Jan 16, 2017
Obesity is of epidemic
proportions in the United States and, unfortunately, many
physicians are ill-equipped to tackle this disease. In this
episode, we talk with Dr. Timothy Garvey, MD, FACE, one of the
world’s leading experts in obesity research. We asked the
American Association of Clinical Endocrinology to recommend an
obesity expert and they gave us the best!
Got feedback? Email firstname.lastname@example.org
- Obesity is a DISEASE. Not a lifestyle
- Obesity is known to be associated with many of
the most common preventable diseases and, thus, should be an
important component of any treatment program.
goals differ between ethnic groups (for example, east Asians
developing heart disease with a BMI greater than 23).
- Weight loss treatment should focus on the
disease burden and not on body image.
diet and exercise are independently important, failure to address
the underlying sedentary lifestyle will likely prove fruitless.
The American College of Sports Medicine recommends avoiding
any sedentary activity greater than 90 minutes at a time and at
least 150 minutes of moderate activity weekly.
- Always ask permission before talking about
weight loss; otherwise, you might negatively impact the
order to prevent weight-related complications, aim for
approximately 10% weight loss.
- Weight regain is a REAL problem that should be
anticipated (decreased BMR, hormonal implications, and many other
issues); weight loss medications help to fight against these
- Weight loss medications (Orlistat [inhibits fat
absorption], Lorcaserine [5HT2C agonist, blunts appetite],
Liraglutide [GLP1-RA] at higher dosages [3mg/day],
Phentermine/Topiramate [“...most effective…”],
Naltrexone/Bupropion) are under-utilized across the board, but
before using these medications, the physicians should understand
how to use these medications and consider them as part of a weight
loss treatment plan that includes lifestyle modifications (i.e.
dietary assessment and exercise “prescription”).
- Liraglutide, Phentermine/Topiramate, and
Naltrexone/Bupropion are the most effective
the patient does not lose at least 5% of their weight by three
months, stop that specific medication and consider trying another
- Follow-up with your weight loss patients
frequently over the telephone (2 weeks after starting a medication)
and in the office (at least monthly).
- Minimal data supports using weight loss
medications in the elderly (>70 years of age)
Dr. Garvey’s “Take-Home” Points:
- Obesity is a DISEASE not a lifestyle
be afraid to use weight loss medications!
- Weight loss should be a tool to improve HEALTH,
Dr. Garvey reports several
financial disclosures for this talk:
- Scientific Advisory Board: Novo Nordisk,
Eisai, Janssen, Vivus, Liposcience, Takeda, Astra Zeneca, Alexion,
- Research Funding (university administered):
Merck, Astra Zeneca, Weight Watchers, Eisai, Sanofi, Pfizer,
Novo Nordisk, Lexicon, Elcelyx
Ownership (publicly traded): Eli Lilly, Pfizer, Novartis,
Merck, Isis, Bristol-Myers-Squibb, Affymetrix
By the end of this podcast
listeners will be able to:
- Understand the impact obesity has on overall
health and disease burden.
- Identify the weight loss medications and which
might be appropriate for your patient(s).
a general understanding of the impact that each individual
treatment modality (lifestyle modification, medications, and
surgery) has on weight loss.
Links from the show:
Timothy Garvey’s bio (UAB): https://www.uab.edu/medicine/diabetes/faculty/faculty-bios/111-w-timothy-garvey
Timothy Garvey’s app recommendation, “Lose It,” available
Timothy Garvey’s book recommendation: “House of God”
2016 Obesity Guidelines: https://www.aace.com/files/final-appendix.pdf
Obesity Treatment Algorithm (highly recommended):
- Naltrexone/Bupropion SR for Weight Loss:
Method-of-use study of naltrexone sustained release
(SR)/bupropion SR on body weight in individuals with obesity.
Obesity (Silver Spring).
2016 Dec 27. doi:
- Phentermine/Topiramine for Weight Loss (Review
Article): Combination phentermine and topiramate extended
release in the management of obesity. Expert Opin Pharmacother.
2015 Jun;16(8):1263-74. doi: