Clinical Guidelines of Treatment of Obesity in Adults

Yong-Woo Park

doi:10.5124/jkma.2003.46.4.345

J Korean Med Assoc > Volume 46(4); 2003 > Article

Park: Clinical Guidelines of Treatment of Obesity in Adults

Continuing Education Column

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2003; 46(4): 345-356.

Published online: April 30, 2003

DOI: http://dx.doi.org/10.5124/jkma.2003.46.4.345

Clinical Guidelines of Treatment of Obesity in Adults

Yong-Woo Park, M.D.

Department of Family Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Korea. ywoopark@samsung.co.kr

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Obesity increases the risk of serious medical conditions such as type 2 diabetes and coronary heart disease. The risks associated with comorbidities can be reduced with a modest weight loss. Obesity should be recognized and treated as a chronic, progressive, and relapsing disease. The management of obesity requires a long-term approach that is tailored to an individual's lifestyle and needs. Initial treatment should focus on lifestyle changes, i.e., reduced calorie intake and increased physical activity, with behavior modification strategies. Medications may be used adjunctively. Most of FDA-approved anti-obesity drugs should be prescribed for short-term weight loss. Recently, sibutramine and orlistat were approved for long-term weight loss and maintenance. In addition to weight reduction, sibutramine and orlistat provided beneficial effects on cardiovascular risk factors in clinical trials. Several drugs, such as fluoxetine, bupropion and topiramate, approved for other uses, have shown weight loss in some clinical trials. Surgical treatment should be reserved for severely obese patients with significant medical comorbidities or physical conditions.

Obesity; Guideline; Anti-obesity drug

References

1. World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation Geneva, Switzerland: Presented at the World Health Organization ; June 3 5, 1997 ; Publication WHO/NUT/NCD/98.1.

2. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999, 2000. JAMA 2002;288:1723-1727.

3. Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obes Res 1998;6:97-106.

4. National Institutes of Health. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults The Evidence Report 1998;Bethesda, MD: National Heart, Lung, and Blood Institute. (http://www.nhlbi.nih.4.gov/guidelines/obesity/ob_home.htm)

5. Van Gaal LF, Wauters MA, De Leeus IH. The beneficial effect of modest weight loss on cardiovascular risk factors. Int J Obes Relat Metab Disord 1997;21:S5-S9.

6. Goldstein DJ. Beneficial health effects of modest weight loss. Int J Obes Relat Metab Disord 1992;16:397-415.

7. Tremblay A, Doucet E, Imbeault P, Mauriege P, Despres J-P, Richard D. Metabolic fitness in active reduced-obese individuals. Obes Res 1999;7:556-563.

8. Khan LK, Serdula MK, Bowman BA, Williamson DF. Use of prescription weight loss pills among US adults in 1996-1998. Ann Intern Med 2001;134:282-286.

9. Connolly HM, Crary JL, McGoon MD, Hensrud DD, Edwards BS, Schaff HV, et al. Valvular heart disease associated with fenfluramine-phentermine. N Engl J Med 1997;337:581-588.

12. American Dietetic Association. Position of the American Dietetic Association: weight management. J Am Diet Assoc 1997;97:71-74.

13. Moloney M. Dietary treatments of obesity. Proc Nutr Soc 2000;59:601-608.

14. Melanson KJ, Dwyer J. In: Stunkard AJ, Wadden TA, editor. Dietary treatment of obesity and overweight: popular diets. Obesity: Theory and Therapy 2000;3rd ed. New York: Raven Press Ltd.

15. Klem M, Wing R, McGuire M, Seagle H, Hill J. A descriptive study of individuals successful at long-term maintenance of substantial weight loss. Am J Clin Nutr 1997;66:239-246.

16. Katzel LI, Bleecker ER, Coleman EG, Rogus EM, Sorkin JD, Goldberg AP. Effects of weight loss vs. aerobic exercise training on risk factors for coronary disease in healthy, obese, middle-aged and older men:a randomized controlled trial. JAMA 1995;274:1915-1921.

