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Clinical Evaluation, Lifestyle, and Pharmacological Management of Obesity

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Nutrition, Weight, and Digestive Health

Abstract

This chapter guides healthcare providers in the clinical evaluation and management of patients with obesity. The clinical evaluation is comprised of a detailed weight history and exam with special attention to signs or symptoms of obesity-related comorbidities. Management of obesity is founded upon lifestyle modifications through nutrition, physical activity, and behavioral counseling. Anti-obesity medication is an additional tool to support patients in achieving and maintaining clinically significant weight loss in order to improve health. This chapter guides clinicians on appropriate utilization of weight loss medications by reviewing their indications, mechanisms of action, clinical effects, and adverse effects.

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References

  1. Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax C, et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med. 2019;381(25):2440–50.

    Article  PubMed  Google Scholar 

  2. Centers for Disease Control and Prevention. Prevalence of self-reported obesity among U.S. adults by state and territory. Behavioral Risk Factor Surveillance System 2018.

    Google Scholar 

  3. Pi-Sunyer FX. Comorbidities of overweight and obesity: current evidence and research issues. Med Sci Sports Exerc. 1999;31(11 SUPPL): S602–8.

    Google Scholar 

  4. Bean M. Weighing the cost of care: how hospitals accommodate obese patients. 2016.

    Google Scholar 

  5. Rubino F, Puhl RM, Cummings DE, Eckel RH, Ryan DH, Mechanick JI, et al. Joint international consensus statement for ending stigma of obesity. Nat Med. 2020;26(4):485–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16(4):319–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Albury C, Strain WD, Brocq SL, Logue J, Lloyd C, Tahrani A. The importance of language in engagement between health-care professionals and people living with obesity: a joint consensus statement. Lancet Diabetes Endocrinol. 2020;8(5):447–55.

    Article  PubMed  Google Scholar 

  8. Teachman BA, Gapinski KD, Brownell KD, Rawlins M, Jeyaram S. Demonstrations of implicit anti-fat bias: the impact of providing causal information and evoking empathy. Health Psychol. 2003;22(1):68–78.

    Article  PubMed  Google Scholar 

  9. Fujioka K, Crockett T. In: Bray GA, Bouchard C, editors. Obesity and the primary care physician. 4th ed. Taylor & Francis; 2014.

    Google Scholar 

  10. Cerhan JR, Moore SC, Jacobs EJ, Kitahara CM, Rosenberg PS, Adami HO, et al. A pooled analysis of waist circumference and mortality in 650,000 adults. Mayo Clin Proc. 2014;89(3):335–45.

    Article  PubMed  Google Scholar 

  11. Jacobs EJ, Newton CC, Wang Y, Patel AV, McCullough ML, Campbell PT, et al. Waist circumference and all-cause mortality in a large US cohort. Arch Intern Med. 2010;170(15):1293–301.

    Article  PubMed  Google Scholar 

  12. World Health Organization (WHO) Expert Consultation. Waist circumference and waist-hip ratio. World Health Organization; 2008.

    Google Scholar 

  13. Ma WY, Yang CY, Shih SR, Hsieh HJ, Hung CS, Chiu FC, et al. Measurement of waist circumference: midabdominal or iliac crest? Diabetes Care. 2013;36(6):1660–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Pouliot MC, Després JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A, et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol. 1994;73(7):460–8.

    Article  CAS  PubMed  Google Scholar 

  15. Vazquez G, Duval S, Jacobs DR, Silventoinen K. Comparison of body mass index, waist circumference, and waist/hip ratio in predicting incident diabetes: a meta-analysis. Epidemiol Rev. 2007;29:115–28.

    Article  PubMed  Google Scholar 

  16. Romero-Corral A, Somers VK, Sierra-Johnson J, Thomas RJ, Collazo-Clavell ML, Korinek J, et al. Accuracy of body mass index in diagnosing obesity in the adult general population. Int J Obes. 2008;32(6):959–66.

