COVID-19 remains center stage, and efforts to contain it endanger our focus on other conditions, including obesity, which is known to lead to many serious, life-threatening co-morbidities.

• Obesity is defined by a BMI of ≥30Kg/m² and abdominal obesity is defined by a waist circumference of ≥40 in. for men and ≥35 in. for women. Both BMI and waist circumference may vary according to racial norms.
• 33% of adults and 17% of adolescents and children in the US are clinically obese.
• Causative factors include genetic inheritance, culture and environment, socioeconomic status, some medications, and long illness or injury recuperations, among others.
• Diet and exercise are essential components of treatment:

• • • Caloric intake of 1000-1200 kcal/day for women and 1200-1500 kcal/day for men
    • Initially, a low carbohydrate diet, followed at about 6 months with a high protein/low carbohydrate diet
    • Activity: 30 minutes a day, 5 days a week. Moderate activity such as walking, bicycling on level ground, and swimming are recommended, with level of difficulty and duration increased as tolerated

• Adjunct psychological therapies, either web-based or in-office consultations can be effective in treating causes and challenges of an obesity diagnosis
• Medications that have been shown to be effective are:

• • • Orlistat, 60 mg PO TID
    • Phentermine/topiramate combination, initial 14-day dose 3.75 mg (phentermine)/23 mg (topiramate)PO QD, then 7.5 mg/46 mg PO QD for 12 weeks. If weight loss is ≤3% of baseline, discontinue or escalate as follows:
      • • 11.25 mg/69 mg PO QD x14 days, then 15 mg/92 mg PO QD for 10 more weeks. If     weight loss is ≤5% after 12 weeks, discontinue.
        • Maintenance dose is 7.5mg Phentermine/46 mg Topiramate or 15 mg/92 mg PO QD
    • Liraglutide: escalated doses initially 0.6 mg SQ QD; add 0.6 mg weekly until the maintenance dose of 3 mg SQ QD is reached
    • Naltrexone/bupropion HCl combination: 8 mg (naltrexone)/90 mg (bupropion) PO QD initially, increased to maintenance dose of 16MG/180 mg BID

• Surgery or balloon insertion are appropriate for patients with BMI ≥ 40 and for those with BMI ≥ 35 with co-morbidities.

 

For more information:

https://www.aace.com/files/obesity/final-appendix.pdf

https://www.rethinkobesity.com/pdfs/aace-guidelines-brochure.html

https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

https://www.nhlbi.nih.gov/health-pro/guidelines/current/obesity-guidelines/e_textbook/txgd/4142.htm