17. Rippe JM, Price JM, Hess SA, Kline G, DeMers KA, Freedson P, et al. Improved psychological well-being, quality of life and health practices in moderately overweight women participating in a 12-week structured weight loss program. Obes Res 1998;6:208-218.

18. American College of Sports Medicine. ASCM's Guidelines for Exercise Testing and Prescription 2000;6th ed. Baltimore: Lippincott Williams Wilkins.

19. Perri MG, Nezu AM, McKelvey WF, Shermer RL, Renjilian DA, Viegener BJ. Relapse prevention training and problem-solving therapy in the long-term management of obesity. J Consult Clin Psychol 2001;69:722-726.

20. Klein S. Medical management of obesity. Surg Clin North Am 2001;81:1025-1038.

21. WHO/International Association for the Study of Obesity/International Obesity Task force. The Asia-Pacific perspective: redefining obesity and its treatment 2000.

22. Yanovski SZ, Yanovski JA. Obesity. New Engl J Med 2002;346(8):591-602.

23. Munro JF, MacCuish AC, Wilson EM, Duncan LJ. Comparison of continuous and intermittent anorectic therapy in obesity. BMJ 1968;1:352-354.

24. Cass LJ. Evaluation of phendimetrazine as an appetite suppressant. Can Med Assoc J 1961;84:1114-1116.

25. Smith IG. Randomized placebo-controlled trial of long-term treatment with sibutramine in mild to moderate obesity. J Fam Pract 2001;50:505-512.

26. Apfelbaum M, Vague P, Ziegler O, Hanotin C, Thomas F, Leutenegger E. Long-term maintenance of weight loss after a very-low-calorie diet:a randomized blinded trial of the efficacy and tolerability of sibutramine. Am J Med 1999;106:179-184.

27. James WP, Astrup A, Finer N, Hilsted J, Kopelman P, Van Gaal LF, et al. Effect of sibutramine on weight maintenance after weight loss:a randomised trial. Lancet 2000;356:2119-2125.

28. Bach DS, Rissanen AM, Mendel CM, Shepherd G, Weinstein SP, Armstrong WF, et al. Absence of cardiac valve dysfunction in obese patients treated with sibutramine. Obes Res 1999;7:363-369.

29. Levine LR, Enas GG, Thompson WL, Byyny RL, Dauer AD, McIlwain HH, et al. Use of fluoxetine, a selective serotoninuptake inhibitor, in the treatment of obesity: a doseresponse study. Int J Obes 1989;13:635-645.

30. Goldstein DJ, Rampey AH Jr, Roback PJ, Wilson MG, Hamilton SH, Tollefson GD, et al. Efficacy and safety of longterm fluoxetine treatment of obesity maximizing success. Obes Res 1995;3:Suppl 4. 481S-490S.

31. Reimherr FW, Cunningham LA, Batey SR, Johnston JA, Ascher JA. A multicenter evaluation of the efficacy and safety of 150 and 300 mg/d sustained-release bupropion tablets versus placebo in depressed outpatients. Clin Ther 1998;20:505-516.

32. Gadde KM, Parker CB, Maner LG, Wagner HR 2nd, Logue EJ, Krishnan KR, et al. Bupropion for weight loss: an investigation of efficacy and tolerability in overweight and obese women. Obes Res 2001;9:544-551.

33. Anderson JW, Greenway FL, Fujioka K, Gadde KM, McKenney J, O'Neil PM. Bupropion SR enhances weight loss:a 48-week double-blind placebo-controlled trial. Obes Res 2002;10:633-641.

34. Jain AK, Kaplan RA, Gadde KM, Wadden TA, Allison DB, Metz A, et al. Bupropion SR vs. placebo for weight loss in obese patients with depressive symptoms. Obes Res 2002;10:1049-1056.

35. Picard F, Deshaies Y, Lalonde J, Samson P, Richard D. Topiramate reduces energy and fat gains in lean and obese Zucker rats. Obes Res 2000;8:656-663.

36. Bray G, Klein S, Levy B, et al. Topiramate produces dose-related weight loss in obese patients. The American Diabetes Association Annual Meeting June 15, 2002. Abstract A 1727 - P.

