Experts recommend weight loss drugs, surgery as supplement to lifestyle interventions

The Endocrine Society today issued a Clinical Practice Guideline (CPG) on strategies for prescribing drugs to manage obesity and promote weight loss.

15 jan 2015--The CPG, entitled "Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline," was published online and will appear in the February 2015 print issue of the Journal of Clinical Endocrinology and Metabolism (JCEM), a publication of the Endocrine Society.

Obesity is a worsening public health problem. According to the 2012 National Health and Nutrition Examination Survey, about 33.9 percent of adults ages 19-79 were overweight, 13.4 percent were obese and 6.4 were extremely obese.

The Food and Drug Administration has approved four new anti-obesity drugs - lorcaserin, phentermine/topiramate, naltrexone/bupropion and liraglutide - in the past two years. Medications like these can be used in combination with diet and exercise to help people lose weight.

"Lifestyle changes should always be a central part of any weight loss strategy," said Caroline M. Apovian, MD, of Boston University School of Medicine and Boston Medical Center, and chair of the task force that authored the guideline. "Medications do not work by themselves, but they can help people maintain a healthy diet by reducing the appetite. Adding a medication to a lifestyle modification program is likely to result in greater weight loss."

In the CPG, the Endocrine Society recommends that diet, exercise and behavioral modifications be part of all obesity management approaches. Other tools such as weight loss medications and bariatric surgery can be combined with behavioral changes to reduce food intake and increase physical activity. Patients who have been unable to successfully lose weight and maintain a goal weight may be candidates for prescription medication if they meet the criteria on the drug's label.

Other recommendations from the CPG include:

• If a patient responds well to a weight loss medication and loses 5 percent or more of their body weight after three months, the medication should be continued. If the medication is ineffective or the patient experiences side effects, the prescription should be stopped and an alternative medication or approach considered.
• Since some diabetes medications are associated with weight gain, people with diabetes who are obese or overweight should be given medications that promote weight loss or have no effect on weight as first- and second-line treatments. Doctors should discuss medications' potential effects on weight with patients.
• Certain types of medication - angiotensin converting enzyme inhibitors, angiotensin receptor blockers and calcium channel blockers - should be used as a first-line treatment for high blood pressure in obese people with Type 2 diabetes. These are effective blood pressure treatments that are less likely to contribute to weight gain than the alternative medication, beta-adrenergic blockers.
• When patients need medications that can have an impact on weight such as antidepressants, antipsychotic drugs and medications for treating epilepsy, they should be fully informed and provided with estimates of each option's anticipated effect on weight. Doctors and patients should engage in a shared-decision making process to evaluate the options.
• In patients with uncontrolled high blood pressure or a history of heart disease, the medications phentermine and diethylpropion should not be used.

More information: The Hormone Health Network offers resources on weight and health at www.hormone.org/diseases-and-c… ns/weight-and-health

Provided by The Endocrine Society

Mental barriers hamper obese women's efforts to get exercise

Tailored programs could help curb aversion and improve adherence to weight loss plan

06 oct 2008--For arachnophobes, it's difficult to kill a spider as it scurries across the floor. Those who are scared to fly might not ever set foot on a plane. While nothing physically stops people with these aversions, a mental barrier can keep them from the task at hand.
The same could be said for obese women when it comes to physical activity, according to research presented at the Obesity Society's Annual Meeting on Oct. 5.
Researchers from the Center for Obesity Research and Education and the department of kinesiology at Temple University found that obese women face a significant number of barriers when it comes to exercise, more so than their normal weight counterparts.
"This is the first time we've been able to systematically look at what stops obese women from getting the activity they need," said Melissa Napolitano, associate professor of kinesiology and clinical psychologist at the Center for Obesity Research and Education at Temple University.
Napolitano and her team surveyed data collected from 278 women, both normal weight and obese, enrolled in a yearlong physical activity encouragement study. At baseline, and at a 3- and 12-month follow up, all participants were administered a questionnaire to determine what factors kept them from getting exercise, including:
Feeling self-conscious;
Not wanting to fail;
Fearing injury;
Perceived poor health
Having minor aches or pains
Feeling too overweight to exercise.
At all time points, obese women reported greater barriers to being active than normal weight women. For obese women, barriers they identified at the beginning of the study predicted how much or how little they would be exercising at the 12 month follow-up.
"These might sound like excuses to some people, but for those who have these aversions, they're real problems," said Napolitano.
She theorizes that tailoring programs to maneuver around these barriers is the key to curbing some of that aversion and improving adherence to a weight loss goal. She cites the popular Curves® gyms as a step in the right direction, because they offer a comforting, welcoming environment for women to exercise in.
"There is an underlying attitude about weight loss, that it's easy if you just eat less and exercise more," she said. "But if losing weight were easy, we wouldn't have the obesity epidemic we have today."
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This study was co-authored by Kelley Borradaile, research assistant professor of public health at the Center for Obesity Research and Education at Temple University. Funding for this research was provided by the Robert Wood Johnson Foundation and assistance from the American Heart Association.