Overview of Medical and Surgical Treatment of Severe Obesity
This chapter will explore medical treatments and potential surgical options for treating severe obesity. Medications commonly used for weight loss will be summarized including potential limitations. A brief description of bariatric surgery procedures will
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Overview of Medical and Surgical Treatment of Severe Obesity Kristel Lobo Prabhu and Timothy Jackson
This chapter will explore medical treatments and potential surgical options for treating severe obesity. Medications commonly used for weight loss will be summarized including potential limitations. A brief description of bariatric surgery procedures will be illustrated followed by a summary of the risk-adjusted outcomes as well as rates of improvement of obesity-related comorbidities.
K.L. Prabhu, M.D., F.R.C.S.C. University of Toronto, Toronto, ON, Canada Minimally Invasive and Bariatric Surgery, Division of General Surgery, Department of Surgery and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst St, 8MP-322, Toronto, ON, Canada M5T 2S8 e-mail: [email protected] T. Jackson, B.Sc., M.D., M.P.H., F.R.C.S., F.A.C.S. (*) Minimally Invasive and Bariatric Surgery, Division of General Surgery, Department of Surgery and Institute of Health Policy, Management and Evaluation Faculty of Medicine, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst St, 8MP-322, Toronto, ON, Canada M5T 2S8 e-mail: [email protected]
6.1
vidence for Medical E Treatments of Obesity
The management of an obese adult should begin with the determination of the patient’s BMI and waist circumference. If the BMI is found to be greater than 25 or the waist circumference is above the cut-off point for the patient’s ethnicity, investigations must be undertaken to assess for the presence of comorbidities [1]. Major obesity-related medical problems include type 2 diabetes mellitus, hypertension, dyslipidemia, cardiovascular disease, and sleep apnea [2]. The first step in the management of the obese patient is lifestyle modification with interventions aimed at diet, exercise, and behavioural modification. Pharmacotherapy may be used as an adjunct to lifestyle modification in patients with a BMI ≥27 with one of more obesity-related comorbidities or in patients with a BMI ≥30 with or without associated risk factors [1]. Drugs currently approved by the United States Food and Drug Administration (FDA) for the treatment of obesity include orlistat, lorcaserin, and noradrengeric agents including phentermine, diethylpropion, phendimetrazine, and benzphetamine [3].
6.1.1 Orlistat Orlistat inhibits the actions of gastric and pancreatic lipases, thus decreasing the absorption of
© Springer International Publishing AG 2017 S. Sockalingam, R. Hawa (eds.), Psychiatric Care in Severe Obesity, DOI 10.1007/978-3-319-42536-8_6
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dietary fat [4]. A systematic review by Yanovski et al., analyzing Orlistat 120 mg trails, found that 35–73 % of participants in the treatment group achieved a ≥5 % weight loss at 1 year [3]. Weight loss was found to be maintained up to 24–36 months with continued use of Orlistat [5]. The XENDOS trial which followed 3305 patients treated for
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