Management of Obesity: Review of Adjunctive Therapies and Clinical Management Pearls

Obesity remains one of the most prevalent and costly diseases in the United States and across the world. New therapies are available to treat obesity, and more are in the pipeline. Although lifestyle therapy by itself achieves only modest weight loss, the new generation of anti-obesity medications, endoscopic bariatric and metabolic therapies, and bariatric surgeries are highly effective for the treatment of obesity. Despite these therapies, the rate of obesity in the United States has remained stable. Multiple factors likely contribute to inadequate obesity treatment in the United States, including cost and insufficient health insurance coverage. However, even with improved health insurance coverage, the lack of access to care remains due to insufficient numbers of health care providers to prescribe anti-obesity medications and perform endoscopic or surgical procedures. Although most gastroenterologists have not received training specific to treating obesity, they are in a unique position to help fill this void, as the most effective obesity therapies are gut- or gut hormone-directed. This review outlines current obesity treatments; future therapies; and clinical pearls on obesity management medications, endoscopic bariatric and metabolic therapies, and bariatric and metabolic surgery.