1. KORIN M. TRUMPIE Evidence Based Medicine Spring 2009

2. Pharmacotherapy and Obesity P: Overweight or obese adult patients with a BMI greater or equal to 30 I: Diet/exercise combined with pharmacotherapy C: Diet/exercise alone O: Greatest weight reduction In overweight or obese adult patients is diet/exercise combined with pharmacotherapy more successful than diet/exercise alone measured by weight reduction? Exercise defined as 30-45 minutes cardio at least 3x/week.

3. Introduction Greater than 1/5 of the world’s population is overweight or obese World population: 6.7 billion (July 2008 est.) 1/5 of 6.7 billion is 1.34 billion

4. Definitions Overweight: BMI greater or equal to 25 Obese: BMI greater or equal to 30 Obesity trends continue to increase

5. Possible Health Effects of Obesity: Osteoarthritis Hypertension Dyslipidemia Dyspnea Sleep Apnea Diabetes Coronary Heart Disease Stroke Depression

6. Current Therapy for Weight Loss Weight loss medications  Are often misunderstood and used improperly without guidance  Have a bad reputation due to side effects Diet plans  Requires a lifestyle change  Yo-yo diets are most popular and the least effective long-term Exercise programs  Requires a lifestyle change  Lack of monitoring or accountability Surgery  Most drastic measure- often last resort  Bariatric surgery or Lap-band

7. Weight loss is not an easy and takes work!!!! For a healthy quality of life it is a MUST!!!!

8. Health Benefits of Weight Loss A weight loss of 5-10% dramatically reduces the progression of Type 2 Diabetes A weight loss of 11% reduces cardiovascular disease and diabetes mortality by 25% For every 1kg of weight loss there is a decrease in:  Systolic BP by 0.68 mmHg  Diastolic BP by 0.34 mmHg  Total cholesterol by 0.06 mmol/L  LDL by 0.02 mmol/L  Triglycerides by 0.04 mmol/L

9. Where does pharmacotherapy fit in with weight loss?

10. Pharmacotherapy and Weight loss Weight loss medication recommendations:  BMI greater or equal to 30  BMI greater than 27 with obesity related comorbidities Used in combination with:  Nutrition education  Behavioral intervention  Diet and exercise lifestyle modification Commonly used weight loss meds:  Orlistat (Xenical)  Sibutramine (Meridia)

11. Pharmacotherapy and Weight loss Prior to beginning weight loss medications:  Encourage caloric intake reduction  Adopt healthy eating habits  Begin an exercise program Beneficial in patients who are not responsive to lifestyle modifications or in those who have reached a weight loss plateau

12. Systemic Review and Meta-Analysis of Weight Loss Clinical Trials 8 Types Weight loss interventions:  1. Diet alone  2. Diet and exercise  3. Exercise alone  4. Meal replacements  5. Very low energy diets  6. Orlistat  7. Sibutramine  8. Advice alone 80 studies were included in the analysis

14. Randomized Trial for Lifestyle Modification and Pharmacotherapy for Obesity Adults were randomized into 1 of 4 categories:  Sibutramine alone delivered by a PCP in 8 visits 10-15 minutes each  Lifestyle modification counseling alone delivered in 30 group sessions  Sibutramine plus 30 group sessions of lifestyle modification counseling (AKA: Combined therapy)  Sibutramine plus brief lifestyle modification counseling delivered by a PCP in 8 visits 10-15 minutes each

16. Application Addressing the issue of obesity is important in preventing secondary disease processes The addition of medication to a weight loss regime increases the amount of weight lost compared to diet and exercise alone To be most effective  pharmacotherapy and a weight loss regime must be combined with counseling and accountability

17. Applications The addition of a weight loss medication may “jump- start” an individual’s weight loss and increase their motivation for weight loss causing them to continue with their lifestyle modifications, healthy eating and exercise program

18. Weight Loss Medications

19. References Barnett, A. H. (2008). Pharmacotherapy as Part of a Weight Management Programme: A UK Perspective. The British Journal of Diabetes and Vascular Disease. Franz, M. J. (2007). Weight-Loss Outcomes: A Systemic Review and Meta-Analysis of Weight-Loss Clinical Trials with a Minimum 1-year Follow-Up. Journal of the American Dietetic Association. Huizinga, M. M. (2007). Weight Loss Pharmacotherapy: A Brief Review. Clinical Diabetes, 135-140. Sharma, A.M. (2008). A Weighty Issue. Canadian Family Physician, 498-499. Wadden, T.A., Berkowitz, R.I., & Womble, L.G. (2005). Randomized Trial of Lifestyle Modification and Pharmacotherapy for Obesity. The New England Journal of Medicine, 2111-2120.

20. Questions????