A Guide to Selecting Treatment
{"Image DocumentName": "A Guide to Selecting Treatment", "Image ImageDescription": "Malabsorptive procedures: Jejunoileal Bypass. Restrictive procedures: Gastric Banding, Sleeve Gastrectomy. Combination procedures: Roux-en Y Gastric Bypass (RYGB), Biliopancreatic Diversion/Duodenal Switch >40. Surgery. Effective over time RYGB: One study showed up to \u226552% EWL at 10 years1. LAGB: One study showed up to 59% EWL at 8 years1. BMI (kg/m\u00b2) >30. Medications >27. (5% to 10% EWL, on average, when used with lifestyle changes)2,3. The clinical approach to overweight and obesity can be viewed as a pyramid consisting of several levels of therapeutic options. Treatments offered to patients should be a function of how much extra weight they have, as shown in the slide. In general, life style changes are recommended to persons with BMIs in the 25 to < 27 kg/m2 range. Weight loss medications (pharmacotherapy) are indicated for individuals with BMIs of 27 and above, depending on coexisting comorbidities. For moderate obesity, pharmacotherapy, sibutramine (Meridia) and orlistat (Alli, Xenical) results in very modest weight loss.4 Lifestyle modification also should be a component of pharmacotherapy and surgery. Optimal and continuous application of a combination of dietary and drug therapy in association with increased exercise and behavioral modification can, at best, achieve and maintain a 5\u201310% loss of body weight. For severely obese individuals, this is insufficient to solve the problem.3. Bariatric surgery is an option for patients with severe obesity, who have not responded to less-intensive interventions. Surgery is indicated for people with BMIs > 40 if no comorbidities are present or when their BMIs are > 35 with coexisting comorbidities. Surgery is not an alternative to lifestyle therapy or medications and is not a quick fix. Surgery or medication has to be combined with lifestyle changes to be successful.4 The number of obese patients who require a specific level of treatment decreases as one moves up to the surgery treatment option. All patients should be involved in an effort to change their lifestyle behaviors to decrease energy intake and increase physical activity. A malabsorptive procedure is a a procedure that interferes with ingested nutrient absorption and restrictive procedure as a procedure that restricts a person\u2019s ability to eat \u2013Fisher, et al., Amer J. Surgery, Ref 2. The Practical Guide Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Source: National Institutes of Health et al.  Accessed May18, 2009 [provides a guideline for selecting treatment_ found on page 25} Ref 3, Dixon et al., Diabetes Care, 2002, reports that combined medications and lifestyle changes can, at best, achieve 5-10% EWL, but does not segregate the statistics. Ref 4. Bhoyrul S. JMCM (4):10-17 JMCM=Journal of Managed Care Medicine) Diet. Exercise. Behavior modification. Comorbidity. + - Lifestyle Changes. (5% to 10% EWL, on average, when used with medication)1,2. National Institutes of Health et al.  Accessed May 18, O\u2019Brien PE, Mc Phail T, Chaston TB, et al. Systematic Review of Medium-Term Weight Loss after Bariatric Operations. Obes Surg ; 16: Dixon JB, O Brien PE. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care. 2002;25: Wierzbicki A. Rimonabant: endocannabinoid inhibition for the metabolic syndrome. Int J Clin Pract. 2006; 60 (12): Fisher BL, Schauer P. Medical and Surgical Options in the Treatment of Severe Obesity. The Amer Journ of Surg. 2002; 184 (6B): 9S-16S. Images taken from: Bhoyrul S., Lashock J. The Physical and Fiscal Impact of the Obesity Epidemic: The Impact of Comorbid Conditions on Patients and Payers. .JMCM :11(4):", "Image XResolution": "37", "Image YResolution": "37", "Image ResolutionUnit": "Pixels/Centimeter", "Image Software": "SlidePlayer", "Image YCbCrPositioning": "Centered"}