Approach to Obesity in the Elderly

Until recently, weight loss in the elderly obese was feared due to ensuing muscle loss and frailty. Facing overall increasing longevity, high rates of obesity in older subjects (≥65 years) and a growing recognition of the health and functional cost of the number of obesity years, abetted by evidence that intentional weight loss in older obese subjects is safe, this approach is gradually, but not unanimously, being replaced by more active principles. Lifestyle interventions that include reduced but sufficient energy intake, age-adequate protein and micronutrient intake, coupled with aerobic and resistance exercise tailored to personal limitations can induce weight loss with improvement in frailty indices. Sustained weight loss in this age can prevent/ameliorate diabetes. More active steps are controversial. The use of weight loss medications, particularly GLP-1 analogs (liraglutide as the first example), provides an additional treatment tier. Its safety and cardiovascular health benefits have been convincingly shown in elderly obese subjects with type 2 diabetes. In our opinion, this option should not be denied to obese subjects with prediabetes or other obesity-related comorbidities based on age. Finally, many reports now provide evidence that bariatric surgery can be safely performed in older subjects as the last treatment tier. Risk-benefit issues should be considered with extreme care and disclosed to candidates. The selection process requires good presurgical functional status, individualized consideration of the sequels of obesity and reliance on centers which are highly experienced in the surgical procedure as well as short and long term subsequent comprehensive care and support.

Unsuccessful Weight-Loss in Adults Admitted to Health Centers, Ahvaz, Khuzestan: A Phenomenological Study

Background: Nowadays, obesity is one of the most important public health problems worldwide. There are so many various factors interfering with obesity that it is necessary to be studied separately in each population. Although many people can lose weight by observing low-energy diets, they often return to the former weight and even higher. The present study aimed to identify the causes of unsuccessful weight-loss in adults admitted to health centers in Ahvaz. Methods: This was a qualitative phenomenological study carried out in one of the health centers in western Ahvaz, 2017. The data collection tool for this study was semi-structured in-depth interview conducted face-to-face and individually. The interviews were recorded and transferred word-by-word on paper immediately. Then interviews were analyzed using the content analysis method. Results: Seven themes and 11 key concepts were extracted from the contents of the interviews.The following items led to a failure of keeping the diet and achieving the proper weight: Underlying diseases, the effects of drugs on overweightness and obesity, physical characteristics, lifestyle, affecting overweight and obesity behaviors, food habits, and psychological factors. Conclusion: Lifestyle and some diseases and medications can lead to a failure of overweight and obesity confronting programs. Provision of the educational and informational programs to the society with emphasis on the side effects of weight loss medications and lifestyle changes, especially the dietary habits, together with a consideration of the mental health dimension may affect the success of people in controlling obesity.

Exploring the Role of Community Pharmacists in Weight Management in Qatar: A Mixed Methods study

Aim: Obesity is a major public health burden in Qatar. Pharmacists can play an important role in providing weight management services (WMS). This study aimed to explore the attitude, practice, perceived competence and role of community pharmacists in obesity and WMS in Qatar. Methods: A mixed-method explanatory sequential design was applied in the study. A validated online questionnaire was used followed by qualitative one-to-one interviews. Quantitative data were analyzed using Statistical Package of Social Sciences Version 24, while qualitative data were analyzed using thematic analysis. Results: Of 600 randomly selected community pharmacists, 270 completed the survey (response rate 45%). More than half of the pharmacists indicated that they often or always explain to patients the risks associated with overweight and obesity (56.2%), recommend weight loss medications, herbs or dietary supplements (52.4%), and counsel about their proper use and/or side effects (56.9%). Conversely, a large proportion of the pharmacists rarely or never measure patients’ waist circumference (83.8%) or calculate their body mass index (72.1%). Over 80% had very positive attitudes towards their role in weight management. Around three-quarters of the participants agreed or strongly agreed that difficulty in following-up with the patient (80.7%), lack of private consultation area (75.7%) and lack of pharmacist time (75.2%) are barriers for implementing WMS. More than 60% stated that they are fully competent in 7 out of 24 WMS related statements. Some emerging include pharmacist’s role and impact in weight management, need for training about weight management, impact of social media on patients’ perceptions, and adoption of best practices for WMS. Conclusion: Qatar pharmacists reported positive attitudes towards provision of WMS. However, they identified several barriers against provision of comprehensive weight management programs. Several strategies are proposed to overcome barriers and to improve provision of WMS in community pharmacies in Qatar.

Trends in pediatric obesity management, a survey from the Pediatric Endocrine Society Obesity Committee

BackgroundIn the United States, 18.5% of children are obese. Dietary and lifestyle modifications are key, but often ineffective. There are limited approved pediatric pharmacotherapies. The objective of this study was to evaluate current treatment practices for pediatric obesity among members of the Pediatric Endocrine Society (PES, n = 1300) and the Pediatric Obesity Weight Evaluation Registry (POWER, n = 42) consortium.MethodsA 10-question online survey on treatment of children with obesity in clinical practice was conducted.ResultsThe response rates were 19% for PES and 20% for POWER members. The majority were female (65%) and board certified in pediatric endocrinology (81%). Most practitioners saw 5–10 patients with obesity/week and 19% prescribed weight-loss medications. POWER participants were more likely to prescribe weight-loss medications than PES participants (46% vs. 18%, p = 0.02). Metformin was the most commonly prescribed medication. Response to medication was poor. Use of dietary non-pharmacological treatment options was uncommon. Over half of the respondents (56%) referred patients for bariatric surgery and 53% had local access to pediatric bariatric surgery.ConclusionsMetformin was the most common drug prescribed among respondents, but successful weight-loss responses were uncommon. Among practitioners who are using pharmacological interventions, therapeutic strategies vary widely. Targeted research in pharmacologic and surgical treatment for pediatric obesity is urgently needed.