37. Shapira NA, Goldsmith TD, McElroy SL. Treatment of bingeeating disorder with topiramate: a clinical case series. J Clin Psychiatry 2000;61:368-372.

38. Appolinario JC, Coutinho W, Fontenelle L. Topiramate for binge-eating disorder. Am J Psychiatry 2001;158:967-968.

39. Finer N, James WPT, Kopelman PG, Lean MEJ, Williams G. One-year treatment of obesity:a randomized, double-blind, placebo-controlled, multicentre study of orlistat, a gastrointestinal lipase inhibitor. Int J Obes Relat Metab Disord 2000;24:306-313.

40. Hauptman J, Lucas C, Boldrin MN, Collins H, Segal KR. Orlistat in the long-term treatment of obesity in primary care settings. Arch Fam Med 2000;9:160-167.

41. Hill JO, Hauptman J, Anderson JW, Fujioka K, O'Neil PM, Aronne LJ, et al. Orlistat, a lipase inhibitor, for weight maintenance after conventional dieting:a 1-y study. Am J Clin Nutr 1999;69:1108-1116.

42. Hauptman JB, Jeunet FS, Hartmann D. Initial studies in humans with the novel gastrointestinal lipase inhibitor(tetrahydrolipstatin). Am J Clin Nutr 1992;55:309S-313S.

43. Scheen AJ, Lefebvre PJ. Pharmacological treatment of obesity: present status. Int J Obes Relat Metab Disord 1999;23:Suppl 1. 47-53.

44. Astrup A, Breum L, Toubro S, Hein P, Quaade F. The effect and safety of an ephedrine/caffeine compound compared to ephedrine, caffeine and placebo in obese subjects on an energy restricted diet. A double blind trial. Int J Obes Relat Metab Disord 1992;16:269-277.

45. Boozer CN, Daly PA, Homel P, Solomon JL, Blanchard D, Meredith T, et al. Herbal ephedra/caffeine for weight loss: a 6-month randomized safety and efficacy trial. Int J Obes Relat Metab Disord 2002;26(5):593-604.

46. Daly PA, Krieger DR, Dulloo AG, Young JB, Landsberg L. Ephedrine, caffeine and aspirin:safety and efficacy for treatment of human obesity. Int J Obes Relat Metab Disord 1993;17:Suppl 1. S73-S78.

47. Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 2000;343(25):1833-1838.

48. Finer N, Bloom SR, Frost GS, Banks LM, Griffiths J. Sibutramine is effective for weight loss and diabetic control in obesity with type 2 diabetes:a randomised, double-blind, placebo-controlled study. Diabetes Obes Metab 2000;2:105-112.

49. Fujioka K, Seaton TB, Rowe E. Sibutramine improves glycemic control and other metabolic parameters in obese patients with type 2 diabetes mellitus. Diabetes Obes Metab 2000;2:175-187.

50. Hollander PA, Elbein SC, Hirsch IB, Kelley D, Hauptman J. Role of orlistat in the treatment of obese patients with type 2 diabetes. A 1-year randomized double-blind study. Diabetes Care 1998;21(8):1288-1294.

51. Krejs GJ. Metabolic benefits associated with sibutramine therapy. Int J Obes Relat Metab Disord 2002;26:Suppl 4. S34-S37.

52. Wirth A, Krause J. Long-term weight loss with sibutramine: a randomized controlled trial. JAMA 2001;286:1331-1339.

53. New frontiers in the weight management (XENDOS Study) 2002;mini-symposium by Roche, ICO, Sao Paulo.

54. Kelley DE, Bray GA, Pi-Sunyer FX, Klein S, Hill J, Hollander P. Clinical efficay of orlistat therapy in overweight and obese patietns with insulin-treated type 2 diabetes. Diabetes Care 2002;25:1033-1041.

55. Hauner H. Current pharmacological approaches to the treatment of obesity. Int J Obes Relat Metab Disord 2001;25:Suppl 1. S102-S106.

56. Monteforte MJ, Turkelson CM. Bariatric surgery for the morbid obese. Obes Surg 2000;10:391-401.

57. Brolin RE. Gastric bypass. Surg Clin North Am 2001;81:1077-1095.