DOCSLIB.ORG

Many Most People Believe That Obesity Is a Disorder of Willpower

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Many Most People Believe That Obesity Is a Disorder of Willpower Comprehensive Weight Control Center 2013 AHA/ACC/TOS Guideline for the Louis J. Aronne, MD, FACP, FTOS, DABOM Jonathan A. Waitman, MD Sanford I. Weill Professor of Metabolic Research Assistant Professor of Medicine Management of Medical Director, Comprehensive Weight Control Internal Medicine, Clinical Nutrition, Obesity Medicine Center Overweight and Alpana P. Shukla, MD, MRCP (UK) Rekha B. Kumar, MD, MS Leon I. Igel, MD Obesity in Adults: Assistant Professor of Research Assistant Professor of Medicine Assistant Professor of Clinical A Report of the American College Medicine Medicine Endocrinologist Endocrinologist Endocrinologist of Cardiology/ American Heart Association Task Force on Practice Guidelines and The Obesity Society Katherine H. Saunders, MD Joy Pape, MSN RN FNP-C Wanda Truong, MS CDE WOCN CFCN FAADE Instructor in Medicine Clinical Research Coordinator Internal Medicine, Obesity Clinical Nurse Practitioner Medicine July 1, 2014 Rachel A. Lustgarten, MS, RD, Janet L. Feinstein, MS, RD, Anthony J. Casper, BS CDN CDN Senior Research Aide Clinical Dietitian Clinical Dietitian In my opinion, Devika Umashanker, MD Jeselin Andono, MS Samir Touhamy, MS this is the “standard of care”. Clinical Fellow in Obesity Graduate Student (IHN) Graduate Student (IHN) Medicine 1165 York Avenue, New York, NY weillcornell.org/weight J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2985-3023. PHARMACOLOGICAL MANAGEMENT of OBESITY: An Endocrine Society Clinical Practice Guideline January 15, 2015 Obesity Medicine: The Newest Specialty in Medicine Apovian CM, Aronne LJ, Bessesen D et al. J Clin Endocrinol Metab. 2015;100:342-362. 7 Number of Certificates Issued in Various Medical Specialties Many Most people believe that 400 obesity is a disorder of willpower. 350 Obesity Medicine Infectious Disease However, 300 Endocrinology 250 200 Rheumatology Many prominent medical societies 150 Geriatric Medicine agree that current scientific evidence 100 supports the view that obesity is a 50 disease. Certificates issued per year (#) X Certificates issued in 2011 0 2011 2012 2013 2014 What is the disease? 10 11 The Fat Cell is a Multiendocrine Organ: Medical Complications of Obesity: now 70+ ! Obesity Produces Too Much of Some / Less of Others, Almost every organ system is affected by obesity and may benefit from weight loss Leading to Disease Hypertension Hypertension Idiopathic Stroke Coronary Lipoprotein intracranial Dyslipidemia heart disease Type 2 DM Lipase hypertension Cataracts Lactate Cancer Angiotensinogen Pulmonary disease Nonalcoholic fatty • Breast, uterus, cervix Inflammation • Asthma liver disease • Colon, esophagus Dyslipidemia • Obstructive sleep • Steatosis Diabetes • Pancreas IL - 6 apnea • Steatohepatitis • Kidney Fat • Hypoventilation • Cirrhosis Arthritis Leptin FFA Insulin • Prostate Stores syndrome Severe pancreatitis TNF- Type 2 DM Osteoarthritis Gall bladder disease Skin Resistin Reproductive Adipsin Thrombosis abnormalities (Complement D) • Abnormal menses Estrogen Phlebitis Plasminogen • Infertility • Venous Activator Inhibitor 1 • Polycystic ovarian ASCVD stasis Adiponectin (PAI-1) syndrome DM=diabetes mellitus; FFA=free fatty acid; PAI-1=plasminogen activator inhibitor-1; TNF=tumor necrosis 1. Bays HE. Am J Cardiol. 2012;110:4B‐12B. 2. Bays HE. Expert Rev Cardiovasc Ther. Gout factor alpha; IL-6=interleukin 6. 2008;6:343‐368. 3. Bays HE. J Am Coll Cardiol. 