Proceedings of a Workshop
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This activity was supported by the Academy of Nutrition and Dietetics; Alliance for a Healthier Generation; American Cancer Society; American Council on Exercise; American Society for Nutrition; Bipartisan Policy Center; Eli Lilly and Company; Found; General Mills, Inc.; The JPB Foundation; Mars, Inc.; Nemours Children’s Health System; Novo Nordisk; Obesity Action Coalition; Partnership for a Healthier America; Reinvestment Fund; Rudd Center for Food Policy and Health; Robert Wood Johnson Foundation; SHAPE America; Society of Behavioral Medicine; The Obesity Society; Trust for America’s Health; Wake Forest Baptist Medical Center; and Walmart. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2024. Medications and obesity: Exploring the landscape and advancing comprehensive care: Proceedings of a workshop. Washington, DC: National Academies Press. https://doi.org/10.17226/27940.
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PLANNING COMMITTEE ON MEDICATIONS AND OBESITY: EXPLORING THE STATE OF THE SCIENCE: A WORKSHOP1
IHUOMA ENELI (Co-Chair), Professor and Section Head, Children’s Hospital Colorado
NICOLAAS (NICO) P. PRONK (Co-Chair), President, HealthPartners Institute; Chief Science Officer, HealthPartners, Inc.; and Adjunct Professor, Harvard T.H. Chan School of Public Health
DAVID E. ARTERBURN, Senior Investigator, Kaiser Permanente Washington Health Research Institute; Manager, Washington Permanente Medical Group; and Affiliate Professor, University of Washington
JEANNE BLANKENSHIP, Vice President of Policy Initiatives and Advocacy, Academy of Nutrition and Dietetics
CHRISTINA R. CHOW, Head of Research, Emerald Lake Safety, LLC
LAURA HIGGINBOTHAM, Lead Physician, Division of Diabetes, Lipid Disorders, and Obesity, U.S. Food and Drug Administration
JOSEPH (JOE) NADGLOWSKI, President and CEO, Obesity Action Coalition
ANAND K. PAREKH, Chief Medical Advisor, Bipartisan Policy Center
KRISTEN R. SULLIVAN, Director, Prevention and Survivorship, American Cancer Society
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1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
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ROUNDTABLE ON OBESITY SOLUTIONS (AS OF MARCH 2024)2
NICOLAAS (NICO) P. PRONK (Chair), HealthPartners Institute and HealthPartners, Inc., Bloomington, Minnesota
CHRISTINA ECONOMOS (Vice Chair), Tufts University, Boston, Massachusetts
IHUOMA ENELI (Vice Chair), Children’s Hospital Colorado, Denver, Colorado
JAMY D. ARD, Wake Forest University, Winston-Salem, North Carolina
HEIDI MICHELS BLANCK, Centers for Disease Control and Prevention, Atlanta, Georgia
JEANNE BLANKENSHIP, Academy of Nutrition and Dietetics, Washington, DC
JAMIE BUSSEL, Robert Wood Johnson Foundation, Princeton, New Jersey
LAURIE FRIEDMAN DONZE, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
JENNIFER FASSBENDER, Reinvestment Fund, Philadelphia, Pennsylvania
AMENDA FISHER, Walmart, Bentonville, Arkansas
ALLISON GERTEL-ROSENBERG, Nemours Children’s Health System, Washington, DC
JAMIE GLONEK, Novo Nordisk, Plainsboro, New Jersey
J. NADINE GRACIA, Trust for America’s Health, Washington, DC
KAYLA JACKSON, The School Superintendents Association, Alexandria, Virginia
JOHN JAKICIC, American College of Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas
GABRIELLE N. JOHNSTON, American Council on Exercise, San Diego, California
PETER T. KATZMARZYK, Pennington Biomedical Research Center, Baton Rouge, Louisiana
REKHA KUMAR, Found Health Inc., New York, New York
THEODORE KYLE, The Obesity Society, Rockville, Maryland
BRUCE Y. LEE, City University of New York, New York, New York
KYLE MACDONALD, Alliance for a Healthier Generation, Portland, Oregon
MYETA MOON, United Way Worldwide, Alexandria, Virginia
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2 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
STEPHANIE MORRIS, SHAPE America, Reston, Virginia
JOSEPH NADGLOWSKI, JR., Obesity Action Coalition, Tampa, Florida
MELISSA NAPOLITANO, Society of Behavioral Medicine, The George Washington University, Washington, DC
PATRICIA NECE, Washington, DC
MEGAN NECHANICKY, General Mills, Inc., Minneapolis, Minnesota
ANAND K. PAREKH, Bipartisan Policy Center, Washington, DC
CHRIS T. PERNELL, National Association for the Advancement of Colored People, Washington, DC
BARBARA PICOWER, The JPB Foundation, New York, New York
MARGARET READ, Partnership for a Healthier America, Prince Frederick, Maryland
SYLVIA ROWE, American Society of Nutrition, SR Strategy, LLC, Washington, DC
MARLENE SCHWARTZ, The Rudd Center for Food Policy and Health, Hartford, Connecticut
STEPHANIE A. NAVARRO SILVERA, Montclair State University, Montclair, New Jersey
TRACY SIMS, Eli Lilly and Company, Indianapolis, Indiana
JESSICA SMITH, Mars Wrigley, Hackettstown, New Jersey
KRISTEN R. SULLIVAN, American Cancer Society, Decatur, Georgia
SUSAN Z. YANOVSKI, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
Staff
HEATHER DEL VALLE COOK, Roundtable Director
CYPRESS LYNX, Associate Program Officer
AMANDA NGUYEN, Program Officer
MEREDITH PARR, Research Assistant
ANN L. YAKTINE, Director, Food and Nutrition Board
Consultant
WILLIAM (BILL) H. DIETZ, The George Washington University, Washington, DC
Food and Nutrition Board Liaison
SHIRIKI KUMANYIKA, Drexel University, Philadelphia, Pennsylvania
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
DAVID E. ARTERBURN, Kaiser Permanente Washington Health Research Institute
CHRISTINE “CRISTY” GALLAGHER, STOP Obesity Alliance, The George Washington University
DANIEL S. HSIA, Emory University, Children’s Healthcare of Atlanta
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by JAMES O. HILL, University of Alabama at Birmingham. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies.
