Dr. Ken Fujioka, MD, prepared obesity infographics for this CME activity titled "Leveraging the Tools at Hand: Current Perspectives on Weight-Loss Pharmacotherapy for Obesity Management." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at https://bit.ly/2BOJ38x. CME credit will be available until September 22, 2021.

1. Current Recommendations for Obesity Management:
Focus on Weight-Loss Medications as Tools That Can Help With the Job
Many Pathways Regulate Food Intake1
Leptin
Eat (hunger) Stop eating
Hypothalamus
PancreasFat cells
POMC
Mesolimbic
system
0:
No apparent
risk factors
1:
Subclinical
risk factors
2:
Established
chronic
disease
3:
End-organ
damage
4: Severe
disabilities
Edmonton Obesity Staging System2,8,9
Anthropometric:
BMI, WC
Weight-related
complications
Physiologic Changes Make It Hard to Keep Weight Off1-7 Identifying Candidates
for Obesity Intervention2
Favor food
intake
Energy storage
Recommendations for
Weight-Loss Medication2,10
AACE
The Endocrine Society
Decreased energy expenditure
Obesity Medicine
Association
Amylin,
insulin
Dopamine
Norepinephrine
Motivated
reward eating
Dorsal vagal
complex
Hind brain
Stop eating
Hormone changes
(and many more)
GI tract
GLP-1
NPY
Treatment Treatment
Health
status
Leveraging the Tools at Hand: Current Perspectives on Weight-Loss Pharmacotherapy
for Obesity Management
Full references, accreditation, and disclosure information available at PeerView.com/QTC930

2. All contraindicated in pregnancy
Liraglutide
(LIRA)
3.0 mg
Phentermine/
topiramate ER
(PT)
Naltrexone ER/
bupropion ER
(NB)
LIRA
3.0 mg
PT
NB
ORL
1x/day
2x/day
1x/day
3x/day
Lipidexcretion(GItract)Appetiteregulation(CNS)
-8.8 -9.6
-8.1
-9.2
-4.3
-1.6 -1.8
-3.5
-25
-20
-15
-10
-5
0
ORL PT NB LIRA 3.0 mg
WeightLossFromBL,%
Agent Control
Medications Approved for Long-Term Use2,10-19
Weight Loss Over 1 Year2,20,21
Possible Adverse Effects2,10
Ap
proved Pharmacotherapi
es
Emerging
Therapies22-29
Know Your Tools: Specifics Regarding Current and Emerging Weight-Loss Pharmacotherapies
GI
Insomnia Dry mouth Dysgeusia
Raise BP Seizures
GI
GI
Decreased absorption
HowWhat When
Orlistat
(ORL)
Devices
Hormone-based medications
Leveraging the Tools at Hand: Current Perspectives on Weight-Loss Pharmacotherapy
for Obesity Management
Full references, accreditation, and disclosure information available at PeerView.com/QTC930

3. Coming Up With a Plan of Attack: Individualizing Treatment Plans and the Role of Shared Decision-Making
• Treatment
options
• Risks and
benefits
• Personal
preferences
• Values and
concerns
Physician
provides
Patient
provides
permission to discuss weight
obesity-related risks and causes of obesity
to help identify health and behavioral goals
on health risks and treatment options
with resource and provider access
Be
Positive
Environmentally
aware
Understanding
Helpful and
supportive
Aware of
nonverbal
communication
Collaborative
Smart
scales
eHealth Mobile
health
Wearable
technology
Lifestyle
not sufficient
Multiple
comorbidities
Medication
not working
Combat Stigma30-33
Talk To Your Patients About Obesity10 5As: Motivational Interviewing Technique34-36
Communication Technologies37-40
ASK
ADVISE
AGREE
ASSIST
ASSESS
Shared
decision
Patient Profiles
Telehealth
Leveraging the Tools at Hand: Current Perspectives on Weight-Loss Pharmacotherapy
for Obesity Management
Full references, accreditation, and disclosure information available at PeerView.com/QTC930

4. ADDITIONAL
RESOURCES
Current Recommendations for Obesity Management: Focus on
Weight-Loss Medications as Tools That Can Help With the Job
Full abbreviations, accreditation, and disclosure information available at PeerView.com/QTC
0:
No apparent
risk factors
1:
Subclinical
risk factors
2:
Established
chronic
disease
3:
End-organ
damage
4: Severe
disabilities
Treatment Treatment
Health
status
Edmonton Obesity Staging Scale1
Obesity Stage Description Stage-Based Treatment
0. Identify factors contributing to BW;
counsel on LSI for preventing BW gain
2. Initiate obesity treatments considering all options (eg, behavioral,
pharmacological, surgical); closely monitor and manage comorbidities
1. Investigate contributions, other than BW, to RF; more intense LSI;
monitor RF and health status
3. More intensive obesity treatment;
aggressive management of comorbidities
4. Aggressive obesity management, as feasible; palliative measures
(eg, pain management, occupational therapy, psychosocial support)
0. No medical or psychologic problems, despite patient
being 50-100 lb overweight
2. Established weight-related chronic disease
(eg, T2DM, prediabetes, dyslipidemia)
1. Weight-related problems become more apparent
3. End-organ damage (eg, diabetic neuropathy) develops
4. Mobility is significantly decreased, and medical problems are severe

5. ADDITIONAL
RESOURCES
Current Recommendations for Obesity Management: Focus on
Weight-Loss Medications as Tools That Can Help With the Job
Full abbreviations, accreditation, and disclosure information available at PeerView.com/QTC
1. Sharma AM, Kushner RF. Int J Obes. 2009;33:289-295. 2. Garvey WT et al. Endocr Pract. 2016;22(Suppl 3):1-203. 3. Apovian CM et al. J Clin Endocrinol Metab. 2015;100:342-362.
Recommendations for Initiating Long-Term Weight-Loss
Pharmacotherapy for Obesity Management2,3
For patients who have
ü Failure to lose weight or weight
regain on lifestyle therapy alone
ü Presence of weight-related
complications, particularly
if severe, to achieve sufficient
weight loss to ameliorate the
complication
American Association
of Clinical Endocrinologists
ü For patients with BMI ≥27 kg/m2
and ≥1 comorbidity or with
BMI >30 kg/m2
ü As adjunct to behavior
modification, to support reduced
food intake and increased
physical activity
ü For long-term treatment to
ameliorate chronic comorbidities
and support adherence to
behavior changes for weight
loss and maintenance
The Endocrine Society