Combination therapy, shared decision-making key to treating obesity

Combination therapy is usually the best option to treat obesity, but it may take multiple attempts until the right combination is found, a speaker at the Obesity Medicine Association fall conference said.

The most common components of combination therapy for obesity are surgery, endoscopic procedures, pharmacotherapy, prescriptive nutritional interventions (eg, Nutrisystem) and lifestyle modifications, according to Angela Fitch, MD, FACP, FOMA, a co-director of the Massachusetts Weight Center at Harvard Medical School. Physician and patient must engage in thorough, two-way conversations when discussing these treatment strategies, she said.

“We need to start to do more shared decision-making,” she said. “What are they willing to give? What are they willing to take to get the best outcome? What are their goals?”

Physicians should also ascertain how much weight the patient wants to lose, whether the patient prefers pills or lifestyle changes and what other conditions (besides obesity) the patient wants to treat. These discussions should help determine if a stepwise approach, high-intensity approach or combination therapy approach is the best way to treat the patient’s obesity.

Fitch encouraged health care professionals to review the medical literature with their patients to see which obesity treatment option best matches their goals. For instance, a study showed that 42% of patients who were administered phentermine and topiramate experienced 10% weight loss, compared with only about 20% to 25% of patients who only took one of those medications. Another study showed 72% of patients who underwent weight-loss surgery and exercised were able to keep 20% or more of their weight off after 10 years, according to Fitch. This process of sharing the medical literature with patients greatly diminishes “bias, stigma and emotion,” Fitch said.

Thinking outside the box to come up with an obesity treatment plan, either with the first attempt at combination therapy or subsequent attempts, is OK, according to Fitch.

“Don’t be afraid to put a new spin on it and do something different, as long as you don’t hurt somebody,” she said.

It is also acceptable for physician and patient to back up and start over, according to Fitch.

“If the weight loss isn’t quite on track where we would expect it to be, then maybe we should do something different, sooner versus later,” she said.