Pharmacologic and Surgical Management of Obesity in Primary Care: A Clinical Practice Guideline from the American College of Physicians

Abstract

This guideline is based on the evidence report and accompanying background papers developed by the Southern California Evidence-Based Practice Center. The American College of Physicians nominated this topic to the Agency for Healthcare Research and Quality Evidence-Based Practice Center program as part of a concerted effort to complement the guidelines of the U.S. Preventive Services Task Force. The College recommends that all clinicians refer to the Task Force recommendations as part of an overall strategy for managing overweight and obesity, which should always include appropriate diet and exercise for all patients who are overweight or obese. The intent of this guideline is to provide recommendations based on a review of the evidence on pharmacologic and surgical treatments of obesity. The target audience is all clinicians caring for obese patients, defined as a body mass index of 30 kg/m2 or greater. This guideline is not intended to be used by commercial weight loss centers or for direct-to-consumer marketing by manufacturers and does not apply to patients with body mass indices below 30 kg/m2.

Voltammetric determination of sibutramine in beverages and in pharmaceutical formulations

“…4 Appetite suppressors are no longer indicated due to its high potential to drug dependency. 5-hydroxytryptamine reuptake inhibitors such as fenfluramine and dexfenfluramine were approved for obesity, but they were immediately withdrawn from the market because they were associated with pulmonary hypertension and increasing of the incidence of heart valve disease.…”

Calcium Intake and Metabolic Bone Disease after Eight Years of Roux-en-Y Gastric Bypass

“…Although behavioral modification and/or pharmacotheraty have failed to effect significant sustained weight loss, bariatric surgery can result in sustained weight loss in the long term, as well as striking remission of many obesity-related comorbidities for most morbidly obese individuals [1]. The procedure associated with the best long-term weight loss is the Roux-en-Y gastric bypass (RYGBP), but this surgical technique promotes significant changes in the gastrointestinal anatomy, which will bring consequences in the nutritional and metabolic status in a short-and a long-term period [2].…”

Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data

“…Decreased caloric intake in the setting of increased physical activity has proven inadequate as a treatment for those patients with body mass index (BMI) [40 kg/m 2 , and medical treatments have been equally disappointing [10][11][12][13][14][15]. Accordingly, bariatric surgery has gained acceptance as the foremost (and perhaps only) durable treatment for morbid obesity.…”