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Fitch AK, Malhotra S, Conroy R. Differentiating monogenic and syndromic obesities from polygenic obesity: Assessment, diagnosis, and management. OBESITY PILLARS 2024; 11:100110. [PMID: 38766314 PMCID: PMC11101890 DOI: 10.1016/j.obpill.2024.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/22/2024]
Abstract
Background Obesity is a multifactorial neurohormonal disease that results from dysfunction within energy regulation pathways and is associated with increased morbidity, mortality, and reduced quality of life. The most common form is polygenic obesity, which results from interactions between multiple gene variants and environmental factors. Highly penetrant monogenic and syndromic obesities result from rare genetic variants with minimal environmental influence and can be differentiated from polygenic obesity depending on key symptoms, including hyperphagia; early-onset, severe obesity; and suboptimal responses to nontargeted therapies. Timely diagnosis of monogenic or syndromic obesity is critical to inform management strategies and reduce disease burden. We outline the physiology of weight regulation, role of genetics in obesity, and differentiating characteristics between polygenic and rare genetic obesity to facilitate diagnosis and transition toward targeted therapies. Methods In this narrative review, we focused on case reports, case studies, and natural history studies of patients with monogenic and syndromic obesities and clinical trials examining the efficacy, safety, and quality of life impact of nontargeted and targeted therapies in these populations. We also provide comprehensive algorithms for diagnosis of patients with suspected rare genetic causes of obesity. Results Patients with monogenic and syndromic obesities commonly present with hyperphagia (ie, pathologic, insatiable hunger) and early-onset, severe obesity, and the presence of hallmark characteristics can inform genetic testing and diagnostic approach. Following diagnosis, specialized care teams can address complex symptoms, and hyperphagia is managed behaviorally. Various pharmacotherapies show promise in these patient populations, including setmelanotide and glucagon-like peptide-1 receptor agonists. Conclusion Understanding the pathophysiology and differentiating characteristics of monogenic and syndromic obesities can facilitate diagnosis and management and has led to development of targeted pharmacotherapies with demonstrated efficacy for reducing body weight and hunger in the affected populations.
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Affiliation(s)
| | - Sonali Malhotra
- Harvard Medical School, Boston, MA, USA
- Rhythm Pharmaceuticals, Inc., Boston, MA, USA
- Massachussetts General Hospital, Boston, MA, USA
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Godziuk K, Hawker GA. Obesity and body mass index: Past and future considerations in osteoarthritis research. Osteoarthritis Cartilage 2024; 32:452-459. [PMID: 38354848 DOI: 10.1016/j.joca.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/12/2024] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Abstract
Obesity is an important topic for the osteoarthritis (OA) scientific community. However, the predominant use of body mass index (BMI) to define obesity in OA research is associated with uncertainties and limitations. These include an inability to discern fat and muscle mass, account for sex-differences in fat distribution, or identify adiposity-related health impairments. A focus on BMI in OA research may influence weight bias in clinical practice and impact disparities in access to effective OA treatments. To ensure that our understanding and approaches to improve health outcomes for individuals with or at risk for OA continues to advance in the next decade, future research will need to consider alternative measures beyond BMI for obesity identification and align with evolving obesity science. OA researchers must be aware of issues associated with weight stigma and work to minimize negative generalizations based on BMI.
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Affiliation(s)
- Kristine Godziuk
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB, Canada.
| | - Gillian A Hawker
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Abdi Beshir S, Ahmed Elnour A, Soorya A, Parveen Mohamed A, Sir Loon Goh S, Hussain N, Al Haddad AH, Hussain F, Yousif Khidir I, Abdelnassir Z. A narrative review of approved and emerging anti-obesity medications. Saudi Pharm J 2023; 31:101757. [PMID: 37712012 PMCID: PMC10497995 DOI: 10.1016/j.jsps.2023.101757] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/20/2023] [Indexed: 09/16/2023] Open
Abstract
Background Recently, many drugs have been approved for halting overweight and obesity-few types of research shifted to using Anti-obesity medications (AOM) solely for well-being and shape-keeping. Objective This narrative review's objective was to explore the use of AOM in relation to their medical indications, efficacy, and cardiovascular safety. Methods and materials We have conducted a narrative review of the literature on approved/non-approved AOM used for obesity and overweight. We have shed light on the emerging trials of therapies and evolving remedies. Results Recently, there has been an enormous change in the use of AOM with high consumption that deserves extensive surveillance for the long-term consequences and impact on social, mental, and physical health. Nearly six AOMs and combined therapy are approved by the Food and Drug Administration. The recent guidelines for obesity management have shifted the focus from weight loss to goals that the patient considers essential and toward targeting the root cause of obesity. Conclusion The use of AOM increased enormously despite its sometimes-dubious safety and ineffectiveness. The public and medical professionals should be vigilant to the real-world benefits of anti-obesity drugs and their achieved effectiveness with an improved safety profile.
