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Content Update
June 17, 2022
FDA Approves Wegovy (semaglutide) for Chronic Weight Management in Adults: In June 2021, the U.S. Food and Drug Administration approved Wegovy™ (semaglutide), a glucagon-like peptide-1 (GLP-1) receptor agonist, as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with either body mass index (BMI) ≥ 27 and at least one weight-related comorbidity (e.g., cardiovascular disease, dyslipidemia, hypertension, obstructive sleep apnea), or BMI of ≥ 30. This once weekly, under-the-skin injection, is the first drug approved for chronic weight management in adults with general obesity or overweight since 2014. Nausea, vomiting, and diarrhea are the most common adverse reactions leading to discontinuation. Semaglutide has not been compared directly with other agents, so further study is necessary to determine where it will fit into therapy.
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LEARNING OBJECTIVES
Upon completion of the chapter, the reader will be able to:
Explain the underlying causes of overweight and obesity.
Identify parameters used to diagnose obesity and indicate the severity of disease.
Identify desired therapeutic goals for patients with obesity.
Recommend appropriate nonpharmacologic and pharmacologic therapeutic interventions for overweight or obese patients.
Implement a monitoring plan that will assess both the efficacy and safety of therapy initiated.
Educate patients about the disease state and associated risks, comprehensive lifestyle interventions, drug therapy, and surgical options necessary for effective treatment.
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Overweight and obesity are terms used to describe weight measurements greater than what is considered healthy for a given height.1 
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 waist circumference. 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. 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.
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ETIOLOGY AND EPIDEMIOLOGY
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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 obese individuals are ...