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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Bariatric Times • December 2016 • Supplement C C5 misclassifications. However, both BMI and waist circumference are excellent first tools for classifcation. 10 Patients should be counseled to lose weight and the initial target should be set at 3 to 5 percent of their total body weight. 2,11 For example, a 3- to 5- percent weight loss for patient who weighs 300 pounds would be 9 to 15 pounds. Even a five-percent weight loss improves triglyceride levels and glycemic index. 12–14 Sustained weight loss of this amount results in clinically meaningful health benefits and is not usually perceived by patients as an overwhelming or impossible goal. Clinicians should advise patients that they need not achieve normal weight or some idealized "goal weight" in order to get genuine and meaningful improvements in health. A relatively modest weight loss will produce important results. However, this modest weight loss should not be viewed as the end target, but rather as the first step toward further weight Table 1. Key Guidelines for Obesity Management 1 –6 THE AMERICAN HEART ASSOCIATION/ AMERICAN COLLEGE OF C ARDIOLOGY/ THE OBESITY SOCIETY 2013 GUIDELINE FOR THE MANAGEMENT OF OBESITY IN ADULTS (AHA/ACC/TOSA 1 ,2 THE ENDOCRINE SOCIETY: PHARMACOLOGICAL M ANAGEMENT OF OBESITY 3 THE AMERICAN ASSOCIATION OF CLINICAL E NDOCRINOLOGISTS ASSOCIATION OF CLINICAL ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES 2016 (AACE/ACEA 4 ,5 THE OBESITY MEDICINE ASSOCIATION O BESITY ALGORITHM 2016 6 Primary target PCPs PCPs and specialists Endocrinologists Obesity practitioners and others Process Systematic review of RCTs Systematic review, expert Expert consensus Expert and member consensus Focus Five key questions on the risks, benefits, and treatment areas Two key questions on medications Endocrinologist care of obesity Obesity specialist care of obesity AACE/ACE: American Association of Clinical Endocrinologists; AHA/ACC/TOS: American Heart Association/American College of Cardiology/The Obesity Society) 2013 Guideline for the Management of Obesity in Adults; Endocrine Guideline: The Endocrine Society: Pharmacological Management of Obesity; PCP: primary care physician; RCT: randomized clinical trial Table 2. Questions addressed in the AHA/ACC/TOS guidelines QUESTION TOPIC RECOMMENDATIONS 1 Is weight loss good for you? Benefits of weight loss Use Body Mass Index (BMI) as an easily performed first screening step to identify higher-risk patients; use waist circumference as an indicator of cardiovascular disease (CVD), diabetes mellitus (DM), and mortality risk. 2 How do you identify who is at risk sufficient to mandate weight loss efforts? Risks of having overweight/obesity Counsel patients to achieve at least a 3% to 5% sustained weight loss, which results in clinically meaningful health benefits. Greater weight loss leads to further benefits. 3 What is the efficacy/effectiveness of the different dietary strategies? Diets for weight loss There is no ideal diet for weight loss. Prescribe a diet to reduce caloric intake as part of a comprehensive lifestyle intervention. 4 What is the efficacy/effectiveness in achieving and maintaining weight loss? Comprehensive lifestyle interventions The gold standard treatment for obesity is a comprehensive, high-intensity session (≥14 sessions in six months) delivered in group or individual sessions by a trained interventionalist and persisting for ≥1 year. 5 What are the benefits and risks of surgical procedures for weight loss? The role of bariatric surgery Advise patients with a BMI ≥40kg/m 2 (or ≥35kg/m 2 with comorbidity) that bariatric surgery may be an appropriate option to improve health. Insights into the Patient Population with Obesity: Assessment and Treatment

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