2011;57:2461‐2473. Slide: LJ Aronne after Dr. G Bray Why Is 5%-10% Weight Loss the Goal of Interactions among hormonal and neural pathways Treatment? Major Health Benefits ! that regulate food intake and body-fat mass Modest weight loss (5%-10%) can: • Prevent T2DM1 • Improve glycemic control in T2DM • Reduce need for antidiabetic agents • Reduce blood pressure • Reduce triglycerides • Increase HDL-C • Reduce CRP Why? Dramatic change in • Improve symptoms of sleep apnea adipocyte hormones with small weigh loss? • Improve markers of NAFLD CRP: C-reactive protein; DPP: Diabetes Prevention Program; HDL-C: high-density lipoprotein cholesterol; NAFLD: nonalcoholic fatty liver disease. AGRP: agouti-related peptide; α-MSH: α-melanocyte-stimulating hormone; GHSR: growth hormone secretagogue receptor; INSR: insulin receptor; LepR: leptin receptor; MC4R: melanocortin-4 receptor; NPY: neuropeptide Y; POMC: proopiomelanocortin; 1. Hamman RF et al. Diabetes Care. 2006;29:2102-2107. PYY: peptide YY; Y1R; neuropeptide Y1 receptor; Y2R: neuropeptide Y2 receptor. 2. http://www.lookaheadtrial.org/public/bibliography.pdf. Accessed September 17, 2014. 14 Apovian CM, Aronne LJ, Bessesen D et al. J Clin Endocrinol Metab. 2015;100:342-362. 15 Bad Habits Damage Hypothalamic Pathways if Hypothalamus is Damaged, Leptin Resistance is a Result Hypothalamic Injury AGRP: agouti-related peptide; α-MSH: α-melanocyte-stimulating hormone; GHSR: growth hormone secretagogue receptor; INSR: insulin receptor; LepR: leptin receptor; MC4R: melanocortin-4 receptor; NPY: neuropeptide Y; POMC: proopiomelanocortin; PYY: peptide YY; Y1R; neuropeptide Y1 receptor; Y2R: neuropeptide Y2 receptor. Thaler PT, et al. J Clin Invest. 2012 Jan 3;122(1):153-62. doi: 10.1172/JCI59660. Epub 2011 16 Apovian CM, Aronne LJ, Bessesen D et al. J Clin Endocrinol Metab. 2015;100:342-362. 17 Hypothetical “Feed-forward” Fattening food causes physical changes in weight regulating pathways ! Creates a Positive Feedback Mechanism to Drive Weight Up, Up, Up Why People Can’t Lose Weight: the Plateau Phenomenon DIRECT: Dietary Intervention Randomized Controlled Trial, two-year results High Fat/High Carb Food n=272 completers Increased Diet type and mean weight loss: Hypothalamic injury - endocannabinoids Low-fat: -3.3 kg CNS insulin and leptin and resistance to resistance leptin and insulin Mediterranean: -4.6 kg Low-carbohydrate: -5.5 kg 1. Increased food “Brain can’t tell how intake much fat is stored, how much food is Partial rebound and plateau 2. Weight gain eaten” Weight Loss Maintenance 6 months 18 months 1.Reduced sense of satiety © 2007 Louis J. Aronne, MD 2. Craving Wang J, Diabetes, 2001 DiMarzo V pers comm Ozcan L, et al, Cell Metabolism; 2009 19 Shai I, et al. N Engl J Med. 2008;359:229-241. 21 14% Weight Loss Produced Changes in OK, Great, Now What? 8 Hormones That Encourage Weight Regain Mean fasting and postprandial levels of some peripheral signals at baseline and 62 weeks 15% Weight Loss •What do I do for my patients Reduced: Increased: Leptin - 65% Ghrelin until we have better Peptide YY Pancreatic polypeptide Cholecystokinin Gastric inhibitory polypeptide treatments! Insulin Amylin Measures of appetite 10-week, lifestyle-based weight loss intervention in healthy overweight and obese adults (n=34) led to sustained elevations in appetite stimulating hormone(s) and decreases in appetite suppressing hormones NET RESULT OF THESE HORMONAL CHANGES is WEIGHT GAIN! Sumithran P et al. N Engl J Med. 2011;365:1597-1604. 