Bariatric Times

Insights into Patient Pop with Obesity 2016

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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C6 Bariatric Times • December 2016 • Supplement C loss. Greater weight loss will result in more and more important health benefits. Assuming that diets all restrict caloric intake in one way or another, there is no "perfect diet" or even one diet that could be recommended over others. Caloric restriction was defined in the guidelines using several "rules of thumb." Calories might be cut by 500 to 750 per day or total calorie count decreased to 1,200 to 1,500 per day for women or 1,500 to 1,800 per day for men. However, diets differ in the way in which they achieve these caloric deficits, and there is no apparent advantage of one method over others. For example, there is no clear reason to opt for a "low-fat" diet over a "low-carb" diet or to select a Mediterranean plan versus a "Paleo diet." Commercial plans that promote sensible caloric restriction are essentially equivalent, and thus patients should be encouraged to select the diet plan that is most compatible with their own tastes and preferences. Patient preference is important here, as patients are more likely to adhere to diet plans they like or with which they are most familiar. For certain patients who can be medically supervised, very low calorie diets (such as 800 to 1,000 calories per day) may be reasonable options. For outpatients who will be going about their daily activities with limited clinical supervision, moderately reduced plans (1200–1500 or 1500–1800 calories per day for women and men, respectively) are appropriate. It is unreasonable to expect a patient to participate in a very low calorie diet for an extended period of time without strong clinical support and supervision. While it may be important for the physician to recommend diet and exercise programs to patients with obesity, these steps alone are insufficient in most cases to lead to real weight loss and change. It is crucial that physicians understand this point as without more intensive intervention, significant and sustained weight loss may not be possible. The key aspects of these interventions are that they are multifaceted (diet, exercise, behavior), intensive, and long term. The fifth question from these guidelines is answered in guidance that may be one of the strongest statements in favor of bariatric surgery that has yet been published. Obesity specialists recognize that bariatric surgery confers on patients both risks and benefits. These new guidelines suggest that for a subset of patients who have the most extreme forms of obesity or obesity plus comorbid health conditions, bariatric surgery should be considered. endocrine Society Clinical Practice Guideline. This guideline from the Endocrine Society provides insight into pharmacological management of patients with obesity, 3 a topic not addressed by the AHA/ACC/TOS guidelines. The Endocrine Society guidelines provide insight into drugs that may aid weight loss (antiobesity drugs) as well as drugs for other indications that may promote weight gain as a side effect. This guideline was written following a systematic review of the literature and findings were then supplemented by expert consensus. Its recommendations are based on high- quality evidence and suggestions by the experts were offered in those cases when the evidence from the literature was not yet sufficient to craft a recommendation. These guidelines strongly recommend the consideration of pharmacotherapy for individuals with a BMI >30kg/m 2 (or BMI≥27kg/m 2 with comorbidity) who have been unable to successfully lose weight or maintain weight loss. While obesity specialists are largely familiar with this recommendation for drug therapy, primary care physicians (PCPs) may be surprised that this recommendation for pharmacological therapy occurs in patients with such relatively "low" BMIs. For example, a patient with diabetes and a BMI of 27kg/m 2 is not technically considered as having obesity—this might occur in a patient who is 5 foot 6 inches tall and weighs 170 pounds. The use of drugs for these "lower BMI" patients is an important recommendation that has not yet fully translated to clinical practice. A number of antiobesity medications are available. Once a patient is prescribed pharmacotherapy for weight loss, the safety and efficacy of that regimen should be assessed monthly for the first three months, then every three months thereafter. After three months, the patient should have lost five percent of his or her total body weight. For the 170-pound patient in the example given previously, that would be about 8 pounds. If that weight loss or more could be achieved and the drug is well tolerated, then the regimen should continue. On the other hand, if the patient has failed to lose that amount of weight or does not tolerate the drug, it should be discontinued and a different drug Insights into the Patient Population with Obesity: Assessment and Treatment

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