A complications-based clinical staging of obesity to guide treatment modality and intensity

Abstract

Purpose of review: The current medical model for obesity management is BMI-centric because BMI is the predominant measure used to gauge disease severity, as well as indications for various treatment modalities. Recent advancements in therapy and understanding of the relationship between BMI and obesity-related complications call for a re-examination of this approach.

Recent findings: Advancements in treatment, including the recent approval of two new weight loss medications in the USA, have enabled development of new medical models for management of obesity. On the basis of accumulating data demonstrating the benefits of weight loss regarding multiple obesity-related complications (e.g., diabetes prevention, type 2 diabetes mellitus, cardiovascular disease risk, nonalcoholic steatohepatitis, sleep apnea), a complications-centric model is proposed that employs weight loss as a tool to treat and prevent obesity comorbidities. This model assures that the aggressiveness of therapy is commensurate with disease severity, and that therapy is directed at those obese patients who will benefit most from weight loss therapy. The treatment algorithm is comprehensive in addressing complications and quantitative when possible in the staging of risk or disease severity.

Summary: A complications-centric approach to obesity management identifies patients who will benefit most from weight loss, and optimizes patient outcomes, benefit/risk ratio, and the cost-effectiveness of interventions.

Conflict of interest statement

Conflicts of interest

This work was supported by the Merit Review program of the Department of Veterans Affairs, the National Institutes of Health (DK-038765 and DK-083562), and the UAB Diabetes Research Center (P60-DK079626).

W.T.G. is a speaker for Merck, Amylin, and Liposcience. He is on the advisory boards of Daiichi-Sankyo, Vivus, Alkermes, Eisai, Liposcience, Tethys Bioscience, and Janssen. He receives research support from Merck, Amylin, and Weight Watchers. S.D. is a speaker for Vivus. T.S. is a speaker for Vivus.

Figures

FIGURE 1

Comprehensive obesity treatment algorithm (COTA). The figure illustrates the three steps of a complications-centric model for the management of obesity. In step 1, a comprehensive approach to the identification and staging of obesity-related complications is depicted using quantitative measures wherever possible. Step 2 indicates that weight loss therapy can be intensified, whether involving lifestyle modification or medications or bariatric surgery options, to achieve the targeted improvements in complications. Step 3 reflects the observation that there is a dose–response relationship between the amount of weight loss and the degree of improvement for multiple complications. GERD, gastroesophageal reflux disease; OSA, obstructive sleep apnea.