Treatment of Obesity in Patients With Diabetes
Article Figures & Tables
Tables
- TABLE 1.
Weight-Related Complications Caused/Exacerbated by Excess Adiposity (2)
• Elevated blood pressure • Reactive airway disease • Hypertriglyceridemia • Nonalcoholic fatty liver disease • Hypercholesterolemia • Gastroesophageal reflux disease • Decreased HDL cholesterol • Male hypogonadism • Osteoarthritis • Female infertility • Depression • Polycystic ovary disease • Sleep apnea • Stress urinary incontinence - TABLE 2.
The 5 A’s Model for Behavior Change and Its Use for Weight Management in Practice (22)
1. Assess • Assess patients for obesity or overweight with metabolic risk factors • Assess for patients’ readiness and ability to make change at this time 2. Advise • Advise patients about the increased risks of cardiovascular disease with excess adiposity • Advise patients of the health benefits of weight loss and lifestyle change 3. Agree • Agree with patients on a quantifiable and achievable weight loss goal that will lead to health benefits (i.e., a goal of losing 5% of initial body weight in 6 months) 4. Assist • Assist patients in defining a weight management strategy (i.e., practice-based weight loss counseling vs. referral to a weight loss program) 5. Arrange • Arrange follow-up to create a structure for accountability and feedback on progress - TABLE 3.
Common Commercial Weight Loss Programs’ Weight Loss and Glycemic Outcomes In RCTs
Time Point Mean Weight Loss at Time Point (kg) RCTs Conducted in Patients With Diabetes? A1C Change at Time Point (%) Patients Who Reduced Diabetes Medications at Time Point (%) Weight Watchers 12 Months –3.0 to – 9.1 No — — Jenny Craig 12 Months –6.6 to –10.1 Yes –0.3 to –0.7 30–39 (oral); 63–90 (insulin) Nutrisystem 6 Months –7.3 to –10.8 Yes –0.7 28 (all medications) - TABLE 4.
Eating Patterns With Equivalent Effects on Weight Loss (2)
• Low glycemic index/load • Low carbohydrate • High protein • Moderate carbohydrate–moderate protein • Low fat • Mediterranean style - TABLE 5.
Medications Approved by the FDA for Long-Term Use for Weight Management
Medication (Trade Names) Mechanism of Action Five Most Common Side Effects Possible Safety Concerns* Mean 1-Year Weight Loss Compared to Placebo (Dose) A1C Change in Patients With Diabetes (%) Decreases absorption Orlistat (Alli, Xenical) Lipase inhibitor Abdominal pain, flatulence, fecal urgency, back pain, and headache Fat-soluble vitamin deficiencies, altered absorption of medications, cholelithiasis, nephrolithiasis 3.4 kg, 4.0% (120 mg TID) –0.7 Suppresses appetite Lorcaserin (Belviq) Serotonin receptor agonist Headache, nausea, dizziness, fatigue, and nasopharyngitis Serotonin syndrome, hypertension, edema, avoid in liver and renal failure 3.3 kg, 3.6% (10 mg BID) –1.1† Phentermine/Topiramate (Qsymia) Norepinephrine release, GABA receptor modulation Constipation, paresthesia, insomnia, nasopharyngitis, and xerostomia Birth defects, cognitive impairment, acute angle-closure glaucoma, lactic acidosis with metformin, avoid in renal failure 6.7 kg, 6.6% (7.5/46 mg daily) 8.9 kg, 9.0% (15/92 mg daily) –0.4 Naltrexone/Bupropion (Contrave) Opiate antagonist, decreased re-uptake of norepinephrine Constipation, nausea, headache, xerostomia, and insomnia Depression, anxiety, acute angle-closure glaucoma, avoid in patients with uncontrolled hypertension and renal failure 4.1 kg, 5.2% (16/80 mg BID) –0.6 Liraglutide (Saxenda) GLP-1 receptor agonist Hypoglycemia, constipation, nausea, headache, and indigestion Gastroparesis, suicidal ideation, increased heart rate, caution in pancreatitis and cholelithiasis 4.5 kg, 5.6% (3 mg daily) –0.6 to –1.8 ↵* A comprehensive list of safety concerns can be found in each medication’s package insert, which is available from the manufacturing pharmaceutical company.
↵† A1C change has only been assessed in patients with prediabetes (66).
BID, twice daily; GABA, gamma-aminobutyric acid; TID, three times daily.
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November 2017, 30(4)
