Bariatric Times

APR 2018

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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10 The Medical Student Notebook Bariatric Times • April 2018 the efficacy of such a regimen. With the varied risks and benefits of each of the six FDA-approved prescription and over-the-counter weight-loss medicines available today, it is important for providers to individually tailor medication regimens to their patients' unique needs. Patients with obesity remain in need of novel weight-loss therapeutics that are more effective and maintain low risk profiles. Several new drugs not yet approved by the FDA for weight loss are being used effectively off label, including semaglutide (Ozempic). 28 Soon, these medicines might become officially indicated for anti-obesity therapy by the FDA. As we continue to gain insights into pathophysiology of obesity, perhaps we will encounter new therapeutic targets for which drugs can be made. These efforts are essential for offering hope to patients around the world looking for assistance with managing obesity. REFERENCES 1. Moyer VA, LeFevre ML, Siu AL, et al. Screening for and management of obesity in adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2012;157:373–378. 2. Tsigos C, Hainer V, Basdevant A, et al. Management of obesity in adults: European clinical practice guidelines. Obesity Facts. 2008;1:106–16 3. Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149:275–87. 4. Srivastava, Apovian CM. Current pharmacotherapy for obesity. Nat Rev Endocrinol. 2018;14:12–24. 5. Stanford F, Alfaris N, Gomez G, et al. The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: a multi-center study. Surg Obes Relat Dis. 2017;13:491– 500. 6. Tainter ML, Cutting WC, Stockton AB. Use of dinitrophenol in nutritional disorders: a critical survey of clinical results. Am J Public Health Nations Health. 1934;24:1045–53. 7. Grundlingh J, Dargan PI, El-Zanfaly M, Wood DM. 2,4-dinitrophenol (DNP): a weight loss agent with significant acute toxicity and risk of death. J Med Toxic. 2011;7:205. 8. Eckel R. Nonsurgical management of obesity in adults. N Engl J Med. 2008;358:1941–50. 9. Yanovski S, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014;311:74–86. 10. Bersoux S, Byun TH, Chaliki SS, Poole KG. Pharmacotherapy for obesity: what you need to know. Cleve Clin J Med. 2017;84:951–8. 11. Aronne LJ, Wadden TA, Peterson C, et al. Evaluation of phentermine and topiramate versus phentermine/topiramate extended- release in obese adults. Obesity (Silver Spring). 2013;21:2163–71 12. Connolly HM, Crary JL, McGoon MD, et al. Valvular heart disease associated with fenfluramine–phentermine. N Engl J Med. 1997;337:581–8. 13. Prices for Phentermine. GoodRx. 2018; https://www.goodrx.com/phentermine. 14. Finer N, James WP, Kopelman PG, et al. One-year treatment of obesity: a randomized, double-blind, placebo- controlled, multicentre study of orlistat, a gastrointestinal lipase inhibitor. Int J Obes Relat Metab Disord. 2000;24:306–13. 15. Davidson MH, Hauptman J, DiGirolamo M, et al. Weight control and risk factor reduction in obese subjects treated for 2 y with orlistat: a randomized controlled trial. JAMA. 1999;281:235–42. 16. Prices for Alli. GoodRx. 2018; https://www. goodrx.com/alli?drug-name=alli. 17. Smith SR, Weissman NJ, Anderson CM, et al. Multicenter, placebo-controlled trial of lorcaserin for weight management. N Engl J Med. 2010;363:245–56. 18. Prices for Belviq. GoodRx. 2018; https://www.goodrx.com/belviq?drug- name=belviq. 19. Allison DB, Gadde KM, Garvey WT, et al. Controlled-release phentermine/topiramate in severely obese adults: a randomized controlled trial (EQUIP). Obesity (Silver Spring). 2012;20:330–42. 20. Prices for Qsymia. GoodRx. 2018; https://www.goodrx.com/qsymia?drug- name=qsymia. 21. Apovian CM, Aronne L, Rubino D, et al. A randomized, Phase 3 trial of naltrexone SR/bupropion SR on weight and obesity- related risk factors (COR-II). Obesity (Silver Spring). 2013;21:935-43. 22. Prices for Contrave. GoodRx. 2018; https://www.goodrx.com/contrave?drug- name=contrave. 23. Astrup A, Rössner S, Van Gaal L, et al. Effects of liraglutide in the treatment of obesity: a randomised, double-blind, placebo-controlled study. Lancet. 2009;374:1606–16. 24. Prices for Saxenda. GoodRx. 2018; https://www.goodrx.com/saxenda?drug- name=saxenda. 25. Ioannides-Demos LL, Proietto J, Tonkin AM, et al. Safety of drug therapies used for weight loss and treatment of obesity. Drug Safety. 2006;29:277-302. 26. Beyer CE, Dwyer JM, Piesla MJ, et al. Depression-like phenotype following chronic CB1 receptor antagonism. Neurobio of Dis. 2010;39:148–55. 