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What is the best approach to reducing obesity in people living with HIV?
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The association between ART and excessive weight gain in people with HIV presents a challenge to clinicians who are trying to keep patients’ viral loads suppressed and help them avoid the many possible negative effects of obesity. Experts have discussed multidisciplinary approaches to achieving and maintaining favorable outcomes. Infectious Disease News asked Scott Kahan, MD, MPH, director of the National Center for Weight and Wellness in Washington, D.C., and medical director of the Strategies to Overcome and Prevent (STOP) Obesity Alliance, about the best approach to reducing obesity in people living with HIV. Addressing obesity in patients with HIV is an increasingly important public health issue. In general, the approach used in this patient population is similar to that used in the non-HIV population. Patients should have a thorough clinical work-up for medical conditions and contributors to weight gain.
Treatment should include intensive behavioral counseling for patients with a BMI of more than 30 kg/m2. That should include at least biweekly counseling for the initial 6 months, followed by monthly visits thereafter, to build knowledge and skills and to support patients as they incorporate behavioral changes in their lives.
Intensive behavioral counseling provided by primary care physicians is a covered service for Medicare beneficiaries and is often covered for patients with private health insurance as well. As appropriate, referral to specialists such as dietitians and obesity medicine physicians should be considered.
Patients with a BMI greater than 30 kg/m2 or a BMI greater than 27 kg/m2 with at least one obesity-associated comorbid condition (such as hypertension, hyperlipidemia, metabolic syndrome, and so on) are candidates for FDA–approved obesity pharmacotherapy options, which lead to weight loss of 5% to 15%, on average, and many of which are approved for long-term use.
Notably, in addition to weight gain, patients with HIV may experience lipodystrophy, typically associated with older ART regimens. In addition to physical activity, several medications — and occasionally surgery — may be considered.
Disclosure: Kahan reports no relevant financial disclosures.