    Article  CAS  Google Scholar 

  17. Kushner RF, Bray GA. Classification and evaluation of the overweight patient. 2014.

    Google Scholar 

  18. Wiedner M, Aghajanzadeh D, Richter DF. Differential diagnoses and treatment of lipedema. Plast Aesthetic Res. 2020;7(10):1–10.

    Google Scholar 

  19. Rapprich S, Baum S, Kaak I, Kottmann T, Podda M. Treatment of lipoedema using liposuction: results of our own surveys. Phlebologie. 2015;44:121–32.

    Article  Google Scholar 

  20. Kushner RF, Batsis JA, Butsch WS, Davis N, Golden A, Halperin F, et al. Weight history in clinical practice: the state of the science and future directions. Obesity (Silver Spring). 2020;28(1):9–17.

    Article  Google Scholar 

  21. Igel LI, Kumar RB, Saunders KH, Aronne LJ. Practical use of pharmacotherapy for obesity. Gastroenterology. 2017;152(7):1765–79.

    Article  PubMed  Google Scholar 

  22. Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U, et al. Pharmacological management of obesity: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342–62.

    Article  CAS  PubMed  Google Scholar 

  23. Sax PE, Erlandson KM, Lake JE, McComsey GA, Orkin C, Esser S, et al. Weight gain following initiation of antiretroviral therapy: risk factors in randomized comparative clinical trials. Clin Infect Dis. 2020;71(6):1379–89.

    Article  CAS  PubMed  Google Scholar 

  24. Obayashi K, Saeki K, Iwamoto J, Okamoto N, Tomioka K, Nezu S, et al. Exposure to light at night, nocturnal urinary melatonin excretion, and obesity/dyslipidemia in the elderly: a cross-sectional analysis of the HEIJO-KYO study. J Clin Endocrinol Metab. 2013;98(1):337–44.

    Article  CAS  PubMed  Google Scholar 

  25. Fonken LK, Lieberman RA, Weil ZM, Nelson RJ. Dim light at night exaggerates weight gain and inflammation associated with a high-fat diet in male mice. Endocrinology. 2013;154(10):3817–25.

    Article  CAS  PubMed  Google Scholar 

  26. Engin A. Circadian rhythms in diet-induced obesity, vol. 960. New York: Springer New York LLC; 2017. p. 19–52.

    Google Scholar 

  27. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25 SUPPL. 1):102–38.

    Google Scholar 

  28. Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22(Suppl 3):1–203.

    Article  PubMed  Google Scholar 

  29. Wadden TA, Tronieri JS, Butryn ML. Lifestyle modification approaches for the treatment of obesity in adults. Am Psychol. 2020;75(2):235–51.

    Article  PubMed  PubMed Central  Google Scholar 

  30. McGandy RB, Hegsted DM, Stare FJ. Dietary fats, carbohydrates and atherosclerotic vascular disease. N Engl J Med. 1967;277(4):186–92. contd.

    Article  CAS  PubMed  Google Scholar 

  31. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.

    Article  CAS  PubMed  Google Scholar 

  32. Pi-Sunyer X. The look AHEAD trial: a review and discussion of its outcomes. Curr Nutr Rep. 2014;3(4):387–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Diabetes Prevention Program Research Group. The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care. 2002;25(12):2165–71.

    Article  Google Scholar 

  34. Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378(25):1–14.

    Article  Google Scholar 

  35. Harsha DW, Lin PH, Obarzanek E, Karanja NM, Moore TJ, Caballero B. Dietary approaches to stop hypertension: a summary of study results. DASH Collaborative Research Group. J Am Diet Assoc. 1999;99(8 Suppl):S35–9.

    Article  CAS  PubMed  Google Scholar 

  36. Ludwig DS, Ebbeling CB. The carbohydrate-insulin model of obesity: beyond “calories in, calories out”. JAMA Intern Med. 2018;178(8):1098–103.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Westman EC, Feinman RD, Mavropoulos JC, Vernon MC, Volek JS, Wortman JA, et al. Low-carbohydrate nutrition and metabolism. Am J Clin Nutr. 2007;86(2):276–84.

