The Management of Obesity in 2023: An Update

Authors

  • Stephen A. Glazer, MD, FRCPC, FCCP, FAASM Bariatric Medical and Surgical Program, Humber River Hospital, Toronto, ON; Department of Medicine, Division of Endocrinology and Metabolism, Queen’s University; Department of Internal Medicine, University of Toronto

DOI:

https://doi.org/10.58931/cpct.2023.118

Abstract

In 2015, obesity was declared by the Canadian Medical Association (CMA) and other global health organizations (World Health Organization [WHO], World Obesity Federation and the American Medical Association [AMA]) to be a chronic, relapsing and remitting disease caused by the deposition of adipose tissue in organ systems within the body leading to dysfunction and adverse health outcomes. Obesity should be medically addressed no differently than other chronic illnesses such as diabetes, hypertension or coronary artery disease.

Author Biography

Stephen A. Glazer, MD, FRCPC, FCCP, FAASM, Bariatric Medical and Surgical Program, Humber River Hospital, Toronto, ON; Department of Medicine, Division of Endocrinology and Metabolism, Queen’s University; Department of Internal Medicine, University of Toronto

Dr. Stephen Glazer holds certification in Internal Medicine and Intensive Care Medicine from the University of Toronto in Ontario. He is also certified as a specialist in Sleep Medicine through the College of Physicians and Surgeons of Ontario. He has a strong interest in perioperative risk assessment.

Dr. Glazer is both a provincial and a national leader in Bariatric Medicine. In 2010, Dr. Glazer became the Medical Director for both the Bariatric Surgical and Medical Program at Humber River Hospital, a dedicated center of excellence for the management of Obesity in Ontario. He is an active board member of the Ontario Bariatric Network, sitting on numerous subcommittees, including being the Vice-Chair of the OBN Medical Program Task Force. He is involved in establishing the standards of care for patients in Ontario participating in both surgical and medical approaches for weight loss. In 2012, he was among one of the first Canadian physicians who successfully completed the American Board of Obesity Medicine (ABOM) Certification examination and is a diplomat of the ABOM.

In 2019, Dr. Glazer became the President of the Canadian Association of Bariatric Physicians and Surgeons (CABPS), an national organization representing Canadian specialists interested in the treatment of obesity for the purposes of maintenance and improvement for the standards of Bariatric care in Canada, supporting both primary and continuing educational programs, knowledge, research and developing policies and new ideas in the areas of clinical care, education, and research in Bariatric Medicine and Surgery.

Dr. Glazer participates in multiple clinical research projects and publications. He is the author of the Pre-Operative Management for Bariatric Surgery chapter for the 2020 Canadian Obesity Clinical Practice Guidelines. His greatest enjoyment is teaching and interreacting with other health care providers via lecturing at conferences or other educational venues. His enthusiasm and passion for the field of Obesity Medicine and the care of patients living with obesity is blatantly obvious and he hopes infectious to others.

References

World Health Organization. Obesity and overweight. World Health Organization. 2018 [updated 2021 Jun 9]. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.

Statistics Canada. Table 13-10-0096-20. Body mass index, overweight or obese, self-reported, adult, age groups (18 years and older). Statistics Canada. 2022 Aug 26. doi:10.25318/1310009601-eng

Twells LK, Gregory DM, Reddigan J, Midodzi WK. Current and predicted prevalence of obesity in Canada: A trend analysis. CMAJ Open. 2014;2(1): E18-E26. doi:10.9778/cmajo.20130016 DOI: https://doi.org/10.9778/cmajo.20130016

Elflein J. Percentage of Canadian adults that are overweight or obese based on BMI from 2015 to 2021. Statists. 2022 Sep 9. https://www.statista.com/statistics/748339/share-of-canadians-overweight-or-obese-based-on-bmi.

Public Health Agency of Canada. Tackling obesity in Canada: Childhood obesity and excess weight rates in Canada. Public Health Agency of Canada. 2017 Jan 22 [updated 2018 Feb 18]. https://www.canada.ca/en/public-health/services/publications/healthy-living/obesity-excess-weight-rates-canadian-children.html.

