Health state utilities associated with hyperphagia: Data for use in cost-utility models.

Objective: Rare genetic diseases of obesity typically present with hyperphagia, a pathologic desire to consume food. Cost-utility models assessing the value of treatments for these rare diseases will require health state utilities representing hyperphagia. This study estimated utilities associated with various hyperphagia severity levels. Methods: Four health state vignettes were developed using published literature and clinician input to represent various severity levels of hyperphagia. Utilities were estimated for these health states in a time trade-off elicitation study in a UK general population sample. Results: In total, 215 participants completed interviews (39.5% male; mean age 39.1 years). Mean (SD) utilities were 0.98 (0.02) for no hyperphagia, 0.91 (0.10) for mild hyperphagia, 0.70 (0.30) for moderate hyperphagia, and 0.22 (0.59) for severe hyperphagia. Mean (SD) disutilities were -0.08 (0.10) for mild, -0.28 (0.30) for moderate, and -0.77 (0.58) for severe hyperphagia. Conclusions: These data show increasing severity of hyperphagia is associated with decreased utility. Utilities associated with severe hyperphagia are similar to those of other health conditions severely impacting quality of life (QoL). These findings highlight that treatments addressing substantial QoL impacts of severe hyperphagia are needed. Utilities estimated here may be useful in cost-utility models of treatments for rare genetic diseases of obesity.

Increasing clinical awareness of obesity as a serious, chronic, relapsing, and treatable disease.

The American Medical Association recognized obesity as a disease in 2013. Obesity is influenced by genetic, environmental, physiologic, behavioral, and sleep factors and is associated with approximately 200 health conditions. Assessed using body mass index, body composition, and evaluation of weight-related complications, obesity is treated with lifestyle interventions, anti-obesity medications, and metabolic and bariatric surgery. The age-adjusted prevalence of overweight and obesity in US adults has increased substantially in the 21st century, from an estimated 56% in 1988-1994 to approximately 73.1% in 2017-2018. Nevertheless, there are substantial barriers to successful obesity treatment in the United States, including inadequate treatment coverage; a lack of acceptance by providers, patients, and employers that obesity is a disease; the perception that treatment is ineffective; and the belief that obesity is a behavioral concern related to a lack of willpower. Obesity is a serious, chronic, relapsing, and treatable disease associated with many related conditions; it requires long-term medical management and multimodal care strategies.

Obesity pillars roundtable: Phentermine - Past, present, and future.

Background: Phentermine is a sympathomimetic amine, approved for "short-term"treatment of patients with obesity. Among phentermine contraindications include use in patients with cardiovascular disease or patients with uncontrolled hypertension. Methods: This roundtable discussion includes perspectives from 3 obesity specialists with experience in the clinical use of phentermine. The questions asked of the panelists were derived from publications regarding phentermine safety and efficacy. Results: While the panelists generally agreed upon core principles of phentermine use, each obesity specialist had their own priorities and style regarding the administration of phentermine. Among the variances in perceptions (based upon their individual "real world" clinical experiences) included the degree of efficacy and degree of clinical benefit of phentermine, degree of concern regarding phentermine use in patients with cardiovascular disease risk factors, the advisability of a screening electrocardiogram, and the role of telehealth in prescribing phentermine and monitoring for the efficacy and safety of phentermine. Conclusions: Providing universal guidance regarding phentermine treatment for obesity is challenging because of the lack of long-term, prospective, randomized, placebo-controlled, health outcomes data. Such data is unlikely forthcoming any time soon. Also challenging are the substantial variances in governmental restrictions on phentermine use. Therefore, clinicians are left to rely on the best available evidence, their individual practical clinical experience, as well as the collective clinical experiences of others - as reflected by this roundtable.

Cancer and Obesity: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022.

Background: This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) provides an overview of cancer and increased body fat. Methods: The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results: Topics include the increased risk of cancers among patients with obesity, cancer risk factor population-attributable fractions, genetic and epigenetic links between obesity and cancer, adiposopathic and mechanistic processes accounting for increased cancer risk among patients with obesity, the role of oxidative stress, and obesity-related cancers based upon Mendelian randomization and observational studies. Other topics include nutritional and physical activity principles for patients with obesity who either have cancer or are at risk for cancer, and preventive care as it relates to cancer and obesity. Conclusions: Obesity is the second most common preventable cause of cancer and may be the most common preventable cause of cancer among nonsmokers. This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on cancer is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Patients with obesity are at greater risk of developing certain types of cancers, and treatment of obesity may influence the risk, onset, progression, and recurrence of cancer in patients with obesity.

Maintaining Weight Loss by Decreasing Sedentary Time: A Patient and Physician's Perspective.

This article, co-authored by a patient living with obesity and his obesity medicine specialist, reviews how the patient has successfully lost 200 lb and maintained that loss for over a decade. This was achieved primarily with a behavioral intervention including support visits, a structured food plan, and changes in his physical activity. He did not undergo bariatric surgery. For the majority of this time, he was not treated with anti-obesity medication. This article will review how the patient lost the weight and kept it off, particularly in relationship to the importance of decreasing sedentary time.