Open Access
Feature Article

Adjunctive therapies for obesity: VLEDs, pharmacotherapy and bariatric surgery

Janet L. Franklin, Arianne N. Sweeting, ALICE A. GIBSON, Ian D. Caterson
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© africa studio/stock.adobe.com models used for illustrative purposes only
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Abstract

Although lifestyle interventions remain the cornerstone of obesity treatment, this article highlights additional approaches to management that may help reduce and maintain weight. These adjunctive therapies include the role of the multidisciplinary team in obesity management, and the use of very low energy diets, pharmacotherapy and bariatric surgery.

Key Points

  • Obesity is a multifactorial disease requiring a comprehensive and often diverse management approach to both the disease itself and its related comorbidities.
  • Adjunctive therapy, including pharmacotherapy and very low energy diets, can be used to aid weight loss and maintenance.
  • Multidisciplinary obesity clinics are best placed to address the complex causes of obesity and its related comorbidities.
  • Bariatric surgery should be considered for patients who have a body mass index (BMI) 40 kg/m2 and over or 35 kg/m2 and over with comorbidities.
  • Lifestyle intervention remains the cornerstone of treatment irrespective of the type of adjunctive therapy used.

Seeking effective solutions to obesity is arguably one of the greatest public health challenges currently facing Australia. Primary and community-based healthcare professionals are at the forefront of this challenge, often with limited time and resources to sufficiently address the multifactorial aspects of obesity management.

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In the June 2020 issue of Medicine Today, we focused on practical approaches to lifestyle interventions for the management of obesity.1 The cause of obesity, particularly for patients with a very high body mass index (BMI), is multifactorial (e.g. periods of inactivity, disordered eating, medical problems, medications, genetics, lifestyle, and physical and sexual abuse, etc.).2,3 It follows then that the management approach to obesity must address these many causes in addition to addressing obesity-related comorbidities. Although lifestyle interventions remain the cornerstone of obesity treatment, there are additional approaches to management, highlighted in this article, that may help reduce and maintain weight. These include the role of the multidisciplinary team in obesity management, in addition to the use of very low energy diets (VLEDs), pharmacotherapy and bariatric surgery. These adjunctive therapies should be considered when lifestyle interventions have failed to achieve sufficient weight loss or improvement in obesity-related comorbidities after a minimum of three months (Figure 1) or initially if the patient has obesity of grade II or above and psychological, financial and social barriers have been addressed.4 Ensuring the patient is ready to start adjunctive therapy is vital for success.

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© africa studio/stock.adobe.com models used for illustrative purposes only
© africa studio/stock.adobe.com models used for illustrative purposes only
Dr Franklin is a Senior Dietitian at Metabolism and Obesity Services, Royal Prince Alfred Hospital, Sydney. Dr Sweeting is an Endocrinologist at Royal Prince Alfred Hospital, Sydney and an NHMRC Early Career Fellow at the Boden Collaboration, The University of Sydney, Sydney. Dr Gibson is an NHMRC Emerging Leader Research Fellow at Menzies Centre for Health Policy, The University of Sydney, Sydney. Professor Caterson is the Boden Professor of Human Nutrition and Director of the Boden Collaboration at The University of Sydney, Sydney and an Endocrinologist at Royal Prince Alfred Hospital, Sydney, NSW.