An Approach to Obesity Management for Gastroenterologists and Hepatologists
- 21 Downloads
Purpose of Review
Obesity is associated with multiple gastrointestinal and liver diseases such as gastroesophageal reflux disease, Barrett’s esophagus, esophageal adenocarcinoma, cholelithiasis, colon polyps, and fatty liver disease. To effectively manage obesity, it is imperative to understand current and emerging therapies and procedures.
Obesity is becoming increasingly prevalent and is associated with a growing monetary health care burden. Cardiac disease, cerebrovascular disease, and diabetes are among the leading causes of preventable and premature death of Americans related to obesity. In addition to behavioral modification (diet and exercise) and bariatric surgery, multiple pharmacotherapies and endoscopic procedures are newly approved and available for the management of obesity.
This paper reviews the current literature on the treatments available for the management of obesity including behavior modification, pharmacotherapy, endoscopic weight loss procedures (endobariatrics), and bariatric surgery.
KeywordsObesity Diet Pharmacotherapy Endobariatrics Bariatric surgery
Compliance with Ethical Standards
Conflict of Interest
Jessica Briscoe declares that she has no conflict of interest. Monica Saumoy declares that she has no conflict of interest. Octavia Pickett-Blakely declares that she has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as:• Of importance
- 1.DNPAO Data, Trends and maps: explore by location | CDC. https://nccd.cdc.gov/dnpao_dtm/rdPage.aspx?rdReport=DNPAO_DTM.ExploreByLocation&rdRequestForwarding=Form. .
- 3.Adult Obesity Facts | Overweight & obesity | CDC. https://www.cdc.gov/obesity/data/adult.html. Published January 31, 2019. Accessed February 25, 2019.
- 4.2013 AHA/ACC/TOS Guideline for the management of overweight and obesity in adults. :37.Google Scholar
- 5.Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55(6):2005–23. https://doi.org/10.1002/hep.25762.CrossRefPubMedGoogle Scholar
- 7.• Acosta A, Streett S, Kroh MD, et al. White Paper AGA: POWER — Practice guide on obesity and weight management, education, and resources. Clin Gastroenterol Hepatol. 2017;15(5):631–649.e10. https://doi.org/10.1016/j.cgh.2016.10.023. This study provides a comprehensive weight management guide for physicians.CrossRefGoogle Scholar
- 13.Zone diet: what to know | US News Best Diets. https://health.usnews.com/best-diet/zone-diet. Accessed March 17, 2019.
- 21.Wing RR, Vazquez JA, Ryan CM. Cognitive effects of ketogenic weight-reducing diets. Int J Obes Relat Metab Disord J Int Assoc Study Obes. 1995;19(11):811–6.Google Scholar
- 22.Ballaban-Gil K, Callahan C, O’Dell C, Pappo M, Moshé S, Shinnar S. Complications of the Ketogenic diet. Epilepsia. 1998;39(7):744–8. https://doi.org/10.1111/j.1528-1157.1998.tb01160.x.CrossRefPubMedGoogle Scholar
- 27.Patterson RE, Sears DD. Metabolic effects of intermittent fasting. Annu Rev Nutr. 2017;37(1):371–93. https://doi.org/10.1146/annurev-nutr-071816-064634.CrossRefPubMedGoogle Scholar
- 28.Sutton EF, Beyl R, Early KS, Cefalu WT, Ravussin E, Peterson CM. Early time-restricted feeding improves insulin sensitivity, blood pressure, and oxidative stress even without weight loss in men with prediabetes. Cell Metab. 2018;27(6):1212–1221.e3. https://doi.org/10.1016/j.cmet.2018.04.010.CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Trepanowski JF, Kroeger CM, Barnosky A, et al. Effect of alternate-day fasting on weight loss, weight maintenance, and cardioprotection among metabolically healthy obese adults: a randomized clinical trial. JAMA Intern Med. 2017;177(7):930–8. https://doi.org/10.1001/jamainternmed.2017.0936.CrossRefPubMedPubMedCentralGoogle Scholar
- 31.American Heart Association recommendations for physical activity in adults and kids. www.heart.org. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults. Accessed March 22, 2019.