27. Nguyen NT, Varela JE. Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Rev Gastroenterol Hepatol. 2017;14:160–9. 28. Blundell J, Finlayson G, Axelsen M, et al. Effects of once-weekly semaglutide on appetite, energy intake, control of eating, food preference and body weight in subjects with obesity. Diabetes Obes Metab. 2017;19:1242-51. 29. Cefalu WT, Stenlöf K, Leiter LA, et al. Effects of canagliflozin on body weight and relationship to HbA1c and blood pressure changes in patients with type 2 diabetes. Diabetologia. 2015;58:1183–7. FUNDING: No funding was provided for this article. DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article. ADDRESS FOR CORRESPONDENCE: Manoj Kanagaraj, BS, BA; Email: mkanagar@bidmc.harvard.edu. BT Bariatric surgery improves hyperandrogenism, menstrual irregularities, and metabolic dysfunction among women with polycystic ovary syndrome (PCOS). Christ JP, Falcone T. Obes Surg. 2018 March 2. [Epub ahead of print]. Synposis: Forty-four women with polycystic ovary syndrome (PCOS) who underwent bariatric surgery were matched with 65 controls who also had bariatric surgery. The PCOS group saw significant reductions in androgen levels and percent meeting criteria for hyperandrogenism, but there was no significant decrease in ovarian volume. PMID: 29501798 Future pharmacotherapy for obesity: new anti-obesity drugs on the horizon. Srivastava G, Apovian C. Curr Obes Rep. 2018 March 5. [Epub ahead of print]. Synposis: The reviewed list of drugs include centrally acting agents such as setmelanotide, neuropeptide Y antagonist (velneperit), and zonisamide-bupropion (Empatic), as well as gut hormones and incretin targets, such as glucagon- like-peptide-1 (GLP-1) analogues (semaglutide and oral equivalents) and amylin mimetics (davalintide, dual amylin and calcitonin receptor agonists). PMID: 29504049 Bariatric outcomes: self- management for sustained surgical success: a multicomponent treatment for dysregulated overeating in bariatric surgery patients. Anderson LM, Chacko TP. J Addict Nurs. 2018;29(1):32–42. Synposis: This review article discusses the Bariatric Outcomes: Self-management for Sustained Surgical Success (BOSSSS) program, which promotes weight loss and prevents weight regain in patients who have had bariatric surgery. Additionally, the program aims to focus on self-determination theory; initial data reported show that patients who have undergone bariatric surgery have a "lack of skill-based emotional and behavioral support designed to help them over the long term" and that the program could benefit them. PMID: 29505459 Plastic surgery in bariatric patients: a nationwide study of 17,000 patients on the national administrative database. Lazzati A, Katsahian S, Maladry D, et al. Surg Obes Relat Dis. 2018 Jan 12. [Epub ahead of print]. Synposis: In a French study, 183,514 patients who had bariatric surgery were analyzed, and 23,120 plastic surgeries were performed on 17,695 patients. Women were found to be twice as likely to have plastic surgery after bariatric surgery compared to men. Overall, 21 percent of patients who have undergone bariatric surgery elected to have plastic surgery as well. PMID: 29503095 A 4-week preoperative ketogenic micronutrient-enriched diet is effective in reducing body weight, left hepatic lobe volume, and micronutrient deficiencies in patients undergoing bariatric surgery: a prospective pilot study. Schiavo L, Pilone V, Rossetti G, et al. Obes Surg. 2018 March 3. [Epub ahead of print]. Synposis: A cohort of 27 patients with a mean body mass index (BMI) of 45.2kg/m 2 who were scheduled to have bariatric surgery underwent a four-week ketogenic micronutrient-enriched diet prior to surgery. The diet was found to significantly decrease body weight before bariatric surgery—patients averaged a 10.3-percent reduction in body weight after four weeks. PMID: 29502279 Metabolic syndrome 2 years after laparoscopic gastric bypass. Guilbert L, Ortiz CJ, Espinosa O, et al. Int J Surg. 2018 March 1. pii: S1743– 9191(18)30587–9. [Epub ahead of print]. Synposis: Of the 63 patients in the study who had laparoscopic gastric bypass, a significant improvement in metabolic syndrome was seen, which was prevalent in just 6.3 percent of the cohort at the 12- and 24-month followups. The researchers found a direct relationship between the percentage of excess weight lost and the improvement of metabolic syndrome. PMID: 29501798 BT Journal Watch A quick look at the noteworthy articles in bariatric and metabolic research Bariatric Times. 2018;15(4):10

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