R2 Talk: Dr. Wendy Liu

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* Losing weight likely has cardiovascular and mortality benefit, but main proven benefit is in reducing incidence and prevalence of development of diabetes

* Growing epidemic: more than 1/3 of US adults are obese (BMI >30)

* Obesity should be viewed as a chronic, relapsing multifactorial disease

Initial Approach

* Goal is 5-10% weight loss in 6 months

o Based on expert opinion due to 1) Attainable 2) Studies showing metabolic benefit

* Shifting paradigm: focusing on health goals and primary prevention of disease, not just reducing weight and BMI

* No one size fits all approach, but boils down to reducing calories in whatever way works for the patient

o Ie portion control, intermittent fasting, any of the studied diets (Mediterranean, vegetarian, etc.), meal replacements, etc.

* It’s important to monitor progress and associated behavioral changes with real-time progress

o Promotes mindfulness and reflection

o Ie with MyFitnessPal or LoseIt apps

* Where do we get most of this evidence from? Look AHEAD study

* Where does exercise play into this?

o If we’re going to focus on health, low fitness independent predictor of mortality regardless of BMI

o But also it’s an adjunct to help patients lose weight and helps people maintain weight loss

Next Steps

* Community resources

o Weight loss clinic (endocrine, GI, Dr. White)

o UIHC LiveWell program

o Nutritionists (UIHC, HyVee)

* Consider medications if patient’s struggling despite all of above

* FDA approved weight loss medications:

o New kid on the block is semaglutide: once weekly inj, appears most effective one

* Not yet FDA approved

o For patients with BMI >30 or >27 with co-morbidities

o Follow-up in 3 months to determine effectiveness (5% weight loss in 3 months) and monitor for side effects

* Continue meds indefinitely if they’re working and patient tolerating well

* Can try to titrate patients off if they’re doing well

* Try alternative strategy / meds if not

* Consider bariatric surgery if patient’s BMI >40 or >35 with co-morbidities (DM, HLD)

o 40-70% weight loss and patients tend to maintain weight loss

o This is the best medicine has to offer for patients who want to lose weight

Works Cited

Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A., . . . Yanovski, S. Z. (2013). 2013 aha/acc/tos guideline for the management of overweight and obesity in adults. Circulation, 129(25 suppl 2). doi:10.1161/01.cir.0000437739.71477.ee

Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. (2002). New England Journal of Medicine, 346(6), 393-403. doi:10.1056/nejmoa012512

Wadden, T. A., Webb, V. L., Moran, C. H., & Bailer, B. A. (2012). Lifestyle modification for obesity. Circulation, 125(9), 1157-1170. doi:10.1161/circulationaha.111.039453

Wilding, J. P., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., . . . Kushner, R. F. (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine. doi:10.1056/nejmoa2032183

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