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weight gain

Etiology: 1) accumulation of fat a) overeating b) lack of exercise c) genetic predisposition d) uncommon causes - hypothyroidism - Cushing's syndrome - hypothalamic disease - craniopharyngeoma 2) muscle hypertrophy due to strength-training exercise 3) accumulation of fluid a) congestive heart failure b) renal failure c) hepatic cirrhosis with ascites 4) late mealtimes facilitate weight gain [11] - decreases waketime energy expenditure - decreases 24-h core body temperature - decreases lipolysis - increases adipogenesis 5) pharmaceutical agents (see drugs associated with weight gain) Epidemiology: 1) readily available, tasty food 2) readily available exercise sparing devices - automobiles, elevators, escalators Complications: - excessive weight gain during early-middle adulthood associated with higher incidence of type 2 diabetes, hypertension, cardiovascular disease obesity-related cancers all-cause mortality later in life [4,6] Management: 1) diet, exercise, life style changes 2) life style weight reduction strategies including diet & exercise may help curb the obesity epidemic [3] 3) eating nuts is associated with less weight gain over time [5] 4) pharmaceutical agents (also see obesity) a) American Gastroenterological Association (AGA) recommends - semaglutide, liraglutide [2,7] - drug of choice despite no diabetes + irritable bowel syndrome (IBS-D) [12] - phentermine/topiramate extended-release (Qsymia) - phentermine/topiramate (15 mg/92 mg) for 1 year lowers BMI 10% [8] - hypertention & nephrolithiasis contraindications [12] - sustained-release naltrexone/bupropion ER [7,9] - insomnia is adverse effect thus relative contraindication [12] - orlistat (Xenical) only FDA-approved agent for adolescents - not recommended for children [10] - not recommended for adults by AGA [7] b) sibutramine (Meridia) c) phentermine (Fastin, Ionamin, Adipex) d) acarbose (Precose) may be useful

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drugs associated with weight gain obesity overweight weight loss

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sign/symptom

References

  1. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 245
  2. Medical Knowledge Self Assessment Program (MKSAP) 17, 18 American College of Physicians, Philadelphia 2015, 2018
  3. Wing RR, Tate DF, Espeland MA et al Innovative Self-Regulation Strategies to Reduce Weight Gain in Young Adults. The Study of Novel Approaches to Weight Gain Prevention (SNAP) Randomized Clinical Trial. JAMA Intern Med. Published online May 02, 2016 PMID: 27136493 http://archinte.jamanetwork.com/article.aspx?articleid=2517921 - Martin CK, Bhapkar M, Pittas AG et al Effect of Calorie Restriction on Mood, Quality of Life, Sleep, and Sexual Function in Healthy Nonobese Adults. The CALERIE 2 Randomized Clinical Trial. JAMA Intern Med. Published online May 02, 2016 PMID: 27136347 http://archinte.jamanetwork.com/article.aspx?articleid=2517920 - Moin T Obesity Management and Prevention. More Questions Than Answers. JAMA Intern Med. Published online May 02, 2016. PMID: 27135966 http://archinte.jamanetwork.com/article.aspx?articleid=2517918
  4. Zheng Y, Manson JE, Yuan C et al Associations of Weight Gain From Early to Middle Adulthood With Major Health Outcomes Later in Life. JAMA. 2017;318(3):255-269 PMID: 28719691 http://jamanetwork.com/journals/jama/article-abstract/2643761 - Dietz WH Obesity and Excessive Weight Gain in Young Adults. New Targets for Prevention. JAMA. 2017;318(3):241-242 PMID: 28719674
  5. Liu X, Li Y, Guasch-Ferre M et al Changes in nut consumption influence long-term weight change in US men and women. BMJ Nutrition, Prevention & Health. Sept 2019 Not indexed in PubMed https://nutrition.bmj.com/content/early/2019/08/27/bmjnph-2019-000034
  6. Chen C, Ye Y, Zhang Y et al Weight change across adulthood in relation to all cause and cause specific mortality: prospective cohort study. BMJ 2019;367:l5584 PMID: 31619383 Free Article https://www.bmj.com/content/367/bmj.l5584
  7. Haelle T AGA Releases Guidelines on Anti-Obesity Medications for Weight Management. Medscape. October 21, 2022 https://www.medscape.com/viewarticle/982851 - Grunval E, Shah R, Hernaez R et al AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity. Gastroenterology. 2022 163(5):1198-1225. November 2022 PMID: 36273831 https://www.gastrojournal.org/article/S0016-5085(22)01026-5/fulltext
  8. Kelly AS et al. Phentermine/topiramate for the treatment of adolescent obesity. NEJM Evid 2022 Apr 30; 1:EVIDoa2200014 PMID: 36968652 PMCID: PMC10035585 Free PMC article. https://evidence.nejm.org/doi/10.1056/EVIDoa2200014
  9. Greenway FL, Fujioka K, Plodkowski RA et al Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2010 Aug 21;376(9741):595-605. PMID: 20673995
  10. Young Y, Fairchild DG, Hefner JE Canadian Group Offers Guidelines on Managing Childhood Obesity in Primary Care. Physician's First Watch, March 31, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  11. Vujovic N et al. Late isocaloric eating increases hunger, decreases energy expenditure, and modifies metabolic pathways in adults with overweight and obesity. Cell Metab 2022 Oct 4; 34:1486 PMID: 36198293 https://www.cell.com/cell-metabolism/fulltext/S1550-4131(22)00397-7
  12. Khera R, Murad MH, Chandar AK, et al. Association of pharmacological treatments for obesity with weight loss and adverse events: a systematic review and meta-analysis. JAMA. 2016;315:2424-34. PMID: 27299618