    Article  CAS  PubMed  Google Scholar 

  38. Hu T, Mills KT, Yao L, Demanelis K, Eloustaz M, Yancy WS Jr, et al. Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials. Am J Epidemiol. 2012;176(Suppl):S44–54.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Tobias DK, Chen M, Manson JE, Ludwig DS, Willett W, Hu FB. Effect of low-fat diet interventions versus other diet interventions on long-term weight change in adults: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2015;3(12):968–79.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Bueno NB, de Melo IS, de Oliveira SL, da Rocha AT. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr. 2013;110(7):1178–87.

    Article  CAS  PubMed  Google Scholar 

  41. Athinarayanan SJ, Adams RN, Hallberg SJ, McKenzie AL, Bhanpuri NH, Campbell WW, et al. Long-term effects of a novel continuous remote care intervention including nutritional ketosis for the management of Type 2 diabetes: a 2-year non-randomized clinical trial. Front Endocrinol (Lausanne). 2019;10:348.

    Article  Google Scholar 

  42. Westerterp-Plantenga MS, Lemmens SG, Westerterp KR. Dietary protein - its role in satiety, energetics, weight loss and health. Br J Nutr. 2012;108(Suppl 2):S105–12.

    Article  CAS  PubMed  Google Scholar 

  43. Shai I, Schwarzfuch D, Yaakov H, Shaha DR, Witkow S, Greenberg I. Weight loss with a low-carbohydrate, mediterranean, or low-fat diet. N Engl J Med. 2009;362(15):1329–38.

    Google Scholar 

  44. United States Department of Agriculture. ChooseMyPlate Alexandria, VA: United States Department of Agriculture (USDA) Center for Nutrition Policy & Promotion; 1994. Available from: www.choosemyplate.gov.

  45. Jakubowicz D, Barnea M, Wainstein J, Froy O. High caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women. Obesity (Silver Spring). 2013;21(12):2504–12.

    Article  CAS  Google Scholar 

  46. Hutchison AT, Regmi P, Manoogian ENC, Fleischer JG, Wittert GA, Panda S, et al. Time-restricted feeding improves glucose tolerance in men at risk for Type 2 diabetes: a randomized crossover trial. Obesity (Silver Spring). 2019;27(5):724–32.

    CAS  Google Scholar 

  47. Varady KA, Bhutani S, Klempel MC, Lamarche B. Improvements in LDL particle size and distribution by short-term alternate day modified fasting in obese adults. Br J Nutr. 2011;105(4):580–3.

    Article  CAS  PubMed  Google Scholar 

  48. Trepanowski JF, Kroeger CM, Barnosky A, Klempel MC, Bhutani S, Hoddy KK, 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.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Harvie M, Wright C, Pegington M, McMullan D, Mitchell E, Martin B, et al. The effect of intermittent energy and carbohydrate restriction v. daily energy restriction on weight loss and metabolic disease risk markers in overweight women. Br J Nutr. 2013;110(8):1534–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Harvie MN, Pegington M, Mattson MP, Frystyk J, Dillon B, Evans G, et al. The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women. Int J Obes. 2011;35(5):714–27.

    Article  CAS  Google Scholar 

  51. Brandhorst S, Choi IY, Wei M, Cheng CW, Sedrakyan S, Navarrete G, et al. A periodic diet that mimics fasting promotes multi-system regeneration, enhanced cognitive performance, and healthspan. Cell Metab. 2015;22(1):86–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Longo VD, Panda S. Fasting, circadian rhythms, and time-restricted feeding in healthy lifespan. Cell Metab. 2016;23(6):1048–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Gabel K, Hoddy KK, Haggerty N, Song J, Kroeger CM, Trepanowski JF, et al. Effects of 8-hour time restricted feeding on body weight and metabolic disease risk factors in obese adults: a pilot study. Nutr Healthy Aging. 2018;4(4):345–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. 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):1212–21.e3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005;293(1):43–53.

    Article  CAS  PubMed  Google Scholar 

  56. Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360(9): 859–73.

    Google Scholar 

  57. Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK. American College of Sports Medicine position stand: appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41(2):459–71.

