Medications that cause weight gain and alternatives in Canada: a narrative review.

BACKGROUND: The cause of the obesity epidemic is multifactorial, but may, in part, be related to medication-induced weight gain. While clinicians may strive to do their best to select pharmacotherapy(ies) that has the least negative impact on weight, the literature regarding the weight effects of medication is often limited and devoid of alternative therapies. RESULTS: Antipsychotics, antidepressants, antihyperglycemics, antihypertensives and corticosteroids all contain medications that were associated with significant weight gain. However, there are several medication alternatives within the majority of these classes associated with weight neutral or even weight loss effects. Further, while not all of the classes of medication examined in this review have weight-favorable alternatives, there exist many other tools to mitigate weight gain associated with medication use, such as changes in dosing, medication delivery or the use of adjunctive therapies. CONCLUSION: Medication-induced weight gain can be frustrating for both the patient and the clinician. As the use of pharmaceuticals continues to increase, it is pertinent for clinicians to consider the weight effects of medications prior to prescribing or in the course of treatment. In the case where it is not feasible to make changes to medication, adjunctive therapies should be considered.

Optimizing Bariatric Surgery Multidisciplinary Follow-up: a Focus on Patient-Centered Care.

BACKGROUND: Failure to follow-up post-bariatric surgery has been associated with higher postoperative complications, lower percentage weight loss and poorer nutrition. OBJECTIVE: This study aimed to understand the patient follow-up experience in order to optimize follow-up care within a comprehensive bariatric surgery program. METHODS: Qualitative telephone interviews were conducted in patients who underwent surgery through a publically funded multidisciplinary bariatric surgery program in 2011, in Ontario, Canada. Inductive thematic analysis was used. RESULTS: Of the 46 patients interviewed, 76.1 % were female, mean age was 50, and 10 were lost to follow-up within 1 year postsurgery. Therapeutic continuity was the most important element of follow-up care identified by patients and was most frequently established with the dietician, as this team member was highly sought and accessible. Patients who attended regularly (1) appreciated the specialized care, (2) favoured ongoing monitoring and support, (3) were committed to the program and (4) felt their family doctor had insufficient experience/knowledge to manage their follow-up care. Of the 36 people who attended the clinic regularly, 8 were not planning to return after 2 years due to (1) perceived diminishing usefulness, (2) system issues, (3) confidence that their family physician could continue their care or (4) higher priority personal/health issues. Patients lost to follow-up stated similar barriers. CONCLUSION: Patients believe the follow-up post-bariatric surgery is essential in providing the support required to maintain their diet and health. More personalized care focusing on continuity and relationships catering to individual patient needs balanced with local healthcare resources may redefine and reduce attrition rates.

Effectiveness of a publicly funded clinical paediatric weight management program on obesity outcomes.

OBJECTIVE: To determine the effectiveness of a publicly funded, paediatric weight management clinic in decreasing obesity. METHODS: A retrospective chart review of patients four to 16 years of age, from 2006 to 2009, was performed at a medically supervised weight management clinic (n=121). Patients participated in monthly visits and were educated about the cognitive behavioural and nutritional aspects of weight management. RESULTS: The sample included 51 male and 70 female patients with a mean (± SD) initial age of 11.7±3.0 years. Patients participated in 6.4±6.5 visits (range one to 31 visits) over 13.7±15.5 months and 7.4% of patients discontinued treatment after their initial visit. Of the patients who attended the clinic >1 time, 66.1% attended for at least four months, 48.2% attended for >8 months and 33.0% attended for >1 year. Over the course of their treatment, patients experienced a weight gain of 3.8±9.5 kg, but a reduction in body mass index (BMI) percentile (-1.1±3.6%). Post-treatment, the prevalence of obesity decreased from 96.7% to 87.5%. Patients with longer treatment times (>12 months) attained significantly lower final BMI percentiles than patients with shorter treatment times; however, there was no difference in the rate of reduction. Initial treatment age, sex and medical conditions were not related to BMI percentile change. CONCLUSIONS: This paediatric weight management program effectively reduced the prevalence of obesity. Patients who had longer treatment times experienced greater reductions in obesity. Overall, the present study highlights that long-term patient attendance may be needed to better support paediatric weight management patients.

OBJECTIF: Déterminer l'efficacité d'une clinique pédiatrique publique de gestion du poids pour réduire l'obésité. MÉTHODOLOGIE: Les chercheurs ont effectué une analyse rétrospective des dossiers des patients de quatre à 16 ans dans une clinique de gestion du poids supervisée par des médecins (n=121), de 2006 à 2009. Les patients allaient à des rendezvous mensuels et recevaient de l'information sur les aspects cognitivo-comportementaux et nutritionnels de la gestion du poids. RÉSULTATS: L'échantillon était composé de 51 patients et de 70 patientes d'un âge initial moyen (± ÉT) de 11,7±3,0 ans. Les patients ont assisté à 6,4±6,5 rendezvous (plage de un à 31) répartis sur 13,7±15,5 mois, et 7,4 % d'entre eux ont mis un terme au traitement après leur premier rendezvous. Chez les patients qui avaient fréquenté la clinique plus d'une fois, 66,1 % l'avaient fait pendant au moins quatre mois, 48,2 %, plus de huit mois et 33,0 %, plus d'un an. Pendant la durée de leur traitement, les patients ont pris 3,8±9,5 kg, mais ont réduit leur percentile d'indice de masse corporelle (IMC, −1,1±3,6 %). Après le traitement, la prévalence d'obésité diminuait de 96,7 % à 87,5 %. Les patients traités plus longtemps (plus de 12 mois) obtenaient un percentile d'IMC final considérablement plus faible que ceux traités moins longtemps, mais on ne constatait pas de différence dans le taux de perte de poids. L'âge, le sexe et l'état de santé au début du traitement n'étaient pas liés au changement de percentile d'IMC. CONCLUSIONS: Ce programme pédiatrique de gestion du poids assurait une réduction efficace de la prévalence d'obésité. Les patients qui étaient traités plus longtemps devenaient moins obèses. Dans l'ensemble, la présente étude démontre qu'une participation plus longue au programme s'impose peut-être pour mieux soutenir la gestion du poids des patients d'âge pédiatrique.