Obesity Care in Adolescents: Are We Screening for Comorbidities and Providing Anti Obesity Medications?

Background: In the United States, obesity impacts the health of over 20% of adolescents. As more data emerges on obesity and the associated adipose tissue dysfunction, updated screening and treatment guidelines for obesity and its related comorbidities have been published. (See Table 1). However, it is unclear if providers are adhering to these guidelines. Methods: We leveraged the TriNetX Research Network platform, a global federated network of electronic medical record data, to identify current national practice patterns for screening for lipid dysfunction, liver function abnormalities, and insulin resistance, and prescribing of anti-obesity medications. Additionally, we reviewed the prescription patterns of FDA approved and offlabel anti-obesity medications. Our cohort was defined as patients 14-18 years old, with three outpatient encounters between Jan 1, 2017 and March 1, 2020, and obesity, defined as BMI>30 or greater than the 95th percentile recorded on 3 separate outpatient encounters. The date cutoff was set in order to avoid the potential confounding effects of COVID-19 global pandemic. Exclusion criteria included a diagnostic code for lipid dysfunction, fatty liver, or insulin resistance prior to Jan 1, 2017 as well as any diagnosis of type 1 Diabetes. Screening for comorbidity of lipid dysfunction, fatty liver, and insulin resistance were defined by the presence of a total cholesterol, ALT, and Hgb A1C respectively. Results: The cohort included 31,017 patients that met all inclusion and exclusion criteria. The mean age of patients was 16. 56% of patient had an ICD-10 code of obesity in the chart. Screening rates for lipid dysfunction (Total Cholesterol), insulin resistance (Hgb A1c), and fatty liver (ALT) were 44%, 54%, and 41% respectively. Only 31% of patients were screened for all 3. When screened, 28% of patients had a Hgb A1C >5.7%, 22% had an ALT >45, and 13% had a total cholesterol >200. 9% of patients had prescriptions of anti-obesity medication including (Orlistat, Phentermine, Topiramate, Metformin, Liraglutide). The two most used medication were Metformin and Topiramate. However, when excluding individuals with ICD-10 codes for migraines (G40, G43, G44), prevalence of topiramate prescription decreased from 4% to 1%. Conclusion: Screening for obesity comorbidities continues to fall short of recommendations. Screening rates in our study occurred at about the same rates as previously reported in the literature (50- 60% for diabetes, 38-40% for lipid dysfunction, and 2-56% for liver disease). There is evidence to support the use of antiobesity medications in pediatric patients;however, we found that anti-obesity medication prescriptions remain limited nationally. To our knowledge, this is one of the largest studies to evaluate this issue in children. Further studies are warranted to explore the causes of low screening and treatment rates in adolescents with obesity and inform interventions.

