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Obesity

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Diagnosis Table 2. Comorbid Conditions in Obesity and Evidence for Amelioration with Weight Reduction Comorbidity Improvement After Weight Loss Type 2 diabetes mellitus (T2DM) Yes Hypertension (HTN) Yes Dyslipidemia and metabolic syndrome Yes Cardiovascular disease (CVD) Yes Nonalcoholic fatty liver disease (NAFLD) Variable outcomes Osteoarthritis Yes Cancer Yes Major depression Insufficient evidence Obstructive sleep apnea Yes Treatment Î Endocrine Society (ES) recommends that diet, exercise, and behavioral modification be included in all obesity management approaches for BMI ≥25 kg/m 2 and that other tools such as pharmacotherapy (BMI ≥27 kg/m 2 with comorbidity or >30) and bariatric surgery (BMI ≥35 kg/m 2 with comorbidity or >40) be used as adjuncts to behavioral modification to reduce food intake and increase physical activity when this is possible. Drugs may amplify adherence to behavior change and may improve physical functioning such that increased physical activity is easier in those who cannot exercise initially. Patients who have a history of being unable to successfully lose and maintain weight and who meet label indications are candidates for weight loss medications. (1|⊕⊕⊕⊕) Î In order to promote long-term weight maintenance, ES suggests the use of approved a weight loss medication (over no pharmacological therapy) to ameliorate comorbidities and amplify adherence to behavior changes, which may improve physical functioning and allow for greater physical activity in individuals with a BMI ≥30 kg/m 2 or in individuals with a BMI of ≥27 kg/m 2 and at least one associated comorbid medical condition such as hypertension, dyslipidemia, T2DM, and obstructive sleep apnea. (2|⊕⊕ ) a Approval in the United States is based on FDA determination. Approval in Europe is based on EMA determination.

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