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Content Update

August 12, 2019

Oral, Nonsystemic Hydrogel Approved for Weight Management in Adults: In April 2019, the U.S. Food and Drug Administration (FDA) approved a first-in-class oral, nonsystemic, superabsorbent hydrogel (Plenity) to aid in weight management in overweight and obese adults. The product is classified as a device (not a drug) and was shown to be safe and effective when used in combination with diet and exercise, resulting in significantly greater weight loss vs. placebo in patients with and without type 2 diabetes. The incidence of adverse events in the treatment group was no different from placebo. Plenity is the only prescription product to be approved for weight management in adults with a BMI as low as 25 kg/m2, and there is no restriction on its duration of use.

LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Explain the underlying causes of overweight and obesity.

  2. Identify parameters used to diagnose obesity and indicate the severity of disease.

  3. Identify desired therapeutic goals for patients with obesity.

  4. Recommend appropriate nonpharmacologic and pharmacologic therapeutic interventions for overweight or obese patients.

  5. Implement a monitoring plan that will assess both the efficacy and safety of therapy initiated.

  6. Educate patients about the disease state and associated risks, comprehensive lifestyle interventions, drug therapy, and surgical options necessary for effective treatment.

INTRODUCTION

Overweight and obesity are terms used to describe weight measurements greater than what is considered healthy for a given height.1 image Body mass index (BMI), waist circumference (WC), comorbidities, and readiness to lose weight are used in the assessment of overweight or obese patients. BMI should be used to identify adults at increased risk for cardiovascular disease (CVD) and other obesity-related disorders. Evaluation of the patient’s risk status involves not only calculation of the BMI but also the measurement of WC. image The presence of comorbidities (CVD, type 2 diabetes mellitus, and sleep apnea) and cardiovascular risk factors (cigarette smoking, hypertension, elevated low-density lipoprotein cholesterol, low high-density lipoprotein cholesterol, impaired fasting glucose) requires identification and aggressive management for overall effective treatment of the overweight or obese patient to reduce their risk of mortality. 2 Obesity contributes to some of the leading causes of preventable death including hypertension, dyslipidemia, diabetes mellitus, CVD, stroke, sleep apnea, gallbladder disease, osteoarthritis, and certain cancers.2 Obesity is officially recognized as a disease by the American Medical Association with a pathophysiological basis for metabolic and biochemical dysfunctions.

ETIOLOGY AND EPIDEMIOLOGY

Obesity is a multifactorial, complex disease that occurs because of an interaction between genotype and the environment. Although the etiology is not completely known, it involves overlapping silos of social, behavioral, hormonal, and genetic influence.3 The majority of overweight or ...

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