The management of being overweight or type I obesity requires changes in eating habits and physical activity. The pharmacological management has been shown to be effective losing weight faster.
These two therapies (pharmacological and behavioral) allow promising long-term results.
There are multiple pharmacological options, currently the use of GLP-1 analogs have shown some of the best results regarding improvement in metabolic and mechanical comorbidity. The function of these analogs is to produce slow gastric emptying, a reduction in apatite, an increase feeling of fullness. As well as a reduction in the psychological connection to food.
To show how the use of GLP-1 analogs, together with changes in habits, have a favorable effect on overweight patients or patients with type 1 obesity that have regained weight after bariatric surgery.
MATERIALS AND METHODS
40 patients between the ages of 22 and 63, with a diagnosis of being overweight or morbidly obese, consulted the clinic for management of the Obesity between June 2018 and March 2019. All patients underwent interdisciplinary management with a nutritionist and body composition measurement by impedance analysis, physiatrist, behavioral psychologist and Liraglutide (starting with a dose of 0.6 to 3 mg sequentially). Monthly follow-ups were done to evaluate results, adhering to guidelines in order to monitor the presence of adverse symptoms.
Patients were thus distributed according to their BMI; overweight 17% (6) Obesity type I 64% (22) and obesity type II 17%. Five of them had previous bariatric surgery, Two sleeve gastrectomy and Three a gastric bypass. 29% (10) reached a top dose of 3 mg daily, 58% (24) used doses between 0.6 and 1.2 and 13% had doses between 1.8 and 2.4 g.
The most frequent adverse effects were constipation, diarrhea, skin reaction and rashes. The treatment lasted between 3 to 6 months. 58% of the patients lost 10 kg and 39% up to 15 kg. 3%> 20 kg. The percentage of visceral fat lost throughout the group was 10 to 20 cm and body fat between 3 to 7 kg. So far (after 9 months) none of these patients have regained weight after the medication was discontinued.
In the patients that did regain weight after bariatric surgery, emphasis was placed on alimentary measures resulting in a loss of 15% of the excess weight. Meaning it was not necessary to explore further surgical options. There was a 90% improvement in the metabolic profile with cholesterol lowering triglycerides, glycemia and transaminase levels in the first 3 months of follow-up. In addition to the improvement at the mechanical level, no patient presented with pain in their knees because with directed exercise and strengthening.
CONCLUSION The use of pharmacological measures associated with changes in alimetary habits, exercise and behavioral management of eating habits has been shown to be very effective in weight loss, the benefits of liraglutide in coadjuvant management have been evident compared to other pharmacological measures. This treatment must be performed with medical supervision and in a period of no more than 6 months.