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White Paper AGA: POWER — Practice Guide on Obesity and Weight Management, Education, and Resources

Published:February 24, 2017DOI:https://doi.org/10.1016/j.cgh.2016.10.023
      The epidemic of obesity continues at alarming rates, with a high burden to our economy and society. The American Gastroenterological Association understands the importance of embracing obesity as a chronic, relapsing disease and supports a multidisciplinary approach to the management of obesity. Because gastrointestinal disorders resulting from obesity are more frequent and often present sooner than type 2 diabetes mellitus and cardiovascular disease, gastroenterologists have an opportunity to address obesity and provide an effective therapy early. Patients who are overweight or obese already fill gastroenterology clinics with gastroesophageal reflux disease and its associated risks of Barrett’s esophagus and esophageal cancer, gallstone disease, nonalcoholic fatty liver disease/nonalcoholic steatohepatitis, and colon cancer. Obesity is a major modifiable cause of diseases of the digestive tract that frequently goes unaddressed. As internists, specialists in digestive disorders, and endoscopists, gastroenterologists are in a unique position to play an important role in the multidisciplinary treatment of obesity. This American Gastroenterological Association paper was developed with content contribution from Society of American Gastrointestinal and Endoscopic Surgeons, The Obesity Society, Academy of Nutrition and Dietetics, and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, endorsed with input by American Society for Gastrointestinal Endoscopy, American Society for Metabolic and Bariatric Surgery, American Association for the Study of Liver Diseases, and Obesity Medicine Association, and describes POWER: Practice Guide on Obesity and Weight Management, Education and Resources. Its objective is to provide physicians with a comprehensive, multidisciplinary process to guide and personalize innovative obesity care for safe and effective weight management.

      Keywords

      Abbreviations used in this paper:

      AGA (American Gastroenterological Association), BMI (body mass index), CI (confidence interval), CVD (cardiovascular disease), ER (extended release), FDA (Food and Drug Administration), GERD (gastroesophageal reflux disease), GLP-1 (glucagon-like peptide 1), 5-HT (5-hydroxytryptamine), NAFLD (nonalcoholic fatty liver disease), NASH (nonalcoholic steatohepatitis), NASPGHAN (North American Society for Pediatric Gastroenterology, Hepatology and Nutrition), POMC (pro-opiomelanocortin), SAGES (Society of American Gastrointestinal and Endoscopic Surgeons), SR (sustained release), T2DM (type 2 diabetes mellitus), TORe (transoral outlet reduction), TOS (The Obesity Society), TBWL (total body weight loss)
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      References

        • Yach D.
        • Stuckler D.
        • Brownell K.D.
        Epidemiologic and economic consequences of the global epidemics of obesity and diabetes.
        Nat Med. 2006; 12: 62-66
      1. Seger JC, Horn DB, Westman EC, et al. Obesity algorithm: presented by the Obesity Medicine Association, 2015-2016. www.obesityalgorithm.org.

        • Bray G.A.
        • Bouchard C.
        Handbook of obesity: epidemiology, etiology, and physiopathology.
        3rd ed. CRC Press, Boca Raton2014
        • Acosta A.
        • Abu Dayyeh B.K.
        • Port J.D.
        • et al.
        Recent advances in clinical practice challenges and opportunities in the management of obesity.
        Gut. 2014; 63: 687-695
        • Jensen M.D.
        • Ryan D.H.
        • Apovian C.M.
        • et al.
        2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.
        J Am Coll Cardiol. 2014; 63: 2985-3023
        • Daniels S.R.
        • Jacobson M.S.
        • McCrindle B.W.
        • et al.
        American Heart Association Childhood Obesity Research Summit: executive summary.
        Circulation. 2009; 119: 2114-2123
        • Low S.
        • Chin M.C.
        • Deurenberg-Yap M.
        Review on epidemic of obesity.
        Ann Acad Med Singapore. 2009; 38: 57-59
        • Ogden C.L.
        • Carroll M.D.
        • Kit B.K.
        • et al.
        Prevalence of childhood and adult obesity in the United States, 2011-2012.
        JAMA. 2014; 311: 806-814
        • Ogden C.L.
        • Carroll M.D.
        • Fryar C.D.
        • et al.
        Prevalence of obesity among adults and youth: United States, 2011-2014.
        NCHS Data Brief. Nov 2015; : 1-8
      2. World Health Organisation. Fact sheet: obesity and overweight. Available at: http://www.who.int/gho/ncd/risk_factors/overweight_text/en/. 2014. Accessed January 5, 2017.