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Affiliation(s)
- Semira Abdi Beshir
- Department of clinical pharmacy and Pharmacotherapeutics, Dubai Pharmacy College For Girls, Dubai, United Arab Emirates
| | - Asim Ahmed Elnour
- Program of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi Campus, United Arab Emirates
- AAU Health and Biomedical Research Centre, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Aadith Soorya
- College of Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | | | - Sheron Sir Loon Goh
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nadia Hussain
- Department of Pharmaceutical Sciences, College of Pharmacy, 105949, Al Ain University, Al Ain, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Amal H.I. Al Haddad
- Chief Operation Officer, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates
| | - Faizah Hussain
- Department of clinical pharmacy and Therapeutics, Dubai Pharmacy College, Dubai, United Arab Emirates
| | - Israa Yousif Khidir
- Department of Clinical Pharmacy and Pharmacy Practice, (PhD, MSc, B Pharm), College of Pharmacy, University of Hail (UOH), Saudi Arabia
| | - Zainab Abdelnassir
- Fourth-year pharmacy, Abu Dhabi, United Arab Emirates
- College of Pharmacy, Al Ain University, Abu Dhabi Campus, United Arab Emirates
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Phillips E, Traina A, Smolarz BG. A Survey of Obesity Education and Training in United States Pharmacy Schools. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100109. [PMID: 37597919 DOI: 10.1016/j.ajpe.2023.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/24/2023] [Accepted: 03/17/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE To assess how obesity is addressed in Doctor of Pharmacy (PharmD) schools and colleges, identify the extent to which core obesity competencies are covered in the curricula, and identify opportunities for expanding obesity management training. METHODS An online survey was conducted with PharmD program leaders in the United States. Respondents answered questions regarding obesity education in their pharmacy school curricula. Data were analyzed in aggregate, using descriptive statistics. RESULTS We collected responses from 75 of 150 (50%) PharmD programs. One-third (32%) of respondents thought their graduating students were very prepared to discuss obesity pharmacotherapy (anti-obesity medication) options with patients. A total of 45% reported obesity pharmacological treatment was covered to a great extent. Few respondents (19%) were very familiar with anti-obesity medications; 21% thought their students were similarly familiar. No programs covered weight stigma and discrimination to a great extent. Most respondents (88%) believed obesity education was fairly/very important to include in PharmD curricula, and 96% thought it was similarly appropriate to include. But 72% indicated that expanding obesity education was not a priority/low priority. Lack of room in the curricula was cited as the greatest barrier, with 60% of PharmD programs reporting this to be a large barrier. CONCLUSION Pharmacists, as medication experts, are key members of the care team. However, obesity management/pharmacotherapy is not emphasized in most pharmacy schools. Therefore, pharmacists are not well-prepared to provide counseling on medications for obesity. Leveraging guidance on core obesity competencies and available resources could help expand obesity education in pharmacy schools.