    Article  PubMed  Google Scholar 

  58. Food and Agriculture Organization (FAO)/World Health Organization (WHO)/United Nations University (UNU). Human energy requirements. Food Nutr Tech Rep Ser. 2001;1(1):1–103.

    Google Scholar 

  59. Westerterp KR. Diet induced thermogenesis. Nutr Metab 2004;1(1):1–5.

    Google Scholar 

  60. Department of Health and Human Services. Physical activity guidelines for Americans, 2nd edition [Internet]. United States Department of Health and Human Services. 2018.

    Google Scholar 

  61. Donnelly JE, Hill JO, Jacobsen DJ, Potteiger J, Sullivan DK, Johnson SL, et al. Effects of a 16-month randomized controlled exercise trial on body weight and composition in young, overweight men and women: the Midwest Exercise Trial. Arch Intern Med. 2003;163(11):1343–50.

    Article  PubMed  Google Scholar 

  62. Shaw K, Gennat H, O'Rourke P, Del Mar C. Exercise for overweight or obesity. Cochrane Database Syst Rev. 2006;(4):CD003817.

    Google Scholar 

  63. Beddhu S, Wei G, Marcus RL, Chonchol M, Greene T. Light-intensity physical activities and mortality in the United States general population and CKD subpopulation. Clin J Am Soc Nephrol. 2015;10(7):1145–53.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Zhang H, Tong TK, Qiu W, Zhang X, Zhou S, Liu Y, et al. Comparable effects of high-intensity interval training and prolonged continuous exercise training on abdominal visceral fat reduction in obese young women. J Diabetes Res. 2017;2017(5071740): 13–23.

    Google Scholar 

  65. Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, Brychta R, et al. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity (Silver Spring). 2016;24(8):1612–9.

    Article  Google Scholar 

  66. Aristizabal JC, Freidenreich DJ, Volk BM, Kupchak BR, Saenz C, Maresh CM, et al. Effect of resistance training on resting metabolic rate and its estimation by a dual-energy X-ray absorptiometry metabolic map. Eur J Clin Nutr. 2015;69(7):831–6.

    Article  CAS  PubMed  Google Scholar 

  67. Pratley R, Nicklas B, Rubin M, Miller J, Smith A, Smith M, et al. Strength training increases resting metabolic rate and norepinephrine levels in healthy 50- to 65-yr-old men. J Appl Physiol (1985). 1994;76(1):133–7.

    Article  CAS  Google Scholar 

  68. Butryn ML, Webb V, Wadden TA. Behavioral treatment of obesity. Psychiatr Clin North Am. 2011;34(4):841–59.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Zheng Y, Klem ML, Sereika SM, Danford CA, Ewing LJ, Burke LE. Self-weighing in weight management: a systematic literature review. Obesity (Silver Spring). 2015;23(2):256–65.

    Article  Google Scholar 

  70. Klem ML, Wing RR, McGuire MT, Seagle HM, Hill JO. A descriptive study of individuals successful at long-term maintenance of substantial weight loss. Am J Clin Nutr. 1997;66(2):239–46.

    Article  CAS  PubMed  Google Scholar 

  71. 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(4):722–6.

    Article  CAS  PubMed  Google Scholar 

  72. Hinkle W, Cordell M, Leibel R, Rosenbaum M, Hirsch J. Effects of reduced weight maintenance and leptin repletion on functional connectivity of the hypothalamus in obese humans. PLoS One. 2013;8(3):e59114-e.

    Article  CAS  Google Scholar 

  73. Rosenbaum M, Goldsmith R, Bloomfield D, Magnano A, Weimer L, Heymsfield S, et al. Low-dose leptin reverses skeletal muscle, autonomic, and neuroendocrine adaptations to maintenance of reduced weight. J Clin Invest. 2005;115(12):3579–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Rosenbaum M, Hirsch J, Gallagher DA, Leibel RL. Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight. Am J Clin Nutr. 2008;88(4):906–12.

    Article  CAS  PubMed  Google Scholar 

  75. Thomas CE, Mauer EA, Shukla AP, Rathi S, Aronne LJ. Low adoption of weight loss medications: a comparison of prescribing patterns of antiobesity pharmacotherapies and SGLT2s. Obesity (Silver Spring). 2016;24(9):1955–61.