        • Ogden C.L.
        • Yanovski S.Z.
        • Carroll M.D.
        • et al.
        The epidemiology of obesity.
        Gastroenterology. 2007; 132: 2087-2102
        • Guh D.
        • Zhang W.
        • Bansback N.
        • et al.
        The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis.
        BMC Public Health. 2009; 9: 88
        • Guize L.
        • Pannier B.
        • Thomas F.
        • et al.
        Recent advances in metabolic syndrome and cardiovascular disease.
        Arch Cardiovasc Dis. 2008; 101: 577-583
        • Hill M.J.
        • Metcalfe D.
        • McTernan P.G.
        Obesity and diabetes: lipids, ‘nowhere to run to'.
        Clin Sci (Lond). 2009; 116: 113-123
        • Vgontzas A.N.
        • Bixler E.O.
        • Chrousos G.P.
        • et al.
        Obesity and sleep disturbances: meaningful sub-typing of obesity.
        Arch Physiol Biochem. 2008; 114: 224-236
        • Vgontzas A.N.
        Does obesity play a major role in the pathogenesis of sleep apnoea and its associated manifestations via inflammation, visceral adiposity, and insulin resistance?.
        Arch Physiol Biochem. 2008; 114: 211-223
        • Vgontzas A.N.
        • Lin H.M.
        • Papaliaga M.
        • et al.
        Short sleep duration and obesity: the role of emotional stress and sleep disturbances.
        Int J Obes (Lond). 2008; 32: 801-809
        • de Sousa A.G.
        • Cercato C.
        • Mancini M.C.
        • et al.
        Obesity and obstructive sleep apnea-hypopnea syndrome.
        Obes Rev. 2008; 9: 340-354
        • Garfinkel L.
        Overweight and cancer.
        Ann Intern Med. 1985; 103: 1034-1036
        • Deitel M.
        • To T.B.
        • Stone E.
        • et al.
        Sex hormonal changes accompanying loss of massive excess weight.
        Gastroenterol Clin North Am. 1987; 16: 511-515
        • Newbold R.R.
        • Padilla-Banks E.
        • Jefferson W.N.
        • et al.
        Effects of endocrine disruptors on obesity.
        Int J Androl. 2008; 31: 201-208
        • Bean M.K.
        • Stewart K.
        • Olbrisch M.E.
        Obesity in America: implications for clinical and health psychologists.
        J Clin Psychol Med Settings. 2008; 15: 214-224
        • Stunkard A.J.
        • Wadden T.A.
        Psychological aspects of severe obesity.
        Am J Clin Nutr. 1992; 55: 524S-532S
        • Rapaka R.
        • Schnur P.
        • Shurtleff D.
        Obesity and addiction: common neurological mechanisms and drug development.
        Physiol Behav. 2008; 95: 2-9
        • Warren M.W.
        • Gold M.S.
        The relationship between obesity and drug use.
        Am J Psychiatry. 2007; 164 (author reply 1268–1269): 1268
        • Anandacoomarasamy A.
        • Fransen M.
        • March L.
        Obesity and the musculoskeletal system.
        Curr Opin Rheumatol. 2009; 21: 71-77
        • Magliano M.
        Obesity and arthritis.
        Menopause Int. 2008; 14: 149-154
        • Acosta A.
        • Camilleri M.
        Gastrointestinal morbidity in obesity.
        Ann N Y Acad Sci. 2014; 1311: 42-56
      3. Metabolic and Bariatric Accreditation and Quality Improvement Program: 2016. Available at: https://www.facs.org/quality-programs/mbsaqip. Accessed July 25, 2016.

