Obesity is a substantial public health crisis in the United States and internationally, with the prevalence increasing rapidly in numerous industrialized nations.1 A report from the World Obesity Federation predicted that by 2035, over 4 billion people (51% of the world's population) will be classified as overweight or obese.2
Pharmacists and pharmacy technicians have recently become more important in the care of patients with obesity, owing to the rise in popularity and efficacy of weight-loss drugs. Pharmacists play a key role in helping patients understand treatment options and potential efficacy, providing administration guidance, and counseling about management of possible side effects. Pharmacy technicians can assist with navigating insurance benefits for weight-loss drugs and accessing medication assistance programs.
Among several classifications and definitions for degrees of obesity, the following is widely used:3
Individuals who are classified as overweight or obese are at increased risk for the following health conditions:
- Metabolic syndrome
- Type 2 diabetes
- Hypertension
- Dyslipidemia
- Coronary heart disease
- Osteoarthritis
- Stroke
- Depression
- Non-alcoholic fatty liver disease (NAFLD)
- Infertility (women) and erectile dysfunction (men)
- Risk of stillbirth4,5
- Gallbladder disease
- Obstructive sleep apnea
- Gastroesophageal reflux disease (GERD)
- Some cancers (eg, endometrial, breast, and colon)6-8
- Asthma
Possible factors in the development of obesity include the following:
- Metabolic factors
- Genetic factors
- Level of activity
- Endocrine factors
- Race, sex, and age factors
- Ethnic and cultural factors
- Socioeconomic status
- Dietary habits
- Smoking cessation
- Pregnancy and menopause
- Psychological factors
- History of gestational diabetes
- Lactation history in mothers
Behavioral modification for weight loss addresses learned behaviors that contribute to excessive food intake, poor dietary choices or habits, and sedentary activity habits.9
Diet
Conventional diets can be broadly classified into two categories: balanced, low-calorie diets (or reduced portion sizes) and diets with different macronutrient compositions.
Exercise
Among exercise programs, aerobic isotonic exercise is of the greatest value for persons who are classified as obese. The ultimate minimum goal should be to achieve 30-60 minutes of continuous aerobic exercise 5-7 times per week.10
Medications
Highly effective medications called glucagon-like peptide-1 (GLP-1) agonists have been approved for obesity treatment, and other novel agents are under investigation. Generally, the medications approved by the US Food and Drug Administration (FDA) for obesity are intended for patients with a BMI of 30 kg/m2 or more or of 27 kg/m2 or more with a weight-related risk factor (eg, diabetes, hypertension). All are indicated as adjuncts to caloric restriction, increased physical activity, and behavior modification.
Bariatric surgery
Surgical therapy for obesity (bariatric surgery) is associated with clinically significant and relatively sustained weight loss in persons with severe obesity associated with comorbidities.
Bariatric procedures include the following:
- Roux-en-Y gastric bypass
- Adjustable gastric banding
- Gastric sleeve surgery
- Vertical sleeve gastrectomy
- Horizontal gastroplasty
- Vertical banded gastroplasty
- Duodenal-switch procedures
- Biliopancreatic bypass
- Biliopancreatic diversion
For more in-depth information on this topic, visit Medscape’s reference on obesity.
References
- Roundtable on Obesity Solutions, Food and Nutrition Board, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine. Obesity in the Early Childhood Years: State of the Science and Implementation of Promising Solutions: Workshop Summary. 2016 May 23. Available at http://www.ncbi.nlm.nih.gov/books/NBK368372/.
- Reuters Staff. More Than Half of the World Will Be Overweight or Obese by 2035: Report. Reuters Health Information. 2023 Mar 3. [Full Text].
- Weir CB, Jan A. BMI Classification Percentile and Cut Off Points. StatPearls. 2023 Jun 26. [Medline]. [Full Text].
- Yao R, Ananth CV, Park BY, Pereira L, Plante LA, for the Perinatal Research Consortium. Obesity and the risk of stillbirth: a population-based cohort study [abstract]. Presented at: The 2014 SMFM Annual Meeting; February 3-8, 2014; New Orleans, LA. Am J Obstet Gynecol. 2014. 210:[Full Text].
- Hackethal V. Obese women may have 25% increased risk for stillbirth. Medscape Medical News. March 27, 2014. [Full Text].
- Jiao L, Berrington de Gonzalez A, Hartge P, Pfeiffer RM, Park Y, Freedman DM, et al. Body mass index, effect modifiers, and risk of pancreatic cancer: a pooled study of seven prospective cohorts. Cancer Causes Control. 2010 Aug. 21(8):1305-14. [Medline]. [Full Text].
- Kyrgiou M, Kalliala I, Markozannes G, et al. Adiposity and cancer at major anatomical sites: umbrella review of the literature. BMJ. 2017 Feb 28. 356:j477. [Medline]. [Full Text].
- US Centers for Disease Control and Prevention. Obesity and Cancer. CDC. Available at https://www.cdc.gov/cancer/risk-factors/obesity.html. November 7, 2023; Accessed: August 23, 2024.
- Van Dorsten B, Lindley EM. Cognitive and behavioral approaches in the treatment of obesity. Med Clin North Am. 2011 Sep. 95(5):971-88. [Medline].
- Jakicic JM, Marcus BH, Lang W, Janney C. Effect of exercise on 24-month weight loss maintenance in overweight women. Arch Intern Med. 2008 Jul 28. 168(14):1550-9; discussion 1559-60. [Medline]. [Full Text].