Public Health Agency of Canada. Obesity in Canada – Snapshot: Figure 2. Public Health Agency of Canada. 2009 Jun 26. https://www.canada.ca/en/public-health/services/reports-publications/obesity-canada-snapshot.html.

Public Health Agency of Canada. Obesity in Canada – Snapshot: Figure 3. Public Health Agency of Canada. 2009 Jun 26. https://www.canada.ca/en/public-health/services/reports-publications/obesity-canada-snapshot.html.

Statistics Canada. Obesity in Canadian Adults, 2016 and 2017. Statistics Canada. 2018 Oct 24 [updated 2019 Apr 26]. https://www150.statcan.gc.ca/n1/pub/11-627-m/11-627-m2018033-eng.htm.

Rao DP, Krupa E, Do MT, Roberts KC, Jayaraman GC. Childhood overweight and obesity trends in Canada. Heal Promot Chronic Dis Prev Can. 2016;36(9):194-8. doi:10.24095/hpcdp.36.9.03 DOI: https://doi.org/10.24095/hpcdp.36.9.03

Anis AH, Zhang W, Bansback N, Guh DP, Amarsi Z, Birmingham CL. Obesity and overweight in Canada: An updated cost-of-illness study. Obes Rev. 2010;11(1):31-40. doi:10.1111/j.1467-789X.2009.00579.x DOI: https://doi.org/10.1111/j.1467-789X.2009.00579.x

Public Health Agency of Canada. Obesity in Canada: Health and economic implications. Public Health Agency of Canada. 2011 Jun 10. https://www.canada.ca/en/public-health/services/health-promotion/healthy-living/obesity-canada/health-economic-implications.html.

World Obesity Atlas 2022. World Obesity Federation. 2022 Mar 4. https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2022.

Sharma AM, Padwal R. Obesity is a sign – over-eating is a symptom: an aetiological framework for the assessment and management of obesity. Obes Rev. 2010;11(5):362-70. doi: 10.1111/j.1467-789X.2009.00689.x DOI: https://doi.org/10.1111/j.1467-789X.2009.00689.x

Chesi A, Grant SF. The genetics of pediatric obesity. Trends Endocrinol Metab. 2015;26(12):711-21. doi:10.1016/j.tem.2015.08.008 DOI: https://doi.org/10.1016/j.tem.2015.08.008

Mathew B, Francis L, Kayalar A, Cone J. Obesity: effects on cardiovascular disease and its diagnosis. J Am Board Fam Med. 2008;21(6):562-8. doi:10.3122/jabfm.2008.06.080080 DOI: https://doi.org/10.3122/jabfm.2008.06.080080

Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003 Jan 1;289(1):76-9. doi:10.1001/jama.289.1.76 DOI: https://doi.org/10.1001/jama.289.1.76

Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, Zitman FG. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010 Mar;67(3):220-9. doi:10.1001/archgenpsychiatry.2010.2 DOI: https://doi.org/10.1001/archgenpsychiatry.2010.2

Parkin DM, Boyd L, Walker LC. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Br J Cancer. 2011 Dec 6;105(Suppl 2):S77-81. doi:10.1038/bjc.2011.489 DOI: https://doi.org/10.1038/bjc.2011.489

Catenacci VA, Hill JO, Wyatt HR. The obesity epidemic. Clin Chest Med. 2009 Sep;30(3):415-44, vii. doi:10.1016/j.ccm.2009.05.001 DOI: https://doi.org/10.1016/j.ccm.2009.05.001

Wang C, Jackson G, Jones TH, Matsumoto AM, Nehra A, Perelman MA, Cunningham G. Low testosterone associated with obesity and the metabolic syndrome contributes to sexual dysfunction and cardiovascular disease risk in men with type 2 diabetes. Diabetes Care. 2011 Jul;34(7):1669-75. doi:10.2337/dc10-2339 DOI: https://doi.org/10.2337/dc10-2339

Lauby-Secretan B, Vilahur N, Bianchini F, Guha N, Straif K. The IARC perspective on colorectal cancer screening. N Engl J Med. 2018 May 3;378(18):1734-40. doi:10.1056/NEJMsr1714643 DOI: https://doi.org/10.1056/NEJMsr1714643