28 What’s the best diet for my patients? Primary Prevention of Cardiovascular Disease with a Mediterranean Diet • 7447 persons were enrolled (55-80 years); 57% were women. • Med Diet /Extra Virgin Olive oil – I L/week •No diet is “The Best” • Med Diet /Nuts – 1 oz/day • Control Diet - Low Fat • We favor low glycemic, Mediterranean diet – Appears to improve compliance – Reduces CV risk Event Rate Years Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events. 30 Estruch R, et al, N Engl J Med. 2013 Apr 4;368(14):1279-90. 31 Eat Vegetables and Protein Before Carbs The Order in Which Food is Consumed Impacts Post-prandial Glycemia Bread first Vegs and chicken 15 min later Vegs and chicken first Bread 15 min This finding and many others fit with our clinical experience. later A low glycemic diet reduces food intake in many people by reducing the urge to eat later in the day. A high glycemic breakfast may make some people hungrier. 32 Shukla AP, Iliescu RG, Thomas CE, Aronne LJ. Diabetes Care. 2015 Jul;38(7):e98-9. 33 Treatment Gap in Mid-BMI Range Current Treatments: Efficacy and Risks New drugs and devices can reduce weight and weight-related comorbidities Lower Risk Diets VLCD Pharma Diet and Lifestyle Sleeve gastrectomy & Drugs Lower Efficacy Devices Higher Efficacy prior to 2012 • Orlistat Gastric • Phentermine Lap Band Bypass BPD Lap band Sleeve NOT TOO EFFECTIVE Treatment RISKY Roux- enough for en-Y for many many Bypass people Gap people BPD- 0% 5% 10% 15% 20% 25% 30% 35% DS Weight Loss Higher Risk After Aronne L. FDA VI-0521 EMDAC 2010. 39 J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2985-3023. 40 Before You Prescribe, Insert, or Cut: Presentation Medications Can Cause Weight Gain Case Study • 69-year-old M with: 2 • Psychotropic medications • Diabetes medications • Obesity (BMI 35.7 kg/m ) • DM2 (HA1c 6.2) – Tricyclic antidepressants – Insulin • HTN – Monoamine oxidase inhibitors – Sulfonylureas – Specific SSRIs – Thiazolidinediones • S/p lap band 10 years ago – Lithium • -adrenergic receptor – Regained all weight • Atypical antipsychotics blockers – Poor dietary compliance • Specific anticonvulsants • Steroid Hormones • Medications: • Highly active antiretroviral – Glucocorticoids – Pioglitazone 45 mg daily therapy – Progestational steroids – Metformin 500 mg daily • Antihistamines Patient AC – Lisinopril 40 mg daily Weight Regain – Fenofibrate 145 mg daily s/p Lap Band – Ezetimibe simvastatin10-10 mg daily Apovian CM, Aronne LJ, Bessesen D et al. J Clin Endocrinol Metab. 2015;100:342-362. 43
Load more

Recommended publications
  • Management of Side Effects of Antipsychotics
    Management of side effects of antipsychotics Oliver Freudenreich, MD, FACLP Co-Director, MGH Schizophrenia Program www.mghcme.org Disclosures I have the following relevant financial relationship with a commercial interest to disclose (recipient SELF; content SCHIZOPHRENIA): • Alkermes – Consultant honoraria (Advisory Board) • Avanir – Research grant (to institution) • Janssen – Research grant (to institution), consultant honoraria (Advisory Board) • Neurocrine – Consultant honoraria (Advisory Board) • Novartis – Consultant honoraria • Otsuka – Research grant (to institution) • Roche – Consultant honoraria • Saladax – Research grant (to institution) • Elsevier – Honoraria (medical editing) • Global Medical Education – Honoraria (CME speaker and content developer) • Medscape – Honoraria (CME speaker) • Wolters-Kluwer – Royalties (content developer) • UpToDate – Royalties, honoraria (content developer and editor) • American Psychiatric Association – Consultant honoraria (SMI Adviser) www.mghcme.org Outline • Antipsychotic side effect summary • Critical side effect management – NMS – Cardiac side effects – Gastrointestinal side effects – Clozapine black box warnings • Routine side effect management – Metabolic side effects – Motor side effects – Prolactin elevation • The man-in-the-arena algorithm www.mghcme.org Receptor profile and side effects • Alpha-1 – Hypotension: slow titration • Dopamine-2 – Dystonia: prophylactic anticholinergic – Akathisia, parkinsonism, tardive dyskinesia – Hyperprolactinemia • Histamine-1 – Sedation – Weight gain
