Pharmacologic Approach to Obesity Management

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Abstract

LEARNING OBJECTIVES

After reading this article on obesity management, the family physician will be able to:

TARGET AUDIENCE

Family physicians and clinicians who wish to gain increased knowledge and competency regarding primary care management of obesity.

DISCLOSURES

The IAFP adheres to the conflict of interest policy of the ACCME and the AMA. It is the policy of the IAFP to ensure balance, independence, objectivity, and scientific rigor in all its educational activities. All individuals in a position to control the content in our programs are expected to disclose any relationships they may have with commercial companies whose products or services may be mentioned so that participants may evaluate the objectivity of the presentations. In addition, any discussion of off-label, experimental, or investigational use of drugs or devices will be disclosed by the faculty. Only those participants who have no conflict of interest or who agree to an identified resolution process prior to their participation were involved in the CME activity.

DISCLOSURES

Robert Kushner, MD, discloses that he is on the advisory board for Novo Nordisk Inc., WeightWatchers.com, Inc., and Zafgen, Inc. and on the speakers' bureau for Takeda Pharmaceuticals U.S.A., Inc. He has intellectual Property Rights in Retrofit Inc. and does contracted research for Aspire Bariatrics, Inc.

DISCLOSURES

Stephen Brunton, MD, discloses that he serves on the speakers' bureau for AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., and Teva Pharmaceuticals USA, Inc. He also serves as a consultant for Abbott Diabetes Care Inc., Actavis, Inc., AstraZeneca, Becton, Dickinson and Company, Boehringer-Ingelheim GmbH, Eli Lilly and Company, Exact Sciences Corporation, Janssen Pharmaceuticals, Inc., MEDA Pharmaceuticals Inc., Mylan Inc., Novo Nordisk Inc., and Teva Pharmaceuticals USA, Inc.

DISCLOSURES

Michael Hanak MD, CME reviewer, and Dana Randall, MS, PharmD, RPh, and Gregory Scott, PharmD, RPh, editorial support, have disclosed no relevant financial relationship or interest with a proprietary entity producing health care goods or services.

DISCLOSURES

IAFP and PCEC staff have disclosed no relevant financial relationship or interest with a proprietary entity producing health care goods or services.

CONFLICTS OF INTEREST

When individuals in a position to control content have reported financial relationships with one or more commercial interests, the IAFP works with them to resolve such conflicts to ensure that the content presented is free of commercial bias. The content of this activity was vetted by the following mechanisms and modified as required to meet this standard:

OFF-LABEL DISCLOSURES

In accordance with ACCME guidelines, the faculty author has been asked to disclose discussion of unlabeled or unapproved uses of drugs or devices during the course of the activity.

SPONSORSHIP

This activity is sponsored by the IAFP/ Family Practice Education Network and Primary Care Education Consortium.

SUPPORTER

This activity is supported by educational grants from Novo Nordisk, Inc. and Takeda Pharmaceuticals U.S.A., Inc.

ACCREDITATION

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of The Illinois Academy of Family Physicians/Family Practice Education Network and PCEC. The Illinois Academy of Family Physicians/Family Practice Education Network is accredited by the ACCME to provide continuing medical education for physicians.

AMA PRA CATEGORY 1

The Illinois Academy of Family Physicians/Family Practice Education Network designates this activity for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AMA PRA CATEGORY 1

Release Date: 10 Dec 2015

AMA PRA CATEGORY 1

Expiration Date: 9 Dec 2016

METHOD OF PARTICIPATION

PHYSICIANS

METHOD OF PARTICIPATION

To receive CME credit, please read the journal article and on completion, go to http://cme.iafp.com/ and click on “Pharmacologic Approach to Obesity Management” to complete the online evaluation and receive your certificate of completion.

PHYSICIAN ASSISTANTS

AAPA accepts certificates of participation of educational activities certified for AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

PHYSICIAN ASSISTANTS

CASE STUDY #1. JW is a 58-year-old man with a body mass index (BMI) of 38 kg/m2 (height, 177.8 cm; weight, 120 kg) who has lost 3.6 kg (3% body weight) since initiating lifestyle interventions 6 months ago. He is an information technology executive who travels extensively for work. He was referred to a registered dietitian who helped him develop strategies to reduce his portion sizes and make healthier choices at restaurants. When traveling, he has also been going to fitness centers at hotels a few times a week. JW takes esomeprazole 40 mg once daily for gastroesophageal reflux disease and occasionally takes sildenafil for erectile dysfunction. JW is eager to lose more weight, but he finds it difficult to make further lifestyle modifications.

PHYSICIAN ASSISTANTS

CASE STUDY #2. DS is a 61-year-old retiree who had a BMI of 38.5 kg/m2 (height: 166 cm; weight, 106 kg) when she was diagnosed with type 2 diabetes mellitus (T2DM) at which time she decided it was time to lose weight. Since joining Weight Watchers and starting a neighborhood walking group, DS lost 5.1 kg (4.8% of her initial body weight). After an additional 6 months of intensified lifestyle management that included monthly sessions with a registered dietitian and working with a personal trainer at her local YMCA, DS lost another 1.2 kg (1.1% of initial body weight). However, over the next 7 months, DS found it difficult to maintain her intensive lifestyle changes and regained 1.9 kg. Her primary care physician (PCP) subsequently prescribed orlistat 120 mg 3 times a day, which she took for 3 months, helping her to lose 1.6 kg. However, she experienced frequent defecation (sometimes with urgency). Her glycated hemoglobin A1c (HbA1c) was 9.2% at baseline (when she first implemented lifestyle interventions for weight loss) and has ranged from 7.2% to 7.8% during the past 14 months. Her HbA1 c is currently 7.4% and she is taking saxagliptin and metformin extended-release (ER) 5/1000 mg once daily. DS also has hypertension; her blood pressure is 134/82 mm Hg on enalapril and hydrochlorothiazide (10/25 mg once daily). Her current weight is 100 kg.

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