- 35.Blumenthal JA, Sherwood A, Gullette ECD, et al. Exercise and weight loss reduce blood pressure in men and women with mild hypertension: effects on cardiovascular, metabolic, and hemodynamic functioning. Arch Intern Med. 2000;160(13):1947–58. https://doi.org/10.1001/archinte.160.13.1947.CrossRefPubMedGoogle Scholar
- 38.Lemes ÍR, Ferreira PH, Linares SN, Machado AF, Pastre CM, Netto J. Resistance training reduces systolic blood pressure in metabolic syndrome: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2016;50(23):1438–42. https://doi.org/10.1136/bjsports-2015-094715.CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Cauza E, Hanusch-Enserer U, Strasser B, et al. The relative benefits of endurance and strength training on the metabolic factors and muscle function of people with type 2 diabetes mellitus. Arch Phys Med Rehabil. 2005;86(8):1527–33. https://doi.org/10.1016/j.apmr.2005.01.007.CrossRefPubMedGoogle Scholar
- 42.Wycherley TP, Noakes M, Clifton PM, Cleanthous X, Keogh JB, Brinkworth GD. A high-protein diet with resistance exercise training improves weight loss and body composition in overweight and obese patients with type 2 diabetes. Diabetes Care. 2010;33(5):969–76. https://doi.org/10.2337/dc09-1974.CrossRefPubMedPubMedCentralGoogle Scholar
- 48.McMahon FG, Fujioka K, Singh BN, et al. Efficacy and safety of sibutramine in obese White and African American Patients with hypertension: a 1-year, double-blind, placebo-controlled, multicenter trial. Arch Intern Med. 2000;160(14):2185–91. https://doi.org/10.1001/archinte.160.14.2185.CrossRefPubMedGoogle Scholar
- 51.Gadde KM, Allison DB, Ryan DH, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. The Lancet. 2011;377(9774):1341–52. https://doi.org/10.1016/S0140-6736(11)60205-5.CrossRefGoogle Scholar
- 52.Research C for DE and. FDA Drug Safety Communication: completed safety review of Xenical/Alli (orlistat) and severe liver injury. FDA. 2018. http://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fda-drug-safety-communication-completed-safety-review-xenicalalli-orlistat-and-severe-liver-injury. Accessed June 17, 2019.
- 58.Abu Dayyeh BK, Kumar N, Edmundowicz SA, et al. ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies. Gastrointest Endosc. 2015;82(3):425–438.e5. https://doi.org/10.1016/j.gie.2015.03.1964.CrossRefPubMedGoogle Scholar
- 59.• Abu Dayyeh BK, Edmundowicz S, Thompson CC. Clinical practice update: expert review on endoscopic bariatric therapies. Gastroenterology. 2017;152(4):716–29. https://doi.org/10.1053/j.gastro.2017.01.035. This study provides an expert review of available and emerging endoscopic weight loss therapies. Additionally, the authors provide best practice indications, contraindications, and ways to incorporate these procedures into clinical practice.CrossRefGoogle Scholar
- 60.Health C for D and R. Health Care Providers (Medical Devices) - The FDA alerts health care providers about potential risks with liquid-filled intragastric balloons. https://www.fda.gov/medicaldevices/resourcesforyou/healthcareproviders/ucm540655.htm. Accessed March 24, 2019.
- 61.Health C for D and R. UPDATE: potential risks with liquid-filled intragastric balloons - letter to health care providers. FDA. 2018. http://www.fda.gov/medical-devices/letters-health-care-providers/update-potential-risks-liquid-filled-intragastric-balloons-letter-health-care-providers-0. Accessed June 20, 2019.
- 62.Sullivan S, Swain JM, Woodman G, et al. 812d The Obalon swallowable 6-month balloon system is more effective than moderate intensity lifestyle therapy alone: results from a 6- month randomized sham controlled trial. Gastroenterology. 2016;150(4):S1267. https://doi.org/10.1016/S0016-5085(16)34281-0.CrossRefGoogle Scholar
- 73.English WJ, DeMaria EJ, Brethauer SA, Mattar SG, Rosenthal RJ, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surg Obes Relat Dis. 2018;14(3):259–63. https://doi.org/10.1016/j.soard.2017.12.013.CrossRefPubMedGoogle Scholar
- 77.Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: micronutrients. Surg Obes Relat Dis. 2017;13(5):727–41. https://doi.org/10.1016/j.soard.2016.12.018.CrossRefPubMedGoogle Scholar