    [Show full text]
  • Consensus BASO 2020 Een Praktische Gids Voor De Evaluatie En Behandeling Van Overgewicht En Obesitas
    Consensus BASO 2020 Een praktische gids voor de evaluatie en behandeling van overgewicht en obesitas Belgian Association for the Study of Obesity 1 BASO - Redactiecomité Prof. Dr. Bart Van der Schueren (endocrinoloog, KUL) Prof. Dr. Jean-Paul Thissen (endocrinoloog, UCL) Marie Barea (diëtist, ULB) Prof. Dr. Matthias Lannoo (chirurgien, KUL) Prof. Dr. Inge Gies (pediatrische endocrinoloog, VUB) Prof. Dr. Roland Devlieger (gynaecoloog, KUL) Prof. Dr. Veronique Beauloye (pediatrische endocrinoloog, UCL) Barbara Lembo (psycholoog, Clairs Vallons, Ottignies-Louvain-la-Neuve) Dr. Eveline Dirinck (endocrinoloog, UZA, UAntwerpen) An Verrijken (diëtist, UZA, UAntwerpen) Prof. Dr. Dirk Vissers (kinesitherapeut, UAntwerpen). Professionele Medische schrijfondersteuning werd geboden door Sara Rubio, PhD (Modis Life Sciences). SA Novo Nordisk NV nam alle kosten voor zijn rekening die verband houden met de update van deze consensus. We danken ook alle eXperts die hun bijdrage hebben geleverd tijdens het bijwerken van deze consensus. 2 Inhoudstafel 0. Afkortingenlijst .................................................................................................................. 4 1. Hoofdstuk: “Inleiding” ....................................................................................................... 8 2. Hoofdstuk “Voedingsinterventies” .................................................................................. 33 3. Hoofdstuk: “Psychologische zorg bij de behandeling van obesitas” ............................... 46 4. Hoofdstuk: “Interventies
    [Show full text]
  • AHRQ Healthcare Horizon Scanning System – Status Update Horizon
    AHRQ Healthcare Horizon Scanning System – Status Update Horizon Scanning Status Update: April 2015 Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. HHSA290-2010-00006-C Prepared by: ECRI Institute 5200 Butler Pike Plymouth Meeting, PA 19462 April 2015 Statement of Funding and Purpose This report incorporates data collected during implementation of the Agency for Healthcare Research and Quality (AHRQ) Healthcare Horizon Scanning System by ECRI Institute under contract to AHRQ, Rockville, MD (Contract No. HHSA290-2010-00006-C). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. A novel intervention may not appear in this report simply because the System has not yet detected it. The list of novel interventions in the Horizon Scanning Status Update Report will change over time as new information is collected. This should not be construed as either endorsements or rejections of specific interventions. As topics are entered into the System, individual target technology reports are developed for those that appear to be closer to diffusion into practice in the United States. A representative from AHRQ served as a Contracting Officer’s Technical Representative and provided input during the implementation of the horizon scanning system. AHRQ did not directly participate in the horizon scanning, assessing the leads or topics, or provide opinions regarding potential impact of interventions.
