1998;68(4):899-917. Accessed January 10, 2016. Clin Obes. 91. Victoza significantly reduces the risk of major adverse cardio-vascular events in the LEADER trial [news release]. The most common AEs include nausea, vomiting, and abdominal pain or discomfort. The energetic efficiency with which carbohydrate is converted and stored as fat is lower than that of dietary fat, providing a further advantage. Foreyt J, Hill J, Maier H, Dunayevich E, Kim D. Naltrexone. The rarity of events, however, limits interpretations into the relationship with drug treatment, seeing potential risks outweighed by proven superior efficacy of liraglutide 3 mg as an antiobesity agent. N Engl J Med. ClinicalTrials.gov website. Wee CC. This is why obesity management strategies have to be realistic and sustainable. Compliance and weight loss were better with this approach than with a fixed 5 MJ (1200 kcal) diet. 2006;29(9):2102-2107. doi: 10.2337/dc06-0560. 46. All rights reserved. 2015;162(7):522-523. doi: 10.7326/M15-0429. soard.2015.08.496. Population-based studies have consistently shown an increased incidence of sleep disordered breathing with weight gain and obesity.3–5 Third, weight reduction by dietary and surgical treatment has been shown to improve co-morbid conditions including sleep disordered breathing and sleep quality.6 For these reasons, a thorough evaluation and treatment plan for OSA should specifically address weight loss for patients who are overweight or obese. 44. 2014;22(10):2137-2146. doi: 57. Clinicians can be reimbursed for a maximum of 22 visits (15 minutes each) over one year, with reimbursement in the second 6 months contingent on patients achieving at least a 3-kg weight loss.29 Educational resources to help PCPs acquire obesity counseling and management skills have expanded, as well. The most common AEs include nausea and gastrointestinal complaints. Thus, patients who respond to treatment, often defined as at least a 5% weight loss after 3 months of treatment, should continue the medication, with goals of continuous weight loss and maintenance of lost weight.2 For this reason, although short-term medications may be useful in some cases, this article will only review those medications approved by the FDA for long-term use. Treatment should be stopped if patients do not achieve at least 5% weight loss. Investigations for secondary causes of obesity and management of co-morbidities like diabetes should be provided with a holistic approach. Sjöström L, Narbro K, Sjöström CD, et al; Swedish Obese Subjects Study. Multicenter, placebo-con-trolled trial of lorcaserin for weight management. On average, topiramate leads to relatively little weight loss by itself. It appears that withdrawing all solid or ‘proper’ food helps the patient to define himself or herself as ‘not eating,’ in the same way that some quitting smokers find it easier to abstain completely from cigarettes rather than to cut down. Table 1. O’Neil PM, Smith SR, Weissman NJ, et al. 2005;28(12):2939-2941. Kraschnewski JL, Sciamanna CN, Stuckey HL, et al. Treatment was generally successful and well tolerated. Weight loss in obese women with PCOS, through a protein-rich and a very low-calorie diet, has been shown to significantly reduce serum fasting glucose and insulin, improve insulin sensitivity and decrease PAI-1 activity [45]. 2015. doi: 10.1007/ s11695-015-1974-2. Medicare began reimbursing for obesity counseling in primary care in 2011—although reimbursement is limited to services provided by PCPs, not specialists or allied health professionals. Moreover, progression to T2D was reduced by 76% compared with placebo in patients treated with the high dose of the medication.59, In the EQUIP trial, patients with severe obesity (BMI ≥35 kg/m2) who completed one year of treatment with phentermine-topiramate ER 15/92 lost 14.4% of body weight compared with 2.1% in the placebo group; 83.5% lost at least 5% of body weight, compared with 25.5% in the placebo group, and 67.7% lost at least 10% of body weight compared with 13.0% of those completing placebo treatment.60 Sub-analysis in patients with extreme obe-sity (BMI >45 kg/m2), a population that is rarely studied for nonsurgical weight-loss interventions, showed even greater benefits, with more than 50% of patients who completed the trial losing more than 15% of initial body weight and 28% of patients losing more than 20% of initial body weight.61, Notably, the maximum approved dose of phenter-mine is 37.5 mg and the maximum approved dose of topiramate is 400 mg; therefore, the doses of each medication in this combination treatment are quite low and well tolerated.7 Treatment is initiated at 3.75 mg phentermine/23 mg topiramate ER and escalated to 7.5/46 mg after 2 weeks. doi: 10.1002/oby.20660. 2012;20(2):330-342. doi: 10.1038/oby.2011.330. 2007;357(8):753-761. doi: 10.1056/NEJMoa066603. Lopez-Nava G, Bautista-Castaño I, Jimenez-Baños A, Fernandez-Corbelle JP. It should be noted that most available medications have been studied for 2 years only (although liraglutide has pos-itive 3-year data and orlistat has positive 4-year data).52,72 Although many intermediate cardiovascular risk factors are improved by use of these medications, long-term car-diovascular safety has not yet been established. The most common AEs are nausea, constipation, diarrhea, headache, and vomit-ing. 53. From: Decision Making in Medicine (Third Edition), 2010, L.J. Birkmeyer NJ, Dimick JB, Share D, et al; Michigan Bariatric, Surgery Collaborative. A silent response to the obesity epidemic: decline in US physician weight counseling. Suggesting gradual changes is helpful in altering diet composition. It is essential that the concept of a long-term change in dietary habits be accepted at the start of treatment. Bariatric surgery: a systematic review and meta-analysis. A low-calorie, individualized food-based diet that is either balance-deficit (reducing the total number of calories while keeping proportions from carbohydrate, fat, and protein basically the same as before) or a fat-deficit diet, with most of the caloric reduction resulting from restriction of fat, can be prescribed. Cornier MA, Donahoo WT, Pereira R, et al. 87. Few commercial programs had long-term data available.46, Very low calorie diets (<800 kcal/day) are viable options in some patients but should be provided only within the context of a high-intensity lifestyle interven-tion and close medical monitoring.3,32 Patients should be supervised by trained practitioners in a medical care set-ting because rapid weight loss has the potential for medical complications, such as gallstones and electrolyte distur-bances.3,32,47 Total meal replacement with a very low calorie diet over 3 months has the potential to achieve 10% to 15% weight loss, but it may result in substantial weight regain, especially in the absence of a maintenance program.3 These diets are typically prescribed in medical settings, but several commercial options are also available.46. , Denmark: Novo Nordisk ; March 4, 2015 ; 11 ( 2 ): S47-S51 are in use! Flanagin a, et al ):522-523. doi: 10.1016/ S0140-6736 ( 09 ) 61457-4 € 14,06 par. 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