Obesity Management in Adults: A Review

被引:275
作者
Elmaleh-Sachs, Arielle [1 ,2 ,3 ]
Schwartz, Jessica L. [4 ]
Bramante, Carolyn T. [5 ]
Nicklas, Jacinda M. [6 ]
Gudzune, Kimberly A. [4 ]
Jay, Melanie [2 ,7 ]
机构
[1] NYU, Dept Med, Div Gen Internal Med & Clin Innovat, Grossman Sch Med, 550 1St Ave, New York, NY 10016 USA
[2] New York Univ, Dept Populat Hlth, Grossman Sch Med, 550 First Ave, New York, NY 10016 USA
[3] NYU Langone, Family Hlth Ctr, New York, NY USA
[4] Johns Hopkins Sch Med, Div Gen Internal Med, Baltimore, MD USA
[5] Univ Minnesota, Sch Med, Div Gen Internal Med, Minneapolis, MN 55455 USA
[6] Univ Colorado, Div Gen Internal Med, Sch Med, Aurora, CO USA
[7] New York Harbor Vet Affairs, New York, NY USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2023年 / 330卷 / 20期
关键词
LIFE-STYLE INTERVENTION; WEIGHT-LOSS PROGRAMS; CONTROLLED-TRIAL; DOUBLE-BLIND; BARIATRIC SURGERY; AMERICAN SOCIETY; EXTENDED-RELEASE; OVERWEIGHT; CARE; METAANALYSIS;
D O I
10.1001/jama.2023.19897
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
IMPORTANCE Obesity affects approximately 42% of US adults and is associated with increased rates of type 2 diabetes, hypertension, cardiovascular disease, sleep disorders, osteoarthritis, and premature death. OBSERVATIONS A body mass index (BMI) of 25 or greater is commonly used to define overweight, and a BMI of 30 or greater to define obesity, with lower thresholds for Asian populations (BMI >= 25-27.5), although use of BMI alone is not recommended to determine individual risk. Individuals with obesity have higher rates of incident cardiovascular disease. In men with a BMI of 30 to 39, cardiovascular event rates are 20.21 per 1000 person-years compared with 13.72 per 1000 person-years in men with a normal BMI. In women with a BMI of 30 to 39.9, cardiovascular event rates are 9.97 per 1000 person-years compared with 6.37 per 1000 person-years in women with a normal BMI. Among people with obesity, 5% to 10% weight loss improves systolic blood pressure by about 3 mm Hg for those with hypertension, and may decrease hemoglobin A(1c) by 0.6% to 1% for those with type 2 diabetes. Evidence-based obesity treatment includes interventions addressing 5 major categories: behavioral interventions, nutrition, physical activity, pharmacotherapy, and metabolic/bariatric procedures. Comprehensive obesity care plans combine appropriate interventions for individual patients. Multicomponent behavioral interventions, ideally consisting of at least 14 sessions in 6 months to promote lifestyle changes, including components such as weight self-monitoring, dietary and physical activity counseling, and problem solving, often produce 5% to 10% weight loss, although weight regain occurs in 25% or more of participants at 2-year follow-up. Effective nutritional approaches focus on reducing total caloric intake and dietary strategies based on patient preferences. Physical activity without calorie reduction typically causes less weight loss (2-3 kg) but is important for weight-loss maintenance. Commonly prescribed medications such as antidepressants (eg, mirtazapine, amitriptyline) and antihyperglycemics such as glyburide or insulin cause weight gain, and clinicians should review and consider alternatives. Antiobesity medications are recommended for nonpregnant patients with obesity or overweight and weight-related comorbidities in conjunction with lifestyle modifications. Six medications are currently approved by the US Food and Drug Administration for long-term use: glucagon-like peptide receptor 1 (GLP-1) agonists (semaglutide and liraglutide only), tirzepatide (a glucose-dependent insulinotropic polypeptide/GLP-1 agonist), phentermine-topiramate, naltrexone-bupropion, and orlistat. Of these, tirzepatide has the greatest effect, with mean weight loss of 21% at 72 weeks. Endoscopic procedures (ie, intragastric balloon and endoscopic sleeve gastroplasty) can attain 10% to 13% weight loss at 6 months. Weight loss from metabolic and bariatric surgeries (ie, laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass) ranges from 25% to 30% at 12 months. Maintaining long-term weight loss is difficult, and clinical guidelines support the use of long-term antiobesity medications when weight maintenance is inadequate with lifestyle interventions alone. CONCLUSION AND RELEVANCE Obesity affects approximately 42% of adults in the US. Behavioral interventions can attain approximately 5% to 10% weight loss, GLP-1 agonists and glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonists can attain approximately 8% to 21% weight loss, and bariatric surgery can attain approximately 25% to 30% weight loss. Comprehensive, evidence-based obesity treatment combines behavioral interventions, nutrition, physical activity, pharmacotherapy, and metabolic/bariatric procedures as appropriate for individual patients.
引用
收藏
页码:2000 / 2015
页数:16
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