How to treat menopausal weight gain

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What can providers do to help patients manage their weight before and during menopause?

This is the question Kara Marlatt, MPH, PhD wanted to answer during her presentation at the North American Menopause Society (NAMS) Annual Meeting 2021: Triangulation of Weight Loss: Behavior, Medicine, and Surgery1.

There are things all clinicians need to know before implementing weight management in primary care. Factors that contribute to the body’s defended fat mass include abnormal diet, poor sleep, stress, sedentary lifestyle, and weight gain medication. “The body really wants to defend its current state,” said Marlatt. “For example, if you’ve just finished exercising, you might want to lie on the couch a little longer. There are systems that help the body to really defend this fat mass. “

So how do we combat this weight gain, especially the fat mass that occurs?

“The first line of defense is behavior change,” continued Marlatt. This includes promoting a healthy diet, regular physical activity, more and better sleep, stress relief, stable eating habits, and weight-stabilizing alternatives. Marlatt noted that these things may even need treatment before they can be successful.

Therapeutic options

In cases where behavior change alone seems insufficient, there are anti-obesity drugs that are available, Marlatt said. However, in severe cases, bariatric surgery can be considered.

Marlatt’s presentation outlined the various therapeutic options for obesity and weight management. As mentioned earlier, behavior modification should always be the treatment of first choice. Using a team-based approach and referring patients to RDs with weight management certification or even commercial programs such as WW, formerly known as Weight Watchers, can also prove successful. There are pharmacotherapeutic options for accompanying therapies.

For patients who need treatment beyond lifestyle changes, bariatric surgery may be the best course of action, but should be reserved for severe cases. In these cases it can result in a 30 to 40% weight loss.

The use of intense lifestyle interventions and older weight loss drugs like orlistat and liraglutide showed up to 10% weight loss. However, according to Marlatt, the older drugs had severe side effects. For example, bupropion increases blood pressure.

“Fortunately, GPs will be able to use new biological drugs more frequently over the next few years,” said Marlatt. “The good thing about these newer drugs is that they are derived from natural peptides that are more stable, not as readily degradable, and have extended-release properties.”

Semaglutide 2.4 mg weekly is one of the drugs that Marlatt sees as a big game changer, with an average weight loss of 15 to 17%. Phase 2 results for bimagrumab have just been published in JAMA network open2which showed significant results in reducing fat mass while increasing lean mass, which Marlatt said should be the primary target of the newer drugs on the market.

Marlatt drew attention to the underprescription of anti-obesity drugs, noting that only 1.3% of eligible people receive a prescription3.

What do your patients need in order to lose weight successfully?

Increasing physical activity beyond 2400 kcal / week has proven to be a successful tactic, as has maintaining dietary alertness and continued medication aimed at weight loss or factors related to increased energy intake and reduced energy expenditure

In her research, Marlatt found that social support and accountability were the primary need. “These women wanted other women like them who experienced the things they did. They wanted reassurance for the things they were feeling, ”said Marlatt.

The second need was more education about menopause. By having more information about what was going to happen, women felt empowered and in more control.

The current hurdles to prescribing are higher than desired, but Marlatt encourages doctors to be patient. “There will be a reimbursement approval for the next few years so just know they’re coming! We just have to be patient, ”she concluded.

References

  1. Marlatt, Kara. September 21, 2021. Triangulation Weight Loss: Behavior, Medicine, and Surgery [Session]. North American Menopause Society, Washington, DC
  2. Heymsfield SB, Coleman LA, Miller R. et al. Effect of bimagrumab vs. placebo on body fat mass in adults with type 2 diabetes and obesity: a phase 2 randomized clinical trial. JAMA network open. 2021; 4 (1): e2033457. doi: 10.1001 / jamanetworkopen.2020.33457
  3. Saxon DR, Iwamoto SJ, Mettenbrink CJ et al. Use of obesity drugs in 2.2 million adults in eight major health organizations: 2009-2015. obesity. 2019; 27 (12): 1975-1981. doi: 10.1002 / oby.22581


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