Treating Obesity: Maintaining a Healthy Weight

Saturday, March 19 at 8:35 am

NEW ORLEANS—For individuals who are obese, losing weight and keeping it off is a struggle, but Dr. Timothy Garvey explained how physicians can help their patients lose weight for good.

W. Timothy Garvey, MD, is the Butterworth Professor and Chair of the Department of Nutrition Sciences at the University of Alabama at Birmingham; Director of the UAB Diabetes Research Center at GRECC; and Investigator and Staff Physician at Birmingham VA Medical Center in Alabama.

In his session, “How Success Should Be Defined in Treating Obesity: Managing Patient Expectations,” Garvey discussed the pathophysiology of obesity as a disease that results in excess adiposity and weight-related complications; defined the principles of a complications-centric approach to weight loss therapy and the need to harmonize treatment goals between health care professional and patient; and assessed rationale, effectiveness, and safety of lifestyle/behavior therapy and weight loss medications in achieving treatment goals.

Garvey also explained the causes and life-threatening complications of obesity and what body mass index (BMI) scores fall into each category: normal (18.5-24.9), overweight (25.0-29.9), obesity class 1 (30.0-34.9), obesity class 2 (35.0-39.9), obesity class 3 (severe, 40.0 or more).

To treat obesity, Garvey said physicians must know when to prescribe lifestyle interventions, medications, and bariatric surgery.

According to Garvey, lifestyle intervention, including diet and exercise, are recommended for obese individuals at any age, but those aged 27 to 30 who have comorbidities can be prescribed pharmacotherapy. Pharmacotherapy can also be prescribed as a supplement to diet and exercise for those aged 30 years and older. However, bariatric surgery is only recommended for those aged 40 years or older with a BMI of 30 or more and a weight-related medical condition.

There are 5 approved medications for treating obesity: orlistat, lorcaserin, phentermine and topiramate, buproprion and naltrexone, and liraglutide. Garvey said that the key to properly treating patients is to balance efficacy, safety, and cost.

“Clinicians should consider differences in efficacy, side effects, cautions, and warnings that characterize the 5 drugs approved for chronic management of obesity, as well as the presence of weight-related complications and medical history,” Garvey said. “Each weight-loss medication has its own side effect profile and potential for adverse reactions. For this reason, benefits and risks must be considered, and the clinician must individualize therapy based on each patient’s unique presentation.”

—Amanda Balbi