New Tools for Weight-Loss Therapy Enable a More Robust Medical Model for Obesity Treatment: Rationale for a Complications-Centric Approach |
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| Affiliation: | 1. Internal Medicine Department, Carlos Haya Hospital, Malaga, Spain;2. CIBER Fisiopatologia de la Obesidad y la Nutricion (CB06/003), Malaga, Spain;3. Preventive Medicine Department, Malaga University, Malaga, Spain;4. Health Center “Ciudad Jardin,” Malaga, Spain;5. Research Laboratory, Internal Medicine Department, Carlos Haya Hospital, Malaga, Spain;6. Endocrinology and Nutrition Department, Virgen de la Victoria Hospital, Malaga, Spain;7. Biomedical Research Laboratory, Endocrinology and Nutrition Department, Virgen de la Victoria Hospital, Malaga, Spain;1. Department of Endocrinology, Tan Tock Seng Hospital, Singapore;2. Yong Loo Lin School of Medicine, Singapore;3. Duke-NUS Graduate Medical School, Singapore;4. Brenner Centre for Molecular Medicine, National University of Singapore, Singapore;1. Department of Internal Medicine, Section of Endocrinology, Paris, France;2. Department of Internal Medicine, Paris, France;3. Department of Ophthalmology, Fondation Ophtalmologique A. de Rothschild. Paris, France.;1. Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York;2. Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York;3. Division of Pediatric Otolaryngology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;4. Department of Radiology, Jacobi Medical Center, Bronx, New York.;1. Department of Diabetes and Endocrinology, Gold Coast Hospital, Queensland, Australia;2. School of Medicine, Griffith University, Queensland, Australia;3. Department of Neurology, Gold Coast Hospital, Queensland, Australia. |
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| Abstract: | ObjectiveRecent advances in lifestyle intervention programs, pharmacotherapy, and bariatric surgery have enabled the development of medical models for the treatment of obesity. Regarding pharmacotherapy, in 2012 the U.S. Food and Drug Administration approved two new effective and safe weight-loss medications, phentermine/ topiramate extended release and lorcaserin, which has greatly augmented options for medically assisted weight loss.MethodsThe rationale for advantages of a complications-centric medical model over current body mass index (BMI)-centric indications for therapy is examined.ResultsCurrently, the baseline BMI level is the principle determinant of indications for obesity treatment using medication and surgery. However, the BMI-centric approach fails to target therapy to those obese patients who will benefit most from weight loss. In contrast, a complications-centric medical model is proposed that will earmark the modality and intensity of the therapeutic intervention based on the presence and severity of complications that can be ameliorated by weight loss.ConclusionThe complications-centric approach to “medicalizing” obesity care employs weight loss primarily as a tool to treat obesity-related complications and promotes the optimization of health outcomes, the benefit/risk ratio, and the cost-effectiveness of therapy. (Endocr Pract. 2013;19:864-874) |
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