SYMPTOM, SIGNS, SYNDROMES GLOSSARY
THIS IS A MULTI-ROLE ACTIVITY WHERE THE FOLLOWING ACTIVITIES ARE ENABLED :
1. SYMPTOM DIFFERENTIAL DIAGNOSIS
2. SIGNS DETAILED EXPLANATIONS
3. SYNDROME COLLECTION
4. MISCELLANEOUS ACTIVITIES
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OBESITY AND TIRZEPATIDE - MOUNJAROObesity is a serious chronic, progressive, and relapsing disease.1 Lifestyle interventions are a cornerstone of obesity management; however, sustaining weight reduction achieved through lifestyle-based caloric restriction is challenging. Therefore, current guidelines recommend adjunctive antiobesity medications to promote weight reduction, facilitate weight maintenance, and improve health outcomes in people with obesity.2-4 Randomized withdrawal studies of antiobesity medications to date have consistently demonstrated clinically significant body weight regain with cessation of therapy.5,6 There is also evidence that antiobesity medications, including long-acting glucagon-like peptide-1 (GLP-1) receptor agonists, naltrexone/bupropion, phentermine/topiramate, and orlistat, may help maintenance of achieved weight reduction.5,7-12 Tirzepatide is a single molecule that combines glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonism13 resulting in synergistic effects on appetite, food intake, and metabolic function.14-16 Tirzepatide is approved in many countries, including the US, EU, and Japan, as a once-weekly subcutaneous injectable for type 2 diabetes and for the treatment of obesity in the US and UK.16-18 In a placebo-controlled trial of participants with obesity or overweight without diabetes, tirzepatide led to mean reductions in body weight up to 20.9% after 72 weeks of treatment.17,18 The aim of the SURMOUNT-4 trial was to investigate the effect of continued treatment with the maximum tolerated dose (ie, 10 or 15 mg) of once-weekly tirzepatide, compared with placebo, on the maintenance of weight reduction following an initial open-label lead-in treatment period in participants with obesity or overweight articipants (n?=?670; mean age, 48 years; 473 [71%] women; mean weight, 107.3 kg) who completed the 36-week lead-in period experienced a mean weight reduction of 20.9%. The mean percent weight change from week 36 to week 88 was -5.5% with tirzepatide vs 14.0% with placebo (difference, -19.4% [95% CI, -21.2% to -17.7%]; P < .001). Overall, 300 participants (89.5%) receiving tirzepatide at 88 weeks maintained at least 80% of the weight loss during the lead-in period compared with 16.6% receiving placebo (P < .001). The overall mean weight reduction from week 0 to 88 was 25.3% for tirzepatide and 9.9% for placebo. The most common adverse events were mostly mild to moderate gastrointestinal events, which occurred more commonly with tirzepatide vs placebo. Conclusions and Relevance. In participants with obesity or overweight, withdrawing tirzepatide led to substantial regain of lost weight, whereas continued treatment maintained and augmented initial weight reduction. Aronne LJ, Sattar N, Horn DB, et al. Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA. 2024;331(1):38–48. doi:10.1001/jama.2023.24945 | |
Obesity Management1) Dieting 2) Physical activity 3) Risk factor management - diabetes, blood pressure, stress 4) Behavior modification techniques | |
Obesity Management by Cognitive RestructuringCognitive restructuring includes correcting all the myths, beliefs, ideas, fears, and concerns that are scientifically not acceptable. Some of the basic thought patterns obese people have are poor self-esteem, distorted body image, and unrealistic expectations of weight loss. For instance, scientific studies have found that realistic weight loss targets are 1 to 2 pounds for a week. In fact, to avoid all the bad health effects of obesity this target alone is more than adequate. Yet many obese people have weight loss targets which are not only unrealistic but bad for health as well. Distorted body image is where measurements do not tally with the beliefs and ideas. For instance, an obese person may feel that weight is low when in reality it is high. These faults can only be corrected by professional consultation and scientific approaches. | |
Obesity Management by Self MonitoringSelf-monitoring is the observation of target behaviors - like eating patterns, how and when urges to eat appear, weight recording, food records, calorie records, calorie expenditure records, and nutrient component recording that records the carbohydrate and fat consumption. Self-monitoring serves many purposes. It gives a baseline against which to evaluate the improvement of any actions taken. It creates an awareness which is essential for motivation. Further some findings at his stage may help complete other behavior modification techniques like stimulus control. | |
Obesity Management by Social SupportSocial support techniques in weight management include - family support for personal weight loss programs, reward, and moral encouragement to persist in dieting and exercising for weight management, peer support for social engagement organization with an emphasis on healthy nutrition, daily life activity patterns to minimize fast foods and frequent snacking, etc | |
Obesity Management by Stimulus ControlStimulus control in the management of obesity includes not eating while watching TV etc, not buying and keeping fast foods in the refrigerator, reminders for exercise, not attending parties temporarily, not getting involved in frequent get-togethers | |
Obesity Management by Stress ManagementStress is one of the main causes of relapse of overeating. Therefore advice on alternative stress management techniques is an essential component of any weight management system. See under stress management for details and techniques | |