A COMPARISON BETWEEN REAL WORLD WEIGHT LOSS OUTCOMES WITH ANTI-OBESITY MEDICATIONS BEFORE AND DURING COVID-19 PANDEMIC

Background: Obesity is a chronic and relapsing disease, with a rising prevalence and a high economic burden. Obesity is a risk factor for COVID-19 infection severity and mortality. Anti-obesity medications (AOMs) are safe and effective for weight loss. However, weight loss outcomes with AOMs during the COVID-19 pandemic are yet to be described. We hypothesized that weight loss outcomes with AOMs during COVID-19 are inferior to those before this period. Methods: We performed a systematic review of electronic medical record of patients from the Mayo Clinic Health System. We included all patients who started a long-term FDA-approved AOM (phentermine-topiramate extended release [PHEN-TOP], naltrexone-bupropion sustained release [NBSR], and liraglutide 3.0 mg). We excluded patients with a history of bariatric surgery or endoscopic procedure, those taking ≥2 AOMs, ≥3 months of prescribed AOM, and/or pregnancy. Demographic and anthropometric data were ed from in person or virtual encounters. Analysis was divided by 1) those who started an AOM at least a year before COVID-19 restrictions were set in place in the USA (i.e. first quarter of 2019 period or earlier, defined as “PreCOVID-19”), and 2) those who started an AOM during or after the first quarter of 2020, (defined as “COVID-19''). We calculated the total body weight loss percentage (TBWL%) at 3, 6, and 12 months after AOM initiation along with the percentage of patients who achieved a TBWL ³5% and ³10%, after one year of starting an AOM. Our primary endpoint was the TBWL% at 12 months. All tests were two-tailed and p-value <0.05 was considered statistically significant. Values are presented as mean ± standard deviation (SD). Results: A total of 249 patients were included in the analysis (77% female, age 48.8±12.6 years, body-mass index [BMI] 41.9±8.6 kg/m2). There were no differences in baseline characteristics between both groups (Table 1). Fifty-five percent of the patients were prescribed PHEN-TOP, 16% NBSR, and 29% liraglutide. There was a statistical difference in TBWL% between the PreCOVID-19 group compared to the COVID-19 group: 5.3±3.5% vs 4±3.7% (p=0.03) and 9.6±7% vs 6.5±5.3% (p=0.02) at 3 and 12 months, respectively (Fig. 1A). After 1 year follow-up, 53.6% of patients in the COVID-19 group achieved >5% TBWL compared with 75.3% in the PreCOVID-19 group (p=0.04), and 17.9% of patients in the COVID-19 group achieved 105% TBWL compared with 44.7% in the PreCOVID-19 group (p=0.01) (Fig. 1B). Conclusion: This study shows that weight loss outcomes to AOMs were inferior when prescribed during COVID-19 pandemic, compared to the outcomes observed prior to this. Further studies are needed to understand whether this observation is due to changes in care delivery during the pandemic or due to individual factors such as stress, decreased physical activity, remote working, among others.(Table Presented)Table 1. The demographic, antiobesity medications, and weight loss outcome distribution among patients Pre- and COVID-19.(Figure Presented) Figure 1. The weight loss outcomes of patients (Pre and COVID-19) after one year of AOM therapy (A). The distribution of patients (Pre and COVID-19) achieving >5% and >10% TBWL following one year of AOM (B).

Anti-Obesity Siddha Medicinal Plants-A Preclinical Review

Obesity is a complex multi factorial preventable disease affecting all age groups of both the sexes. Now one third of world’s population is overweight or obese. From 1980 the world-wide prevalence of obesity has become doubled. Overweight and obesity were the 5th foremost causes of death globally. Obesity is associated with many co morbid diseases. Prevalence of obesity with co morbidities is on big alarm throughout the world. Recently in COVID-19 pandemic most of the obese people get affected due to the co morbidities and reduced immunity. The anti-obesity properties of medicinal plants were known from ancient times in traditional Siddha medicine some thousand years ago. Many Siddha medicinal plants showed anti-obesity activities that can be utilized in the management of obesity, through which the complications of obesity can be prevented. Most researches explored the anti-obesity potentials of medicinal plants. Terminalia chebula, Phyllanthus niruri, zingiber officinale, Piper longum, Curcuma longa, Elettaria cardamomum, Cuminum cyminum, Picrorhiza kurroa, Ipomea turpethum, Tinospora cordifolia, Michelia champaka are some medicinal plants possess anti-obesity properties that had been indicated in Siddha classical text. The objective of this review is to validate the anti-obesity potentials of Siddha medicinal plants scientifically through various research reports. Due to the presence of Phyto compounds like phenols, flavonoids, terpenoids, alkaloids, anti-oxidants these medicinal plants revealed anti-obesity activities and its anti-obesity mechanism had been proven scientifically through various animal experimental studies collected from many research articles. Modern anti-obesity drugs produce numerous side effects. Regular consumption of Siddha anti-obesity medicinal plants, in the prescribed dose and duration, can induce gradual and sustainable weight loss effectively. Furthermore, in future, there is a need for the development of standardized, safe and effective anti-obesity drugs from medicinal plants and highly economical too. Hence eventually exploration of anti-obesity Siddha medicinal plants will lead to safe and effective treatment for obesity.