Medications and Obesity Exploring the Landscape and Advancing Comprehensive Care: Proceedings of a Workshop (2024) / Chapter Skim
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5 Integrating Nutrition, Physical Activity, and Medications into Obesity Treatment
5 Integrating Nutrition, Physical Activity, and Medications into Obesity Treatment
Pages 51-68
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From page 51... ...
(Dawkins, Jakicic) • Providers should discuss nutrition, exercise, and, when appropriate, AOM treatment and metabolic surgery with patients with obesity, but they are often constrained in doing so by lack of knowledge, time, and reimbursement.
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• Physical activity can improve fitness in patients on AOMs even in the presence of loss of lean mass and should be incorporated into obesity treatment plans. (Jakicic)
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Dawkins described how MNT providers can support patients by assessing nutrition status, hydration, access to a safe environment for physical activity, and access to food intake, including transportation to procure food. MNT can include support for the gut microbiome and gastrointestinal
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Although coverage gaps are common, some obesity medicine clinics have begun incorporating MNT for patients preparing for AOM treatment to foster patient understanding of what to expect once taking the medication and during the process of weight loss, she added. Dawkins highlighted two pieces of legislation intended to address gaps in coverage and expand access to obesity care.
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Supports should be put in place to help patients establish healthy habits, improve nutrition quality, and nurture a healthy relationship with food. She noted that medication may be a component of treatment, as appropriate.
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The magnitude of potential weight loss with AOM treatment has rapidly increased its popularity, which can lead to prescriptions without proper support, monitoring, or follow-up, potentially contributing to adverse health consequences. Anecdotal accounts of illness and death related to AOMs -- which are often amplified by media and social media -- exacerbate bias against obesity treatment.
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Food and activity logs can yield additional data for monitoring progress. Lifestyle modifications for obesity often focus on nutrition and physical activity, but sleep and stress management can also benefit patient health, she added.
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Often, MNT providers do not weigh patients, require them to maintain food logs, or engage in other activities focused on calorie and weight reduction. Instead, MNT providers support patients in developing awareness about the effects of different foods on how they feel.
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Physical Activity Considerations John Jakicic, University of Kansas Medical Center, outlined physical activity considerations in the context of AOM treatment. Despite the many potential benefits of GLP-1s and other contemporary AOMs -- such as weight loss, better control of type 2 diabetes, and reductions in cardiometabolic risk and adiposity -- they are also associated with reduced lean body mass.
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According to Jakicic, this indicates that physical activity should be incorporated into obesity treatment plans to improve parameters that weight loss alone will not change. Emphasizing the importance of differentiating lean mass from muscle mass, Jakicic explained that lean mass includes organ tissue, connective tissue, bone, and muscle.
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From page 61... ...
Despite these related diseases, the structures for medication and billing for obesity treatment services are based on BMI rather than health-related metrics, he added. Speculating on the future state of obesity treatment, Bessesen predicted that HEAOMs will eventually become widely prescribed and result in weight loss comparable to bariatric surgery but with a range of advantages, such as dose flexibility.
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From page 62... ...
Bessesen highlighted a set of additional knowledge gaps pertaining to HEAOMs that will need to be addressed, such as how to integrate older, less expensive, and less effective AOMs with HEAOMs in clinical care -- for example, whether to use a low dose of an HEAOM versus an older AOM if less weight loss is needed. Treatment considerations regarding the circumstances in which HEAOMs should be prescribed have yet to be determined, such as whether a person with a BMI of 30 and mild hypertension should be treated with an HEAOM or if this could result in too much weight loss.
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However, much work remains before this future is realized. Panel Discussion A panel discussion addressed metrics for assessing obesity treatment, monitoring weight loss for patients on HEAOMs, the potential influence of hormones on obesity treatment variability, resistance training considerations for patients with obesity, addressing obesity as a chronic disease in communications with patients, considerations for AOM discontinuation, and evidence gaps regarding obesity treatment.
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However, variability is also found in response to lifestyle modifications. He said that guidance is available for approaching physical activity for patients with PCOS, and this guidance could be applied to AOM treatment.
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Helping Patients View Obesity as a Chronic Disease Noting that many patients view obesity as "the need to lose a few pounds," Blankenship asked about approaches to helping patients understand that it is a chronic disease. She also asked whether markers other than weight loss could be helpful in monitoring and managing obesity.
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He also explains to patients that in addition to weight loss, AOMs offer potential benefits for cardiometabolic and musculoskeletal health. Jakicic commented that effective obesity treatment can delay or avoid joint replacements, and such musculoskeletal benefits should be considered in holistic treatment.
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Such data would support providers in adjusting medications to optimize health. Jakicic said that physical activity has long been described as a method of maximizing energy burn to support weight loss.
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Jakicic commented that the benefits of physical exercise cannot be attained through a medication. Providers should understand not only that a combination of medication and exercise is best for patients but also the barriers that patients may encounter in pursuing physical activity.
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