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Contents
2 CURRENT STATE OF PHARMACOKINETICS AND PHARMACOLOGY FOR OBESITY
Medications That Affect Weight Status
Altered Pharmacokinetics and Clinical Effects of Drugs in Patients with Obesity
Inclusion of Subjects with Obesity in Drug Development
Transformation: What Is to Come in the Pipeline of Anti-Obesity Medications
3 LIVED EXPERIENCES OF PHYSICIANS AND PATIENTS
Lived Experience as a Researcher: A Patient’s Perspective
“I Am More than my Body Mass Index”: A Patient’s Perspective
Weight Management Specialist: A Physician’s Perspective
4 MENTAL AND BEHAVIORAL HEALTH CONSIDERATIONS DURING OBESITY TREATMENT
Mental and Behavioral Health Concerns for Adults Using Anti-Obesity Medications
5 INTEGRATING NUTRITION, PHYSICAL ACTIVITY, AND MEDICATIONS INTO OBESITY TREATMENT
Obesity Treatment: Nutrition with Anti-Obesity Medications
Panel: Shifting the Paradigm to a Focus on Health Behaviors
6 EXPLORING OPPORTUNITIES AND BARRIERS FOR CLINICAL PRACTICE GUIDELINES
Adult Clinical Practice Guidelines (CPGs)
Pediatric CPGs for Anti-Obesity Medications
7 NAVIGATING ECONOMIC AND POLICY CHALLENGES OF NEW OBESITY TREATMENTS
Expanding Medicare Coverage for Anti-Obesity Medications
Federal Perspective on Expanding Coverage of Anti-Obesity Medications
The Employer Perspective: Ensuring Comprehensive Care for the Workforce
B Biographical Sketches of Workshop Speakers and Planning Committee Members
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Acronyms and Abbreviations
| AAP | American Academy of Pediatrics |
| ACS | American Cancer Society |
| ActRIIB | activin receptor type-2B |
| ADHD | attention-deficit/hyperactivity disorder |
| AOM | anti-obesity medication |
| BMI | body mass index |
| BRFSS | Behavioral Risk Factor Surveillance System |
| CBO | Congressional Budget Office |
| CDC | Centers for Disease Control and Prevention |
| CHIP | Children’s Health Insurance Program |
| CMS | Centers for Medicare & Medicaid Services |
| CNS | central nervous system |
| CPG | clinical practice guideline |
| DEXA | dual-energy X-ray absorptiometry |
| ED | eating disorder |
| FAM | Future Adult Model |
| FDA | U.S. Food and Drug Administration |
| GIP | gastric inhibitory polypeptide |
| GLP-1 | glucagon-like peptide 1 |
| HEAOM | highly effective anti-obesity medication |
| HHS | U.S. Department of Health and Human Services |
| IBT | intensive behavioral therapy |
| IBW | ideal body weight |
| IHBLT | intensive health behavior and lifestyle treatment |
| MIDD | model-informed drug development |
| MNT | medical nutrition therapy |
| NASH | nonalcoholic steatohepatitis |
| NHLBI | National Heart, Lung, and Blood Institute |
| NIH | National Institutes of Health |
| NuSH | nutrient-stimulated hormone |
| PCORI | Patient-Centered Outcomes Research Institute |
| PCOS | polycystic ovary syndrome |
| PCP | primary care provider |
| PHCP | pediatric health care provider |
| RCT | randomized controlled trial |
| SI | suicidal ideation |
| TROA | Treat and Reduce Obesity Act |