    Article  Google Scholar 

  76. Kanj A, Levine D. Overcoming obesity: weight-loss drugs are underused. Cleve Clin J Med. 2020;87(10):602–4.

    Article  PubMed  Google Scholar 

  77. Adipex-p (phentermine) [package insert]. Sellersville: Teva Pharmaceuticals; 2012.

    Google Scholar 

  78. Aronne LJ, Wadden TA, Peterson C, Winslow D, Odeh S, Gadde KM. Evaluation of phentermine and topiramate versus phentermine/topiramate extended-release in obese adults (EQUATE). Obesity (Silver Spring). 2013;21(11):2163–71.

    Article  CAS  Google Scholar 

  79. Qsymia (phentermine and topiramate extended-release) [package insert]. Winchester: VIVUS Inc.; 2012.

    Google Scholar 

  80. Gadde KM, Allison DB, Ryan DH, Peterson CA, Troupin B, Schwiers ML, 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. Lancet. 2011;377(9774):1341–52.

    Article  CAS  PubMed  Google Scholar 

  81. Xenical (orlistat) [package insert]. San Francisco: Genentech USA, Inc.; 1999.

    Google Scholar 

  82. Davidson MH, Hauptman J, DiGirolamo M, Foreyt JP, Halsted CH, Heber D, et al. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: a randomized controlled trial. JAMA. 1999;281(3):235–42.

    Article  CAS  PubMed  Google Scholar 

  83. Contrave (naltrexone HCl and bupropion HCl) [package insert]. San Diego: Nalpropion Pharmaceuticals, Inc.; 2014.

    Google Scholar 

  84. Greenway FL, Fujioka K, Plodkowski RA, Mudaliar S, Guttadauria M, Erickson J, et al. Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2010;376(9741):595–605.

    Article  CAS  PubMed  Google Scholar 

  85. Saxenda (liraglutide) [package insert]. Plainsboro: Novo Nordisk; 2014.

    Google Scholar 

  86. Pi-Sunyer X, Astrup A, Fujioka K, Greenway F, Halpern A, Krempf M, et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med. 2015;373(1):11–22.

    Article  PubMed  CAS  Google Scholar 

  87. Rothman RB, Baumann MH, Dersch CM, Romero DV, Rice KC, Carroll FI, et al. Amphetamine-type central nervous system stimulants release norepinephrine more potently than they release dopamine and serotonin. Synapse. 2001;39(1):32–41.

    Article  CAS  PubMed  Google Scholar 

  88. Li Z, Maglione M, Tu W, Mojica W, Arterburn D, Shugarman LR, et al. Meta-analysis: pharmacologic treatment of obesity. Ann Intern Med. 2005;142(7):532–46.

    Article  CAS  PubMed  Google Scholar 

  89. Hendricks EJ, Srisurapanont M, Schmidt SL, Haggard M, Souter S, Mitchell CL, et al. Addiction potential of phentermine prescribed during long-term treatment of obesity. Int J Obes. 2014;38(2):292–8.

    Article  CAS  Google Scholar 

  90. Endocrinologic Metabolic Drugs Advisory Committee. VI-0521 (QNEXA) briefing document NDA 022580. Food and Drug Administration 2012:1–166.

    Google Scholar 

  91. McElroy SL, Hudson JI, Capece JA, Beyers K, Fisher AC, Rosenthal NR. Topiramate for the treatment of binge eating disorder associated with obesity: a placebo-controlled study. Biol Psychiatry. 2007;61(9):1039–48.

    Article  CAS  PubMed  Google Scholar 

  92. Milano W, De Rosa M, Milano L, Capasso A. Night eating syndrome: an overview. J Pharm Pharmacol. 2011;64(1):2–10.

    Article  PubMed  CAS  Google Scholar 

  93. Kushner RF. Weight loss strategies for treatment of obesity. Prog Cardiovasc Dis. 2014;61(2):246–52.

    Article  Google Scholar 

  94. Allison DB, Gadde KM, Garvey WT, Peterson CA, Schwiers ML, Najarian T, et al. Controlled-release phentermine/topiramate in severely obese adults: a randomized controlled trial (EQUIP). Obesity (Silver Spring). 2012;20(2):330–42.