        • Kushner R.
        Models of obesity care: implications for practice.
        Obesity Consults. 2015; 3: 17-29
        • Rollnick S.
        • Butler C.C.
        • Kinnersley P.
        • et al.
        Motivational interviewing.
        BMJ. 2010; 340: c1900
        • Kisely S.
        • Ligate L.
        • Roy M.A.
        • et al.
        Applying motivational interviewing to the initiation of long-acting injectable atypical antipsychotics.
        Australas Psychiatry. 2012; 20: 138-142
        • Searight R.
        Realistic approaches to counseling in the office setting.
        Am Fam Physician. 2009; 79: 277-284
        • Tapper E.B.
        • Lai M.
        Weight loss results in significant improvements in quality of life for patients with nonalcoholic fatty liver disease: a prospective cohort study.
        Hepatology. 2016; 63: 1184-1189
        • Singh M.
        • Lee J.
        • Gupta N.
        • et al.
        Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: a prospective intervention trial.
        Obesity. 2013; 21: 284-290
        • Sahakyan K.R.
        • Somers V.K.
        • Rodriguez-Escudero J.P.
        • et al.
        Normal-weight central obesity: implications for total and cardiovascular mortality.
        Ann Intern Med. 2015; 163: 827-835
        • Sharma S.
        • Batsis J.A.
        • Coutinho T.
        • et al.
        Normal-weight central obesity and mortality risk in older adults with coronary artery disease.
        Mayo Clin Proc. 2016; 91: 343-351
        • Siu A.L.
        Screening for abnormal blood glucose and type 2 diabetes mellitus: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2015; 163: 861-868
        • Johns M.W.
        A new method for measuring daytime sleepiness: the Epworth sleepiness scale.
        Sleep. 1991; 14: 540-545
        • Camilleri M.
        • Acosta A.
        Gastrointestinal traits: individualizing therapy for obesity with drugs and devices.
        Gastrointest Endosc. 2016; 83: 48-56
        • Boutelle K.N.
        • Kirschenbaum D.S.
        Further support for consistent self-monitoring as a vital component of successful weight control.
        Obes Res. 1998; 6: 219-224
        • Ames G.E.
        • Heckman M.G.
        • Diehl N.N.
        • et al.
        Further statistical and clinical validity for the Weight Efficacy Lifestyle Questionnaire-Short Form.
        Eat Behav. 2015; 18: 115-119
        • Riebe D.
        • Franklin B.A.
        • Thompson P.D.
        • et al.
        Updating ACSM's recommendations for exercise preparticipation health screening.
        Med Sci Sports Exerc. 2015; 47: 2473-2479
        • Apovian C.M.
        • Aronne L.J.
        • Bessesen D.H.
        • et al.
        Pharmacological management of obesity: an Endocrine Society clinical practice guideline.
        J Clin Endocrinol Metab. 2015; 100: 342-362
        • Saunders K.
        • Igel L.
        • Kumar R.
        • et al.
        Pharmacotherapy for obesity.
        Endocrinol Metab Clin North Am. 2016; 45: 521-538
        • Rothman R.B.
        • Baumann M.H.
        • Dersch C.M.
        • et al.
        Amphetamine-type central nervous system stimulants release norepinephrine more potently than they release dopamine and serotonin.
        Synapse. 2001; 39: 32-41
      4. Alli. Alli (orlistat). GlaxoSmithKline Consumer Healthcare, Moon Township, PA2015
        • Zhi J.
        • Melia A.T.
        • Guerciolini R.
        • et al.
        Retrospective population-based analysis of the dose-response (fecal fat excretion) relationship of orlistat in normal and obese volunteers.
        Clin Pharmacol Ther. 1994; 56: 82-85
        • Acosta A.
        • Camilleri M.
        • Shin A.
        • et al.
        Quantitative gastrointestinal and psychological traits associated with obesity and response to weight-loss therapy.
        Gastroenterology. 2015; 148: 537-546 e534
        • Connolly H.M.
        • Crary J.L.
        • McGoon M.D.
        • et al.
        Valvular heart disease associated with fenfluramine-phentermine.
        N Engl J Med. 1997; 337: 581-588
        • Greenway F.L.
        • Whitehouse M.J.
        • Guttadauria M.
        • et al.
        Rational design of a combination medication for the treatment of obesity.
        Obesity. 2009; 17: 30-39
        • Nauck M.
        • Frid A.
        • Hermansen K.
        • et al.
        Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes: the LEAD (liraglutide effect and action in diabetes)-2 study.
        Diabetes Care. 2009; 32: 84-90
        • Pi-Sunyer X.
        • Astrup A.
        • Fujioka K.
        • et al.
        A randomized, controlled trial of 3.0 mg of liraglutide in weight management.
        N Engl J Med. 2015; 373: 11-22
        • van Can J.
        • Sloth B.
        • Jensen C.B.
        • et al.
        Effects of the once-daily GLP-1 analog liraglutide on gastric emptying, glycemic parameters, appetite and energy metabolism in obese, non-diabetic adults.
        Int J Obes. 2014; 38: 784-793
        • Acosta A.
        • Camilleri M.
        • Burton D.
        • et al.
        Exenatide in obesity with accelerated gastric emptying: a randomized, pharmacodynamics study.
        Physiol Rep. 2015; 3: e12610
        • Abu Dayyeh B.K.
        • Edmundowicz S.A.
        • Jonnalagadda S.
        • et al.
        Endoscopic bariatric therapies.
        Gastrointest Endosc. 2015; 81: 1073-1086
        • Ponce J.
        • Quebbemann B.B.
        • Patterson E.J.
        Prospective, randomized, multicenter study evaluating safety and efficacy of intragastric dual-balloon in obesity.
        Surgery for Obesity and Related Diseases. 2013; 9: 290-295
      5. FDA. ReShape Integrated Dual Balloon System – P1400122015.