    [Show full text]
  • Obesity Management Fundamentals: Essential Clinical Tools
    Obesity Management Fundamentals: Essential Clinical Tools Supported by an educational grant from Novo Nordisk, Inc. Table of Contents Complete Weight History .....3 OPQRST Sample Questions ..... 5 Evaluating Weight-Related Complications ..... 6 Adult Binge Eating Disorder Screener ..... 11 Assessing Readiness for Physical Activity ..... 13 Types of Eating Plans and Meal Patterns .....16 Carbohydrate-Restricted .....17 Calorie-Restricted ..... 18 Fat-Restricted ..... 19 Meal Pattern ..... 20 Time-Restricted ..... 23 Medication Tables ..... 26 TOS Obesity Patient Ad Series ..... 29 OBESITY MANAGEMENT FUNDAMENTALS: Essential Clinical Tools | 2 A Complete Weight History A complete weight history includes: • Personal weight history. • Family weight history. • Nutrition history. • History of obesogenic medications. Personal Weight History The personal weight history includes the patient’s highest weight, the patient’s attempts at weight loss (successes) and how the patient lost weight. The patient should also be asked about any previous use of anti-obesity medications and any herbal or over-the-counter weight loss supplements. Family History The family history should include not only a history of family members who have had overweight or obesity but also family members who have had weight-associated diseases. A focused family history may look like the following. Does anyone in your family have a history of… • Overweight or obesity? • Diabetes? • Coronary heart disease? • Hypertension? • Dyslipidemia? • Cancers? • Genetic disorders? Nutrition History The nutrition history can help clinicians pinpoint both positive and problematic eating patterns, learn about the patient’s food preferences and identify challenges. The nutrition history can also be used to ask about the patient’s access to healthy, affordable food. OBESITY MANAGEMENT FUNDAMENTALS: Essential Clinical Tools | 3 Eating History Tools History Advantages Disadvantages • Detailed intake data.
    [Show full text]
  • Intensification of Treatment: Pharmacotherapy for Obesity
    9/17/20 Intensification of Treatment: Pharmacotherapy for Obesity Angela Golden, DNP, FNP-C, FAANP SCOPE certified OMA Advanced Certificate of Education in Obesity Medicine Owner and Provider at NP Obesity Treatment Center 1 Disclosures Disclosures • Related to Obesity – Novo Nordisk: Speakers bureau and Consultant – Unjury, Consultant • Other – Takeda/Lundbeck: Speakers bureau – Sanofi: Diabetes 2 Objectives • Evaluate evidence-based guidelines for pharmacologic management of chronic disease of obesity • Identify available pharmacotherapeutics that can be utilized to support treatment of chronic disease of obesity 3 1 9/17/20 Pharmacologic Therapy Therapy Options, Factors to Consider When Selecting Therapy, and Efficacy/Safety Evidence 4 Therapeutic Goals Reduce obesity- Weight loss of Improve patient associated 5%-10% of body complications health and weight quality of life within 6 months Reduces CVD risk Reduces sleep factors apnea, depression Prevents/delays T2DM Improves physical Improves osteoarthritis function Jensen MD, et al. Circulation 2014;129:S102-S138; Garvey WT, et al. EnDocr Pract 2016;22 Suppl 3:1-203.; Yanovski SZ, et al. JAMA 2014;311:74-86; Apovian CM, et al. J Clin EnDocrinol Metab 2015;100:342-62 5 FDA-Approved Short-Term (Anti) Obesity Therapies Generic Drug* Dose Contraindications Side Effects Phentermine 8mg-37.5mg Anxiety disorder, Insomnia, palpitations, CVD, hypertension, tachycardia, dry mouth, Diethylpropion 25 mg or 75 MAO inhibitors, taste alterations, mg, SR glaucoma, dizziness, tremors, Phendimetrazine 17.5-70 mg or hyperthyroidism, headache, diarrhea, 105 mg, SR seizures, pregnancy/ constipation, vomiting, Benzphetamine 25-50 mg breastfeeding, drug gastrointestinal distress, abuse history anxiety, restlessness, increased blood pressure https://dailymed.nlm.nih.gov/dailymed/index.cfm; Bray GA, et al.