OBESITY MEDICATIONSRetatrutide [GLPORA, GDIP, GRA] - 24% weight loss, 48 weeks Semaglutide [GLPORA] - Ozampic (1 mg), Wegovy (2.4 mg), - 15-20% weight loss Tirzepatide [GLPORA, GDIP] - Mounjaro - 14.7% weight loss at 72 weeks All quick weight loss medications may have the following adverse effects : The researchers used a random sample of 16 million patients from the PharMetrics Plus database between 2006 and 2020, a timeframe that covers the FDA approvals for weight-loss indication with liraglutide in 2014 and semaglutide in 2021. They ensured every case had an obesity code in the 90 days before or up to 30 days after entry into the study. Patients with a diabetes diagnosis or an antidiabetic drug code were excluded. Underscoring the implications of these potential AEs, Dr. Grunvald told Gastroenterology & Endoscopy News, “these adverse events are rare, but given the potential number of people that will use them, absolute numbers of serious adverse events will not be trivial.” Nevertheless, he added, “I also strongly believe, based on emerging data and my own clinical experience, the overall benefits outweigh these risks in general.” About two-thirds of adults who were prescribed an obesity medication stop taking them after 6 months, and 80% discontinued use at 1 year, according to a retrospective cohort study. Wegovy (semaglutide, Novo Nordisk) had the highest persistence rate, with 40% of people continuing use after 1 year. In its quarterly report, which was released on Tuesday, the agency revealed it is looking into p Semaglutide and liraglutide are both GLP-1 receptor agonists, whereas tirzepatide is a GIP/GLP-1 dual agonist, which has a different mechanism of action. | |
OBESITY UPDATES UNCLASSIFIEDProviders should make plant-based nutrition a central part of obesity treatment Vanita Rahman, MD, clinic director at Barnard Medical Center, Physicians Committee for Responsible Medicine, said anti-obesity medications and bariatric surgery can lead to significant weight loss for people with obesity, but they could also result in adverse events or be cost-prohibitive. Rahman said eating healthier and initiating a plant-based diet can be a less invasive method for people with obesity to lose weight. Key takeaways on the benefits of plant-based eating for people with obesity. Eating healthier is a key part of reducing the prevalence of obesity in the U.S., according to Rahman. According to data from the CDC, 42% of American adults are obese and 32% are overweight. The obesity prevalence is 22.2% for adolescents aged 12 to 19 years, 20.7% for children aged 6 to 11 years, and 12.7% for those aged 2 to 5 years. “The numbers are really alarming,” Rahman said. “Only one out of four Americans has a normal BMI as classified by the BMI scale. That means three out of four Americans are dealing with overweight or obesity. This is a really significant problem.” Concerns with medications, bariatric surgery Rahman also said there are several potential adverse events that can occur with GLP-1 receptor agonists, including gastrointestinal (GI) symptoms, an increase in lipase, an increased heart rate, and hypoglycemia when a GLP-1 receptor agonist is combined with other medications. Cost is also a concern, Rahman said, for example, once-weekly semaglutide costs an average of $1,616 per month. Rahman discussed similar concerns when reviewing data from the SURMOUNT-1 trial, where adults with obesity were randomly assigned to once-weekly tirzepatide or placebo for 72 weeks. Tirzepatide induced up to a 22.5% weight loss at 72 weeks for adults receiving the highest dose of 15 mg once weekly. However, Rahman said the side effect profile for tirzepatide is similar to semaglutide and includes GI symptoms, alopecia, loss of appetite, dizziness, injection site reaction, and cholecystitis. She also noted that tirzepatide costs $307 per dose. Rahman said bariatric surgery also confers significant weight loss for people with obesity. In a study published in Annals of Internal Medicine in 2018, Roux-en-Y gastric bypass was associated with a 31% weight loss at 1 year and 26% weight reduction at 5 years, sleeve gastrectomy induced a 25% weight loss at 1 year and a 19% weight reduction at 5 years, and an adjustable gastric band conferred a 14% weight loss at 1 year and 12% weight loss at 5 years. Despite the benefits, Rahman said, bariatric surgery can be invasive and requires postprocedural monitoring for malabsorption of nutrients. “We’re talking about a complex invasive surgery with short-term and long-term effects,” Rahman said. A focus on healthier eating Data from the CDC show that 41.8% of adolescents and 39.2% of adults eat less than one serving of fruit per day, and 40.7% of adolescents and 21% of adults eat less than one serving of vegetables per day. A study published in JAMA in 2021 revealed that 67% of daily calories consumed by youths in the U.S. in 2017-2018 come from ultra-processed foods. “Clearly, we have a lot of work to do,” Rahman said. “This is a public health disaster.” Changing to a low-fat, plant-based diet could confer benefits for people with obesity without medications or bariatric surgery, according to Rahman. In a study conducted by the Physicians Committee for Responsible Medicine and published in JAMA Network Open in 2020, adults with overweight who ate a plant-based diet for 16 weeks lost a mean of 6.4 kg of body weight compared with a 0.5 kg reduction for those eating a control diet. Another study published in the Journal of the American Nutrition Association in 2021 showed that adults eating a plant-based diet lost 6 kg of weight at 16 weeks compared with no weight change for adults eating a Mediterranean diet. Rahman said providers can promote healthier eating habits by instituting programs. She highlighted how the Physicians Committee for Responsible Medicine has a 12-week plant-based weight-loss program in which people attend 75-minute weekly online sessions with a physician and registered dietitian. The sessions include education, a cooking demonstration, and practical tips for participants. The Physicians Committee for Responsible Medicine also has a 12-week binge and emotional eating program in which attendees participate in weekly online sessions with a physician, clinical psychologist, and registered dietitian. The sessions include education, small-group breakout sessions, weekly homework, and practical tips. “This is not medical care, it’s coaching, education, and diet, so it’s much easier to run,” Rahman said. References: Barnard ND, et al. J Am Nutr Assoc. 2021;doi:10.1080/07315724.2020.1869625. Jastreboff AM, et al. N Engl J Med. 2022;doi:10.1056/NEJMoa2206038. Kahleova H, et al. JAMA Netw Open. 2020;doi:10.1001/jamanetworkopen.2020.25454.
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