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Affiliation(s)
- Elizabeth Phillips
- St. John Fisher University, Wegmans School of Pharmacy, Rochester, NY, USA
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Wong G, Garner EM, Takkouche S, Spann MD, English WJ, Albaugh VL, Srivastava G. Combination anti‐obesity medications to effectively treat bariatric surgery weight regain at an academic obesity center. Obes Sci Pract 2023; 9:203-209. [PMID: 37287513 PMCID: PMC10242249 DOI: 10.1002/osp4.635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2023] Open
Abstract
AbstractBackgroundCombination anti‐obesity medications (AOMs) to treat postoperative bariatric surgery weight regain have limited data on their use in the clinical setting. Understanding the optimal treatment protocol in this cohort will maximize weight loss outcomes.MethodsA retrospective review of bariatric surgery patients (N = 44) presenting with weight regain at a single academic multidisciplinary obesity center who were prescribed AOM(s) plus intensive lifestyle modification for 12 months.ResultsAge: 28–76 years old, 93% female, mean weight 110.2 ± 20.3 kg, BMI 39.7 ± 7.4 kg/m2, presenting 5.2 ± 1.6 years post‐bariatric surgery [27 (61.4%), 14 (31.8%), and 3 (6.8%) laparoscopic Roux‐en‐Y gastric bypass (RYGB), laparoscopic vertical sleeve gastrectomy (VSG), and open RYGB, respectively], with 15.1 ± 11.1 kg mean weight gain from nadir. Mean weight loss after medical intervention at 3‐, 6‐, and 12‐month time points was 4.4 ± 4.6 kg, 7.3 ± 7.0 kg, and 10.7 ± 9.2 kg, respectively. At 12 months, individuals prescribed 3 or more AOMs lost more weight than those prescribed one (−14.5 ± 9.0 kg vs. −4.9 ± 5.7 kg, p < 0.05) irrespective of age, gender, number of comorbidities, initial weight or BMI, type of surgery, or GLP1 use. RYGB patients lost less weight overall (7.4% vs. 14.8% VSG respectively; p < 0.05).ConclusionsCombination AOMs may be needed to achieve optimal weight loss results to treat post‐operative weight regain.
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Affiliation(s)
- Gunther Wong
- Department of Medicine Division of Diabetes, Endocrinology & Metabolism Vanderbilt University School of Medicine Nashville Tennessee USA
- Vanderbilt Weight Loss Center Vanderbilt University Medical Center Nashville Tennessee USA
| | - Erica M. Garner
- Department of Medicine Division of Diabetes, Endocrinology & Metabolism Vanderbilt University School of Medicine Nashville Tennessee USA
- Vanderbilt Weight Loss Center Vanderbilt University Medical Center Nashville Tennessee USA
| | - Sahar Takkouche
- Department of Medicine Division of Diabetes, Endocrinology & Metabolism Vanderbilt University School of Medicine Nashville Tennessee USA
- Vanderbilt Weight Loss Center Vanderbilt University Medical Center Nashville Tennessee USA
| | - Matthew D. Spann
- Vanderbilt Weight Loss Center Vanderbilt University Medical Center Nashville Tennessee USA
- Department of Surgery Vanderbilt University School of Medicine Nashville Tennessee USA
| | - Wayne J. English
- Vanderbilt Weight Loss Center Vanderbilt University Medical Center Nashville Tennessee USA
- Department of Surgery Vanderbilt University School of Medicine Nashville Tennessee USA
| | - Vance L. Albaugh
- Metamor Institute Pennington Biomedical Research Center Baton Rouge Louisiana USA
| | - Gitanjali Srivastava
- Department of Medicine Division of Diabetes, Endocrinology & Metabolism Vanderbilt University School of Medicine Nashville Tennessee USA
- Vanderbilt Weight Loss Center Vanderbilt University Medical Center Nashville Tennessee USA
- Department of Surgery Vanderbilt University School of Medicine Nashville Tennessee USA
- Department of Pediatrics Vanderbilt University School of Medicine Nashville Tennessee USA
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Almughais ES, Alshehri MH, Alsatti M, Almatar A, Albladi FH, Almomatin HH, Alshammari NM, Alshammari R. Awareness and Perception of Anti-obesity Medications Among Al-Ahsaa, Riyadh, and Hail in Saudi Arabia Populations. Cureus 2023; 15:e40425. [PMID: 37456412 PMCID: PMC10348602 DOI: 10.7759/cureus.40425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Obesity is the most prevalent medical disease afflicting low-, middle-, and high-income nations. Hence, the use of anti-obesity drugs is gaining popularity as an adjuvant treatment for this medical condition, along with diet and lifestyle modifications. Different medications have been approved for the treatment of obesity. So, it is of the utmost importance to know the community's perception and awareness on that matter. METHODS An analytical, cross-sectional study design was adopted for this study. The data was collected by distributing an electronic questionnaire to adult males and females aged between 18 and 60 years living in Hail, Riyadh, and Al-Ahsaa, Saudi Arabia. The questionnaire consisted of three sections. The first section dealt with demographic data; the second section included items for measuring the awareness and general perception of anti-obesity medications; and the last section included one item used to recognize the reasons for refusing to take anti-obesity medications. RESULTS A total of 1073 participants from Al-Ahsaa, Hail, and Riyadh completed the questionnaire. Out of the total, 55.6% had an overall good awareness level about anti-obesity medications. Regarding information about the drugs, 77.6% think that there is a certain body mass index (BMI) that allows the use of these medications; 31.4% reported a BMI of > 40. In addition, most participants think that these drugs can make them lose 3-8 kg per year. However, 69.3% and 64.5% think that anti-obesity drugs increase the risk of pancreatitis and thyroid tumors, respectively. Lastly, factors that are associated with a good overall awareness level are: females, participants living in Riyadh, post-graduate degrees, and work in the health care field. CONCLUSION The overall awareness of anti-obesity drugs was good, particularly in Riyadh, the kingdom's capital. However, the majority of the individuals who had low awareness of these medications would not take them if their doctors prescribed them, mainly due to their concern about the treatment's side effects.
