Fast Five Quiz: Modifiable Cancer Risk Factors

George D. Harris, MD, MS

Disclosures

July 26, 2019

According to the AACE and ACE guidelines, bariatric surgery should be considered in patients with a body mass index of ≥ 35 kg/m2 and one or more severe obesity-related complications. These complications include:

  • Type 2 diabetes mellitus

  • Hypertension

  • Obstructive sleep apnea

  • Obesity hypoventilation syndrome

  • Pickwickian syndrome

  • Nonalcoholic fatty liver disease or nonalcoholic steatohepatitis

  • Pseudotumor cerebri

  • Gastroesophageal reflux disease

  • Asthma

  • Venous stasis disease

  • Severe urinary incontinence

  • Debilitating arthritis

Patients with a body mass index of 30-34.9 kg/m2 who have diabetes or metabolic syndrome may also be considered for a bariatric procedure; however, long-term data are lacking.

Weight loss of 10%-40% may be needed to decrease hepatic inflammation, hepatocellular injury, and fibrosis in patients who are obese with nonalcoholic fatty liver disease. In addition to lifestyle modifications and caloric restrictions, orlistat, liraglutide, and bariatric surgery may help achieve necessary weight loss.

Behavioral lifestyle intervention and support should be increased in patients who are obese who do not achieve at least 2.5% weight loss during the first month of treatment. Early weight reduction is a key predictor of long-term weight loss.

Pharmacotherapy should be an adjunct to lifestyle modifications and should not be used alone for weight loss in patients who are obese. However, the addition of pharmacotherapy produces greater weight loss and better weight loss maintenance than lifestyle therapy alone.

Read more about the treatment of obesity.

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