    [Show full text]
  • 4 September 2020 Puretech Health Plc Puretech Founded Entity
    RNS Number : 0122Y PureTech Health PLC 04 September 2020 4 September 2020 PureTech Health plc PureTech Founded Entity Gelesis Presents Plenity® Efficacy and Safety Data at the European and International Congress on Obesity 2020 Subgroup analysis showed adults reaching BMI <27 kg/m2 on average lost 13.5% of total body weight during the trial Plenity (Gelesis100) is an orally administered, non-stimulant, non-systemic aid in weight management based on proprietary hydrogel technology with a highly favourable safety and efficacy profile demonstrated in clinical studies Plenity is currently available in the US in limited release with a full launch in 2021 PureTech Health plc (LSE: PRTC) ("PureTech" or the "Company"), a clinical-stage biotherapeutics company dedicated to discovering, developing and commercialising highly differentiated medicines for devastating diseases, is pleased to note that its Founded Entity, Gelesis, today announced it will deliver one oral presentation and two poster presentations showcasing notable efficacy data for Plenity® (Gelesis100) at the European and International Congress on Obesity (ECO-ICO 2020). The notable data to be presented in the oral presentation are from a subgroup analysis from GLOW, a pivotal weight loss study, assessing the safety and efficacy of Plenity in study participants reaching a Body Mass Index (BMI) of <27 kg/m². The mean BMI at baseline for this Plenity-treated subgroup was 29.9 +/- 1.56 SD. Within this subgroup, adults treated with Plenity, on average, lost 13.5% of their total body weight during the trial with the rate of weight loss tapering as participants approached a healthy BMI. After achieving a BMI of <27 kg/m², participants continued Plenity treatment for an average of 60 days.
    [Show full text]
  • Orexigen Therapeutics Outlook
    Orexigen Therapeutics Outlook Contrave continues rebound Pharma & biotech 16 June 2017 Orexigen’s consumer-focused re-launch of Contrave continues to be successful with a 39% increase in prescriptions in the United States in Price US$2.84 Q117 compared to Q416. Outside of the US, progress continues as the Market cap US$43m product has launched in 14 countries, with another seven expected by the end of the year, including the Nordic countries, where Orexigen has just Net debt ($m), including restricted, 51 signed a local commercial and distribution partner. at 31 March 2017 Shares in issue 15.2m Year Revenue PBT* EPS* DPS P/E Yield Free float 64.8% end ($m) ($m) ($) ($) (x) (%) 12/15 24.5 (67.3) (5.24) 0.0 N/A N/A Code OREX 12/16 33.7 (138.1) (9.73) 0.0 N/A N/A Primary exchange NASDAQ 12/17e 87.3 (139.2) (8.23) 0.0 N/A N/A 12/18e 160.3 (75.5) (4.86) 0.0 N/A N/A Secondary exchange N/A Note: *PBT and EPS are normalised, excluding amortisation of acquired intangibles, Share price performance exceptional items and share-based payments. Successful patient-centric campaign A shift from previous partner Takeda’s healthcare provider-focused marketing to a campaign focused on consumers (but with continued detailing of high prescribing physicians) has yielded a dramatic increase in prescriptions. Prescriptions increased 39% in Q117 versus Q416 and they now have approximately 50% of the branded obesity market (~8% of the total) according to Symphony Health.
