Section 2.4 Organ-Specific, Hormonal, and Mechanical Complications

Key Points

  • Numerous organ-specific and biomechanical complications accompany obesity
  • Weight loss ameliorates all of these conditions

AACE/ACE Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity Recommendations1

Sex Hormone–Related Disorders

Polycystic Ovary Syndrome (PCOS)

  • R48. Women with overweight or obesity and PCOS should be treated with lifestyle therapy with the goal of achieving 5% to 15% weight loss or more to improve hyperandrogenism, oligomenorrhea, anovulation, insulin resistance, and hyperlipidemia; clinical efficacy can vary among individual patients.
  • R49. Patients with overweight or obesity and PCOS should be considered for treatment with orlistat, metformin, or liraglutide, alone or in combination, because these medications can be effective in decreasing weight or improving PCOS manifestations, including insulin resistance, glucose tolerance, dyslipidemia, hyperandrogenemia, oligomenorrhea, and anovulation.
  • R50. Selected patients with obesity and PCOS should be considered for laparoscopic Roux-en- Y gastric bypass to improve symptomatology, including restoration of menses and ovulation.

Female Infertility

  • R51. Weight loss is effective to treat infertility in women with overweight and obesity and should be considered as part of the initial treatment to improve fertility; weight loss of ≥ 10% should be targeted to augment the likelihood of conception and live birth.

Male Hypogonadism

  • R52. Treatment of hypogonadism in men with increased waist circumference or obesity should include weight-loss therapy. Weight loss of more than 5% to 10% is needed for significant improvement in serum testosterone.
  • R53. Bariatric surgery should be considered as a treatment approach that improves hypogonadism in most patients with obesity, including patients with severe obesity (body mass index [BMI] >50 kg/m2) and type 2 diabetes (T2D).
  • R54. Men with true hypogonadism and obesity who are not seeking fertility should be considered for testosterone therapy in addition to lifestyle intervention because testosterone in these patients results in weight loss, decreased waist circumference, and improvements in metabolic parameters (glucose, A1C, lipids, and blood pressure).

Pulmonary Disorders: Obstructive Sleep Apnea (OSA) and Asthma

  • R55. Patients with overweight or obesity and obstructive sleep apnea should be treated with weight-loss therapy including lifestyle interventions and additional modalities as needed, including phentermine/topiramate extended release (ER) or bariatric surgery; the weight-loss goal should be at least 7% to 11% or more.
  • R56. Patients with overweight or obesity and asthma should be treated with weight loss using lifestyle interventions; additional treatment modalities may be considered as needed including bariatric surgery; the weight-loss goal should be at least 7% to 8%.

Biomechanical Disorders

Osteoarthritis (OA)

  • R57. Patients with overweight or obesity and OA involving weight-bearing joints, particularly the knee, should be treated with weight-loss therapy for symptomatic and functional improvement and reduction in compressive forces during ambulation; the weight-loss goal should be ≥ 10% of body weight. A physical activity program should also be recommended in this setting because the combination of weight-loss therapy achieving 5% to 10% loss of body weight combined with physical activity can effectively improve symptoms and function.
  • R58. Patients with overweight or obesity and OA should undergo weight-loss therapy before and after total knee replacement.

Urinary Stress Incontinence

  • R59. Women with overweight or obesity and stress urinary incontinence should be treated with weight-loss therapy; the weight-loss goal should be 5% to 10% of body weight or greater.

Gastroesophageal Reflux Disease (GERD)

  • R60. Patients with overweight or obesity and gastroesophageal reflux should be treated using weight loss; the weight-loss goal should be 10% of body weight or greater.
  • R61. Proton pump inhibitor (PPI) therapy should be administered as medical therapy in patients with overweight or obesity and persistent gastroesophageal reflux symptoms during weight-loss interventions.
  • R62. Roux-en-Y gastric bypass should be considered as the bariatric surgery procedure of choice for patients with obesity and moderate to severe gastroesophageal reflux symptoms, hiatal hernia, esophagitis, or Barrett’s esophagus. Intragastric balloon for weight loss may increase gastroesophageal reflux symptoms and should not be used for weight loss in patients with established gastroesophageal reflux.

Reference

  1. Garvey WT, Mechanick JL, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients With Obesity. Endocr Pract. 2016;22(suppl 3);1-205.