Phentermine/topiramate (Qsymia)
- This low-dose combination of phentermine, a sympathomimetic amine anorectic, and extended-release topiramate, an antiepileptic drug that possibly suppresses appetite and enhances satiety. The drug combination is indicated as an adjunct to a reduced-calorie diet and increased physical activity for long-term weight management in adults and patients aged 12 years or older.
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Phentermine (Lomaira)
- Phentermine is a sympathomimetic amine that increases the release and reuptake of norepinephrine and dopamine. Its anorexigenic effect occurs as a result of satiety-center stimulation in hypothalamic and limbic areas of the brain.
Glucagonlike Peptide-1 Agonists
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Glucagonlike peptide-1 (GLP-1) agonists have shown to promote weight loss in patients with or without type 2 diabetes mellitus. GLP-1 is a physiologic regulator of appetite and calorie intake, and the GLP-1 receptor is present in several areas of the brain involved in appetite regulation.
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Liraglutide (Saxenda)
- Liraglutide is indicated for chronic weight management as an adjunct to diet and exercise in adults with a BMI of ≥30 (obese) or adults with a BMI of ≥27 (overweight) who have at least one weight-related condition (e.g., hypertension, type 2 diabetes, dyslipidemia).
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Semaglutide (Wegovy)
- Semaglutide is indicated similar to Liraglutide. It is administered as a once-weekly SC injection.
- It is also indicated for risk reduction with regard to major adverse cardiovascular events in adults with established cardiovascular disease and either obesity or overweight.
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Tirzepatide (Zepbound)
- Dual glucose-dependent insulinotropic polypeptide (GIP) and glucagonlike peptide-1 (GLP-1) receptor agonist. It is indicated similar to Liraglutide.
Surgical Interventions
- Roux-en-Y gastric bypass
- Adjustable gastric banding
- Gastric sleeve surgery
- Vertical sleeve gastrectomy
- Horizontal gastroplasty
- Vertical banded gastroplasty
- Duodenal-switch procedures
- Biliopancreatic bypass
- Biliopancreatic diversion
Approach to Patient with Obesity
Prevention