    [Show full text]
  • Obesity Is the Single Greatest Threat to Public Health for This Century
    Faculty Affiliation Enhancing the Patient-Provider Connection: Practical Strategies for Improving Outcomes Colleen M. Fairbanks, PhD in Obesity Management Licensed Clinical Health Psychologist Provided by Integrity Continuing Education, Inc. Supported by an educational grant from Novo Nordisk Inc. 1 2 Faculty Disclosures Learning Objectives Dr. Fairbanks has no conflicts of interest to disclose. Analyze regional and ethnic disparities in obesity . Address patients with obesity with sensitivity and a greater understanding of this disorder’s causes, challenges, and treatments . Apply current practice guidelines to optimize screening, diagnosis, and treatment . Implement proven communication strategies, such as The 5 A’s of Obesity Counseling, to effectively engage patients in weight loss discussion . Evaluate the efficacy and safety of available and emerging pharmacologic therapies for weight loss 3 4 Obesity is the single greatest threat to public health for this century Obesity Prevalence and Impact —US Department of Agriculture and US Department of Health and Human Services U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition. 5 Washington, DC: U.S. Government Printing Offices; 2010. 6 1 Overweight/Obesity Classifications Obesity in America: 2011 NIH Guidelines for Identifying Obesity Class in Adults1 BMI for Asian Category BMI Class Populations Overweight 25.0–29.9 Prevalence of 30.0–34.9 I Epidemiologic data Obesity indicate people of obesity, by 35.0–39.9 II Asian descent are at state, in 2011, Extreme obesity* ≥40 III risk for T2DM at lower according to BMI ranges.3,4 Obesity Definitions in Children/Adolescents2 the CDC’s Lower BMI cutpoints BRFSS Sex-specific BMI for age at or above _____ are recommended for of CDC growth charts Asian Americans: .
    [Show full text]
  • A Novel Nonsystemic Oral Hydrogel for Weight Loss Frank L
    Original Article Obesity CLINICAL TRIALS AND INVESTIGATIONS A Randomized, Double-Blind, Placebo-Controlled Study of Gelesis100: A Novel Nonsystemic Oral Hydrogel for Weight Loss Frank L. Greenway1 , Louis J. Aronne2, Anne Raben3, Arne Astrup3, Caroline M. Apovian4, James O. Hill5, Lee M. Kaplan6, Ken Fujioka7, Erika Matejkova8, Stepan Svacina9, Livio Luzi10, Lucio Gnessi11, Santiago Navas-Carretero12, J. Alfredo Martinez12,13, Christopher D. Still14, Alessandro Sannino15, Cosimo Saponaro15, Christian Demitri15, Lorien E. Urban15, Harry Leider15, Elaine Chiquette15, Eyal S. Ron15, Yishai Zohar15, and Hassan M. Heshmati15 Objective: This study aims to assess the efficacy and safety of Gelesis100, a novel, nonsystemic, superabsorbent hydrogel to treat overweight or obesity. Methods: The Gelesis Loss Of Weight (GLOW) study was a 24-week, multicenter, randomized, double- blind, placebo-controlled study in patients with BMI ≥ 27 and ≤ 40 kg/m2 and fasting plasma glucose ≥ 90 and ≤ 145 mg/dL. The co-primary end points were placebo-adjusted weight loss (superiority and 3% margin super-superiority) and at least 35% of patients in the Gelesis100 group achieving ≥ 5% weight loss. Results: Gelesis100 treatment caused greater weight loss over placebo (6.4% vs. 4.4%, P = 0.0007), achieving 2.1% superiority but not 3% super-superiority. Importantly, 59% of Gelesis100-treated patients achieved weight loss of ≥ 5%, and 27% achieved ≥ 10% versus 42% and 15% in the placebo group, respectively. Gelesis100-treated patients had twice the odds of achieving ≥ 5% and ≥ 10% weight loss versus placebo (adjusted OR: 2.0, P = 0.0008; OR: 2.1, P = 0.0107, respectively), with 5% responders having a mean weight loss of 10.2%.