Wolin KY, Carson K, Colditz GA. Obesity and cancer. Oncologist. 2010;15(6):556-65. doi:10.1634/theoncologist.2009-0285 DOI: https://doi.org/10.1634/theoncologist.2009-0285

Prospective Studies Collaboration; Whitlock G, Lewington S, et al. Body mass index and cause-specific mortality in 900 000 adults: Collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083-96. doi:10.1016/S0140-6736(09)60318-4 DOI: https://doi.org/10.1016/S0140-6736(09)60318-4

Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. J Am Med Assoc. 2003;289(2):187-93. doi:10.1001/jama.289.2.187 DOI: https://doi.org/10.1001/jama.289.2.187

Cefalu WT, Bray GA, Home PD, Garvey WT, Klein S, Pi-Sunyer FX, et al. Advances in the science, treatment, and prevention of the disease of obesity: reflections from a diabetes care editors’ expert forum. Diabetes Care. 2015;38(8):1567-82. DOI: https://doi.org/10.2337/dc15-1081

Brown J, Clarke C, Johnson Stoklossa C, Sievenpiper J. Canadian adult obesity clinical practice guidelines: medical nutrition therapy in obesity management. Obesity Canada. 2020 Aug 4 [updated 2022 Oct 21]. https://obesitycanada.ca/guidelines/nutrition.

Boulé NG, Prud’homme D. Canadian adult obesity clinical practice guidelines: physical activity in obesity management. Obesity Canada. 2020 Aug 4 [updated 2021 Mar 29]. https://obesitycanada.ca/guidelines/physicalactivity.

Vallis TM, Macklin D, Russell-Mayhew S. Canadian adult obesity clinical practice guidelines: effective psychological and behavioural interventions in obesity management. Obesity Canada. 2020 Aug 4. https://obesitycanada.ca/guidelines/behavioural.

Rucker D, Padwal R, Li SK, Curioni C, Lau DC. Long term pharmacotherapy for obesity and overweight: updated meta-analysis. BMJ. 2007 Dec 8;335(7631):1194-9. doi:10.1136/bmj.39385.413113.25 DOI: https://doi.org/10.1136/bmj.39385.413113.25

Pi-Sunyer X, Astrup A, Fujioka K, et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med. 2015 Jul 2;373(1):11-22. doi:10.1056/NEJMoa1411892 DOI: https://doi.org/10.1056/NEJMoa1411892

le Roux CW, Astrup A, Fujioka K, et al. 3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomized, double-blind trial. Lancet. 8 Apr 2017;389(10077):1399-409. doi:10.1016/S0140-6736(17)30069-7 DOI: https://doi.org/10.1016/S0140-6736(17)30069-7

Davies MJ, Bergenstal R, Bode B, et al. Efficacy of liraglutide for weight loss among patients with type 2 diabetes: the SCALE diabetes randomized clinical trial. JAMA. 2015 Aug 18;314(7):687-99. doi:10.1001/jama.2015.9676 DOI: https://doi.org/10.1001/jama.2015.9676

Greenway FL, Whitehouse MJ, Guttadauria M, et al. Rational design of a combination medication for the treatment of obesity. Obesity (Silver Spring). 2009 Jan;17(1):30-9. doi:10.1038/oby.2008.461

Greenway FL, Whitehouse MJ, Guttadauria M, et al. Rational design of a combination medication for the treatment of obesity. Obesity (Silver Spring). 2009 Jan;17(1):30-9. doi:10.1038/oby.2008.461 DOI: https://doi.org/10.1038/oby.2008.461

Booth K, Clements JN. Role of bupropion plus naltrexone for the management of obesity. J Pharm Technol. 2016 Jun;32(3):125-32. doi:10.1177/8755122515624220 DOI: https://doi.org/10.1177/8755122515624220

Friedrichsen M, Breitschaft A, Tadayon S, Wizert A, Skovgaard D. The effect of semaglutide 2.4 mg once weekly on energy intake, appetite, control of eating, and gastric emptying in adults with obesity. Diabetes Obes Metab. 2021 Mar;23(3):754-62. doi:10.1111/dom.14280 DOI: https://doi.org/10.1111/dom.14280

Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021 Mar 18;384(11):989-1002. doi:10.1056/NEJMoa2032183 DOI: https://doi.org/10.1056/NEJMoa2032183

Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA. 2021;325(14):1414-25. doi:10.1001/jama.2021.3224 DOI: https://doi.org/10.1001/jama.2021.3224

Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022 Jul 21;387(3):205-16. doi:10.1056/NEJMoa2206038 DOI: https://doi.org/10.1056/NEJMoa2206038

Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery. Surg Obes Relat Dis. 2022 Dec;18(12):1345-56. doi:10.1016/j.soard.2022.08.013 DOI: https://doi.org/10.1007/s11695-022-06332-1

Gondal AB, Hsu CH, Zeeshan M, Hamidi M, Joseph B, Ghaderi I. A frailty index and the impact of frailty on postoperative outcomes in older patients after bariatric surgery. Surg Obes Relat Dis. 2019 Sep;15(9):1582-8. doi:10.1016/j.soard.2019.06.028 DOI: https://doi.org/10.1016/j.soard.2019.06.028

Marceau P, Biron S, Marceau S, et al. Long-term metabolic outcomes 5 to 20 years after biliopancreatic diversion. Obes Surg. 2015 Sep;25(9):1584-93. doi:10.1007/s11695-015-1599-5. DOI: https://doi.org/10.1007/s11695-015-1599-5

Kapeluto JE, Tchernof A, Masckauchan D, Biron S, Marceau S, Hould FS, Lebel S, Lescelleur O, Julien F, Biertho L. Ten-year remission rates in insulin treated type 2 diabetes after biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis. 2020 Nov;16(11):1701-12. doi:10.1016/j.soard.2020.06.052 DOI: https://doi.org/10.1016/j.soard.2020.06.052

Enochs P, Bull J, Surve A, Cottam D, Bovard S, Bruce J, et al. Comparative analysis of the single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) to established bariatric procedures: an assessment of 2-year postoperative data illustrating weight loss, type 2 diabetes, and nutritional status in a single US center. Surg Obes Relat Dis. 2020 Jan;16(1):24-33. doi:10.1016/j.soard.2019.10.008 DOI: https://doi.org/10.1016/j.soard.2019.10.008

Nguyen NT, Kim E, Vu S, Phelan M. Ten-year outcomes of a prospective randomized trial of laparoscopic gastric bypass versus laparoscopic gastric banding. Ann Surg. 2018;268(1):106-13. doi:10.1097/SLA.0000000000002348 DOI: https://doi.org/10.1097/SLA.0000000000002348

Adams TD, Gress RE, Sherman SC, Halverson RC, Simper SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007 Aug 23;357(8):753-61. doi: 10.1056/NEJMoa066603 DOI: https://doi.org/10.1056/NEJMoa066603

Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-center, randomized controlled trial. Lancet. 2015;386(9997):964-973. doi:10.1016/S0140-6736(15)00075-6 DOI: https://doi.org/10.1016/S0140-6736(15)00075-6

Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes – 5-year outcomes. N Engl J Med. 2017;376(7):641-51. doi:10.1056/NEJMoa1600869 DOI: https://doi.org/10.1056/NEJMoa1600869

Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007 Aug 23;357(8):741-52. doi: 10.1056/NEJMoa066254 DOI: https://doi.org/10.1056/NEJMoa066254

Pedersen SD, Manjoo P, Wharton S. Canadian adult obesity clinical practice guidelines: pharmacotherapy for obesity management. Obesity Canada. 2022 Oct 21. https://obesitycanada.ca/guidelines/pharmacotherapy.

Downloads

Published

2023-03-28

How to Cite

1.
Glazer SA. The Management of Obesity in 2023: An Update . Can Prim Care Today [Internet]. 2023 Mar. 28 [cited 2024 May 15];1(1):24–30. Available from: https://canadianprimarycaretoday.com/article/view/1-1-4-Glazer

Issue

Volume 1, Issue 1, March 2023

Section

Articles

License

Copyright (c) 2023 Canadian Primary Care Today

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.