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Affiliation(s)
- Ebtehaj S Almughais
- Family and Community Medicine, University of Hail College of Medicine, Hail, SAU
| | - Manar H Alshehri
- College of Medicine, University of Hail College of Medicine, Hail, SAU
| | - Munirah Alsatti
- College of Medicine, University of Hail College of Medicine, Hail, SAU
| | - Amani Almatar
- College of Medicine, University of Hail College of Medicine, Hail, SAU
| | - Fatima H Albladi
- College of Medicine, University of Hail College of Medicine, Hail, SAU
| | - Heba H Almomatin
- College of Medicine, University of Hail College of Medicine, Hail, SAU
| | | | - Rozan Alshammari
- College of Medicine, University of Hail College of Medicine, Hail, SAU
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Vosburg RW, Chaar ME, Djouzi SE, Docimo S, Choi D, LaMasters T, Srivastava G, Shukla AP, Oviedo RJ, Fitch A, Azagury DE. Literature review on anti-obesity medication use for metabolic and bariatric surgery patients from the ASMBS clinical issues committee. Surg Obes Relat Dis 2022; 18:1109-1119. [DOI: 10.1016/j.soard.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022]
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Mah E, Chen O, Liska DJ, Blumberg JB. Dietary Supplements for Weight Management: A Narrative Review of Safety and Metabolic Health Benefits. Nutrients 2022; 14:nu14091787. [PMID: 35565754 PMCID: PMC9099655 DOI: 10.3390/nu14091787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 12/15/2022] Open
Abstract
Dietary supplements for weight management include myriad ingredients with thermogenic, lipotropic, satiety, and other metabolic effects. Recently, the safety of this product category has been questioned. In this review, we summarize the safety evidence as well as relevant clinical findings on weight management and metabolic effects of six representative dietary supplement ingredients: caffeine, green tea extract (GTE), green coffee bean extract (GCBE), choline, glucomannan, and capsaicinoids and capsinoids. Of these, caffeine, GTE (specifically epigallocatechin gallate [EGCG]), and choline have recommended intake limits, which appear not to be exceeded when used according to manufacturers’ instructions. Serious adverse events from supplements with these ingredients are rare and typically involve unusually high intakes. As with any dietary component, the potential for gastrointestinal intolerance, as well as possible interactions with concomitant medications/supplements exist, and the health status of the consumer should be considered when consuming these components. Most of the ingredients reviewed also improved markers of metabolic health, such as glucose, lipids, and blood pressure, although the data are limited for some. In summary, weight management supplements containing caffeine, GTE, GCBE, choline, glucomannan, and capsaicinoids and capsinoids are generally safe when taken as directed and demonstrate metabolic health benefits for overweight and obese people.
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Affiliation(s)
- Eunice Mah
- Biofortis Research, Addison, IL 60101, USA
- Correspondence:
| | - Oliver Chen
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA; (O.C.); (J.B.B.)
| | | | - Jeffrey B. Blumberg
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA; (O.C.); (J.B.B.)
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