The following article is part of conference coverage from the 2019 American Academy of Physician Assistants Annual Meeting (AAPA 2019) in Denver, Colorado. Clinical Advisor’s staff will be reporting breaking news associated with research conducted by leading physician assistants. Check back for the latest news from AAPA 2019.

 

Antiobesity medications (AOMs) are evidence-based tools used to treat obesity, and incorporating these agents into a patient’s routine may prevent further weight gain and obesity-related complications and improve existing comorbidities, according to research presented at the American Academy of Physician Assistants (AAPA) Annual Meeting, held May 19 to 22, 2019, in Denver, Colorado.

Amy Ingersoll, PA-C, MMS, and Sandra Christensen, MSN, ARNP, FNP-BC, presented a lecture titled, “The Art and Science of Prescribing Anti-Obesity Medications,” in which the authors sought to educate clinicians on the role of pharmacotherapy in obesity treatment. Topics covered included how to initiate, titrate, and monitor response to medications approved by the US Food and Drug Administration, including criteria for continuation and discontinuation.

AOMs are used to:

  • Treat the disease of obesity
  • Facilitate the management of eating behavior
  • Slow the progression of weight gain and regain
  • Improve the patient’s weight, health, and quality of life

AOMs work best when incorporated into a treatment plan that includes optimizing nutrition, engaging in physical activity, and behavior modification. Eligibility criteria for AOMs include having a body mass index >30 kg/m2 or having a body mass index >27 kg/m2 as well as additional comorbidities, including type 2 diabetes, hypertension, dyslipidemia, and obstructive sleep apnea.

AOMs work by regulating hormones in the brain, intestines, and adipose tissue. Each medication has its own mechanism of action. For example, phentermine/topiramate, a short-term treatment approved by the US Food and Drug Administration, works in the hypothalamus to suppress cravings and hunger, whereas bupropion/naltrexone targets appetite regulation and the reward system in the brain. Additional AOMs include orlistat, lorcaserin, and liraglutide.

To further educate clinicians on AOMs, the authors of the study created a 7-step prescribing guide, as follows:

  1. Determine whether the patient is a candidate for AOMs
  2. Consider the complications, comorbidities, symptoms, or other conditions that would benefit from a particular medication or medications
  3. Screen for contraindications
  4. Screen for medication interactions
  5. Discuss options with the patient
  6. Choose and initiate medication
  7. Monitor response

In a patient simulation case in which the authors applied the 7-step process, the patient example lost 19.4 pounds, reduced her hemoglobin A1C from 6.4% to 5.7%, reduced her fasting glucose from 132 mg/dL to 88 mg/dL, reduced triglycerides from 215 mg/dL to 72 mg/dL, increased her high-density lipoprotein from 45 mg/dL to 51 mg/dL, and decreased her low-density lipoprotein from 112 mg/dL to 110 mg/dL. The patient was able to exercise more frequently without pain, and she feels more in control of her eating behaviors.

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The Endocrine Society recommends discontinuing a medication and considering another if the patient has not achieved 5% weight loss by 3 months. However, the guidelines do not state that obesity is a chronic disease; therefore, treatment goals go beyond weight loss.

The authors suggest that before discontinuing AOMs, consider the following goals:

  • Maintaining additional weight loss
  • Preventing weight gain
  • Improving other conditions or comorbidities
  • Enhancing the patient’s quality of life

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Reference

Ingersoll Am, Christensen S. The Art & Science of Prescribing Anti-Obesity Medications. Presented at: The American Academy of Physician Assistants (AAPA) Annual Meeting; May 18-22, 2019; Denver, CO. Presentation DV9115.