    [Show full text]
  • FDA Decision Time Looms for Gelesis
    November 29, 2018 FDA decision time looms for Gelesis Elizabeth Cairns Gelesis’s weight-loss capsule only hit one of the two co-primary endpoints in its approval trial. Will the FDA be persuaded? When its obesity therapy, Gelesis100, fell short of a prespecified weight loss superiority margin over placebo in its pivotal US trial, Gelesis was able to point to a hit on the other endpoint. More patients given the product, a capsule containing a cellulose-based hydrogel which expands in the stomach, achieved the loss of 5% of their bodyweight than those in the placebo group. “You do not have to have success on both endpoints for the FDA to approve a device,” says Harry Leider, chief medical officer at Gelesis. “Other drugs, in addition to devices, have been approved on the basis of success of one endpoint.” The marketing application is filed with the FDA, so the group will find out next year whether these data are in fact good enough. Six-month data from the Glow trial showed that in the intent-to-treat population, 59% of Gelesis100-treated adults achieved weight loss of at least 5% vs. 42% in the placebo group – a success on the second co-primary endpoint. But the first, placebo-adjusted weight loss with a super-superiority margin of 3%, was not hit; the Gelesis100 treatment caused greater weight loss over placebo, but the margin was 2.1%. Placebo Mr Leider ascribes the miss on the placebo-adjusted weight loss metric to an unexpectedly high placebo response rate. “When you look at the drug studies, the percentage of patients that achieve 5% weight loss on placebo is about 20%.
    [Show full text]
  • 8. OBESITY MANAGEMENT for the TREATMENT of TYPE 2 DIABETES Treatment of Type 2 Diabetes (6–17)
    S100 Diabetes Care Volume 44, Supplement 1, January 2021 8. Obesity Management for the American Diabetes Association Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetesd2021 Diabetes Care 2021;44(Suppl. 1):S100–S110 | https://doi.org/10.2337/dc21-S008 The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guide- lines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10 .2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to com- ment on the Standards of Care are invited to do so at professional.diabetes.org/ SOC. There is strong and consistent evidence that obesity management can delay the progression from prediabetes to type 2 diabetes (1–5) and is highly beneficial in the 8. OBESITY MANAGEMENT FOR THE TREATMENT OF TYPE 2 DIABETES treatment of type 2 diabetes (6–17). In patients with type 2 diabetes who also have overweight or obesity, modest and sustained weight loss has been shown to improve glycemic control and reduce the need for glucose-lowering medications (6–8). Several studies have demonstrated that in patients with type 2 diabetes and obesity, more intensive dietary energy restriction with very-low-calorie diets can substantially reduce A1C and fasting glucose and promote sustained diabetes remission through at least 2 years (10,18–21).
    [Show full text]
  • “Eat Less, Move More”— We Know It's Not That Simple
    “Eat Less, Move More”— We Know it’s Not that Simple: Finding Your Evidence-based Approach Christopher D. Still, DO, FACP, FTOS Professor of Medicine Department of Clinical Sciences Geisinger Commonwealth School of Medicine Medical Director, Center for Nutrition & Weight Management Director, Geisinger Obesity Institute Geisinger Health System July 18, 2020 Disclosures: Speaker Bureau/Consultant . Novo Nordisk Investigator-initiated Research . Ethicon-Endosurgery 2 Components of an Effective Obesity Management Program Surgery or Medications Behavior Modification Healthy Physical Eating Activity Pattern Wadden TA, Foster GD. Behavioral treatment of obesity. Med Clin North Am. 2000;84:441-461. Stumbo, PH, et. al. Dietary and medical therapy of obesity. Surg Clin N Am 85(2005)703-723. 3 Benefits of Modest Weight Loss Greater Benefits with Greater Weight Loss Measures of glycemia1 -3% Triglycerides1 HDL cholesterol1 Systolic and diastolic blood pressure Hepatic steatosis measured by MRS2 Measures of feeling and function: -5% Symptoms of urinary stress incontinence3 Measures of sexual function4,5 Quality of life measures(IWQOL)6 NASH Activity Score measured on biopsy7 -10% Apnea-hypopnea index8 Reduction in CV events, mortality, remission of T2DM -15% 1. Wing et al. Diabetes Care 2011;34:81-1486. 2. Lazo et al. Diabetes Care 2010;33:2156–63.3. Phelan et al. Urol. 2012;187:939-44. 4. Wing et al. Diab Care 2013;36:2937-44. 5. Wing et al. Journal of Sexual Medicine 2010 ; 7:156-65. 6. Crosby, Manual for the IWQOL-LITE Measure. 7. Promrat et al. Hepatology 2010;51:121–29. 8. Foster et al. Arch Intern Med 2009;169:1619–26.
    [Show full text]