    Article  CAS  Google Scholar 

  95. Garvey WT, Ryan DH, Look M, Gadde KM, Allison DB, Peterson CA, et al. Two-year sustained weight loss and metabolic benefits with controlled-release phentermine/topiramate in obese and overweight adults (SEQUEL): a randomized, placebo-controlled, phase 3 extension study. Am J Clin Nutr. 2012;95(2):297–308.

    Article  CAS  PubMed  Google Scholar 

  96. Torgerson JS, Hauptman J, Boldrin MN, Sjostrom L. XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care. 2004;27(1):155–61.

    Article  CAS  PubMed  Google Scholar 

  97. Rucker D, Padwal R, Li SK, Curioni C, Lau DCW. Long term pharmacotherapy for obesity and overweight: updated meta-analysis. Br Med J. 2007;335(7631):1194–9.

    Article  CAS  Google Scholar 

  98. Greenway FL, Whitehouse MJ, Guttadauria M, Anderson JW, Atkinson RL, Fujioka K, et al. Rational design of a combination medication for the treatment of obesity. Obesity (Silver Spring). 2009;17(1):30–9.

    Article  CAS  Google Scholar 

  99. Apovian CM, Aronne L, Powell AG. Clinical management of obesity. 1st ed. West Islip: Professional Communications, Inc.; 2015.

    Google Scholar 

  100. Apovian CM, Aronne L, Rubino D, Still C, Wyatt H, Burns C, et al. A randomized, phase 3 trial of naltrexone SR/bupropion SR on weight and obesity-related risk factors (COR-II). Obesity (Silver Spring). 2013;21(5):935–43.

    Article  CAS  Google Scholar 

  101. Wadden TA, Foreyt JP, Foster GD, Hill JO, Klein S, O'Neil PM, et al. Weight loss with naltrexone SR/bupropion SR combination therapy as an adjunct to behavior modification: the COR-BMOD trial. Obesity (Silver Spring). 2011;19(1):110–20.

    Article  CAS  Google Scholar 

  102. Hollander P, Gupta AK, Plodkowski R, Greenway F, Bays H, Burns C, et al. Effects of naltrexone sustained-release/bupropion sustained-release combination therapy on body weight and glycemic parameters in overweight and obese patients with type 2 diabetes (COR-diabetes). Diabetes Care. 2013;36(12):4022–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  103. van Can J, Sloth B, Jensen CB, Flint A, Blaak EE, Saris WHM. Effects of the once-daily GLP-1 analog liraglutide on gastric emptying, glycemic parameters, appetite and energy metabolism in obese, non-diabetic adults. Int J Obes. 2014;38(6):784–93.

    Google Scholar 

  104. Davies MJ, Bergenstal R, Bode B, Kushner RF, Lewin A, Skjøth TV, et al. Efficacy of liraglutide for weight loss among patients with type 2 diabetes: the SCALE diabetes randomized clinical trial. JAMA J Am Med Assoc. 2015;314(7):687–99.

    Article  CAS  Google Scholar 

  105. Wadden TA, Hollander P, Klein S, Niswender K, Woo V, Hale PM, et al. Weight maintenance and additional weight loss with liraglutide after low-calorie-diet-induced weight loss: the SCALE maintenance randomized study. Int J Obes. 2013;37(11):1443–51.

    Article  CAS  Google Scholar 

  106. Glucophage (metformin hydrochloride) [package insert]. Princeton: Bristol-Myers Squibb Company; 1995.

    Google Scholar 

  107. Seifarth C, Schehler B, Schneider HJ. Effectiveness of metformin on weight loss in non-diabetic individuals with obesity. Exp Clin Endocrinol Diabetes. 2013;121(1):27–31.