        • Abu Dayyeh B.K.
        • Kumar N.
        • Edmundowicz S.A.
        • et al.
        ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies.
        Gastrointest Endosc. 2015; 82: 425-438 e425
      6. FDA. ORBERA Intragastric Balloon System – P1400082015.

        • Thompson C.C.
        • Dayyeh B.K.A.
        • Kushner R.
        • et al.
        The AspireAssist is an effective tool in the treatment of class II and class III obesity: results of a one-year clinical trial.
        Gastroenterology. 2016; 150: S86
        • Lopez-Nava G.
        • Sharaiha R.Z.
        • Neto M.G.
        • et al.
        Endoscopic sleeve gastroplasty for obesity: a multicenter study of 242 patients with 18 months follow-up.
        Gastroenterology. 2016; 150: S26
        • Thompson C.C.
        • Chand B.
        • Chen Y.K.
        • et al.
        Endoscopic suturing for transoral outlet reduction increases weight loss after Roux-en-Y gastric bypass surgery.
        Gastroenterology. 2013; 145: 129-137 e123
        • Kumar N.
        • Thompson C.C.
        Transoral outlet reduction for weight regain after gastric bypass: long-term follow-up.
        Gastrointest Endosc. 2016; 83: 776-779
        • Buchwald H.
        • Estok R.
        • Fahrbach K.
        • et al.
        Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis.
        Am J Med. 2009; 122: 248-256 e245
        • Adams T.D.
        • Gress R.E.
        • Smith S.C.
        • et al.
        Long-term mortality after gastric bypass surgery.
        N Engl J Med. 2007; 357: 753-761
        • Chang S.H.
        • Stoll C.R.
        • Song J.
        • et al.
        The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012.
        JAMA Surg. 2014; 149: 275-287
        • Gould J.C.
        • Beverstein G.
        • Reinhardt S.
        • et al.
        Impact of routine and long-term follow-up on weight loss after laparoscopic gastric bypass.
        Surgery for Obesity and Related Diseases. 2007; 3: 627-630
        • Pontiroli A.E.
        • Fossati A.
        • Vedani P.
        • et al.
        Post-surgery adherence to scheduled visits and compliance, more than personality disorders, predict outcome of bariatric restrictive surgery in morbidly obese patients.
        Obes Surg. 2007; 17: 1492-1497
        • Sjostrom L.
        • Narbro K.
        • Sjostrom C.D.
        • et al.
        Effects of bariatric surgery on mortality in Swedish obese subjects.
        N Engl J Med. 2007; 357: 741-752
        • