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In the United States, obesity is a prominent concern. It is linked to heightened mortality rates due to increased occurrences of conditions such as hypertension, atherosclerosis, coronary artery disease, and diabetes compared to nonobese individuals. A patient is classified as obese if their actual body weight surpasses the ideal or desirable body weight by 20%, based on Metropolitan Life Insurance Company data. Ideal body weights consider average weights and heights for males and females...
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Obesity significantly alters the pharmacokinetic processes of drug absorption and distribution, presenting unique challenges in medical treatment. The increased fat tissue and decreased lean muscle in obese individuals can significantly affect how drugs are absorbed into the body and distributed across different tissues. This alteration can lead to variances in the effectiveness and safety of medications, necessitating adjustments in dosing or drug selection for obese patients.One notable...
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Bioavailability studies are essential for evaluating a drug's therapeutic efficacy and understanding its absorption patterns under various physiological conditions. Conducting such studies on target patient populations provides more relevant data by simulating real-world disease states. However, practical challenges often necessitate the use of young, healthy adult volunteers as study subjects.Patients may exhibit altered drug absorption patterns due to the effects of the disease itself,...
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Drug metabolism, a critical process in the liver, involves two primary phases: Phase I reactions and Phase II conjugation. Obesity introduces significant alterations in this metabolic process, primarily due to fatty infiltration of the liver, leading to conditions such as nonalcoholic fatty liver disease (NAFLD). This condition can modify the activities of both Phase I and II enzymes, impacting how drugs are metabolized in obese patients.Phase I metabolism sees variable effects across...
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Multidisciplinary Approach to Obesity Management: A Case Report
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Weight Loss in Underserved Patients - A Cluster-Randomized Trial.

Peter T Katzmarzyk1, Corby K Martin1, Robert L Newton1

  • 1From the Pennington Biomedical Research Center, Baton Rouge (P.T.K., C.K.M., R.L.N., J.W.A., K.D.D., E.F.M., P.J.B., W.D.J.), the Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport (C.L.A., T.C.D.), and Ochsner Clinic Foundation, Center for Outcomes and Health Services Research (E.G.P.-H.) and Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute (C.J.L.), Ochsner Clinical School-University of Queensland School of Medicine (E.G.P.-H., C.J.L.), the Department of Medicine, Division of Endocrinology and Metabolism (T.K.T., V.F.) and the Department of Medicine, Section of General Internal Medicine and Geriatrics (J.G.), Tulane University Health Sciences Center School of Medicine, Southeast Louisiana Veterans Health Care System (T.K.T., V.F.), the College of Pharmacy, Xavier University of Louisiana (K.B.K., D.F.S.), and the Department of Internal Medicine, Louisiana State University School of Medicine, and Program in Health Policy and Systems Management, Louisiana State University School of Public Health (B.S.), New Orleans - all in Louisiana.

The New England Journal of Medicine
|September 3, 2020
PubMed
Summary

A high-intensity lifestyle intervention significantly reduced weight in underserved populations within primary care settings. This obesity treatment program demonstrated clinically meaningful results over 24 months.

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Area of Science:

  • Public Health
  • Clinical Trials
  • Obesity Medicine

Background:

  • Limited evidence exists for obesity treatment effectiveness in underserved populations within primary care.
  • Primary care settings often serve low-income communities with high obesity prevalence.

Purpose of the Study:

  • To evaluate a high-intensity, lifestyle-based obesity treatment program in underserved primary care clinics.
  • To compare the effectiveness of this intensive program against usual care.

Main Methods:

  • A cluster-randomized trial involving 18 primary care clinics serving low-income populations.
  • Patients were assigned to either an intensive lifestyle intervention (diet, physical activity) or usual care.
  • The primary outcome was percent change in body weight at 24 months.

Main Results:

  • The intensive lifestyle group achieved significantly greater weight loss (-4.99%) compared to usual care (-0.48%) at 24 months.
  • The mean difference in weight loss between groups was -4.51 percentage points (P<0.001).
  • No significant differences in serious adverse events were observed between groups.

Conclusions:

  • A high-intensity, lifestyle-based obesity treatment delivered in underserved primary care settings leads to clinically significant weight loss.
  • This approach shows promise for managing obesity in resource-limited community health centers.