    CAS  PubMed  Google Scholar 

  108. Schultes B, Oltmanns KM, Kern W, Fehm HL, Born J, Peters A. Modulation of hunger by plasma glucose and metformin. J Clin Endocrinol Metab. 2003;88(3):1133–41.

    Article  CAS  PubMed  Google Scholar 

  109. Hawley SA, Gadalla AE, Olsen GS, Grahame HD. The antidiabetic drug metformin activates the AMP-activated protein kinase cascade via an adenine nucleotide-independent mechanism. Diabetes. 2002;51(8):2420–5.

    Article  CAS  PubMed  Google Scholar 

  110. Kim YW, Kim JY, Park YH, Park SY, Won KC, Choi KH, et al. Metformin restores leptin sensitivity in high-fat-fed obese rats with leptin resistance. Diabetes. 2006;55(3):716–24.

    Article  CAS  PubMed  Google Scholar 

  111. Hostalek U, Gwilt M, Hildemann S. Therapeutic use of metformin in prediabetes and diabetes prevention. Drugs. 2015;75(10):1071–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  112. Coll AP, Chen M, Taskar P, Rimmington D, Patel S, Tadross JA, et al. GDF15 mediates the effects of metformin on body weight and energy balance. Nature. 2020;578(2295):444–8.

    Article  CAS  PubMed  Google Scholar 

  113. Igel LI, Sinha A, Saunders KH, Apovian CM, Vojta D, Aronne LJ. Metformin: an old therapy that deserves a new indication for the treatment of obesity. Curr Atheroscler Rep. 2016;18(4):16. –.

    Article  CAS  PubMed  Google Scholar 

  114. Ning HH, Le J, Wang Q, Young CA, Deng B, Gao PX, et al. The effects of metformin on simple obesity: a meta-analysis. Endocrine. 2018;62(3):528–34.

    Article  CAS  PubMed  Google Scholar 

  115. Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study (DPPOS). Lancet. 2009;374(9702):1677–86.

    Article  PubMed Central  Google Scholar 

  116. Apolzan JW, Venditti EM, Edelstein SL, Knowler WC, Dabelea D, Boyko EJ, et al. Long-term weight loss with metformin or lifestyle intervention in the diabetes prevention program (DPP) outcomes study (DPPOS). Ann Intern Med. 2019;170(10):682–90.

    Article  PubMed  PubMed Central  Google Scholar 

  117. Ribola FA, Cançado FB, Schoueri JHM, De Toni VF, Medeiros VHR, Feder D. Effects of SGLT2 inhibitors on weight loss in patients with type 2 diabetes mellitus. Eur Rev Med Pharmacol Sci. 2017;21(1):199–211.

    CAS  PubMed  Google Scholar 

  118. Abdul-Ghani MA, Defronzo RA. Lowering plasma glucose concentration by inhibiting renal sodium-glucose cotransport. J Intern Med. 2014;276(4):352–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  119. Lee PC, Ganguly S, Goh SY. Weight loss associated with sodium-glucose cotransporter-2 inhibition: a review of evidence and underlying mechanisms. 2018.

    Google Scholar 

  120. Riddle M, Frias J, Zhang B, Maier H, Brown C, Lutz K, et al. Pramlintide improved glycemic control and reduced weight in patients with type 2 diabetes using basal insulin. Diabetes Care. 2007;30(11):2794–9.

    Article  CAS  PubMed  Google Scholar 

  121. Ratner RE, Want LL, Fineman MS, Velte MJ, Ruggles JA, Gottlieb A, et al. Adjunctive therapy with the amylin analogue pramlintide leads to a combined improvement in glycemic and weight control in insulin-treated subjects with type 2 diabetes. Diabetes Technol Therap. 2002;4(1):51–61.

    Article  CAS  Google Scholar 

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Kolli, S., Tchang, B.G., Redmond, I.P., Barenbaum, S., Saunders, K.H. (2022). Clinical Evaluation, Lifestyle, and Pharmacological Management of Obesity. In: Newberry, C., Laster, J., Pickett-Blakely, O. (eds) Nutrition, Weight, and Digestive Health. Springer, Cham. https://doi.org/10.1007/978-3-030-94953-2_14

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