management of obesity: ACP clinical guidelines, 2005
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Introduction
obesity defined as BMI > 30 kg/m2
Management
- assess co-morbid conditions
- especially diabetes & hypertension (metabolic syndrome X)
- counsel on lifestyle & behavioral modifications
- diet & exercise
- continuous counseling necessary
- determine goals & time frame for acheivement of goals on an individaul basis
- weight loss
- blood pressure reduction
- improved glucose control
- improved lipid panel
- pharmacologic therapy may be offered to patients who fail more conservative measures (diet, exercise): discuss
- adverse effects of pharmaceuticals
- lack of long-term safety data
- temporary weight loss achieved via pharmaceuticals
- pharmacutical agents
- sibutramine (4.45 kg)*
- orlistat ( 2.89 kg)
- phentermine (3.6 kg)*
- diethylpropion ( 3.0 kg)*
- fluoxetine (3.15 kg)*
- bupropion (2.8 kg)*
- choice of pharaceutical agent depends on side effects profile & patient's tolerance of those effects
- no evidence for increased weight loss with combination therapy
- no data about weight regain after medications are withdrawn
- no long-term (>12 months) studies of efficacy or safety of pharmaceutical therapy
- consider surgery for patients with:
- BMI > 40 kg/m2 or greater
- failed attempts of diet & exercise with or without adjunctive pharmacutical therapy
- obesity-related comorbid conditions
- discuss surgical risks
- possible need for reoperation
- gall bladder disease
- malabsorption
- surgery does not preclude continued need for life-style modification
- insufficient evidence define best surgical procedure
- surgery has not been shown to reduce cardiovascular morbidity or mortality
- refer patients to high-volume centers with surgeons experienced in bariatric surgery.
- bariatric surgical mortality rate 0.3%-1.9%
- learning curve for surgeon
- outcomes depend on
- skill of surgical team
- capacity of the system of care
* pooled data for average weight loss at 12 months from meta-analysis
More general terms
Additional terms
References
- ↑ Journal Watch 25(10):82, 2005 Snow V, Barry P, Fitterman N, Qaseem A, Weiss K Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Pharmacologic and surgical management of obesity in primary care: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2005 Apr 5;142(7):525-31. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15809464
Li Z, Maglione M, Tu W, Mojica W, Arterburn D, Shugarman LR, Hilton L, Suttorp M, Solomon V, Shekelle PG, Morton SC. Meta-analysis: pharmacologic treatment of obesity. Ann Intern Med. 2005 Apr 5;142(7):532-46. Summary for patients in: Ann Intern Med. 2005 Apr 5;142(7):I55. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15809465
Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugarman HJ, Livingston EH, Nguyen NT, Li Z, Mojica WA, Hilton L, Rhodes S, Morton SC, Shekelle PG. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005 Apr 5;142(7):547-59. Summary for patients in: Ann Intern Med. 2005 Apr 5;142(7):I55. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15809466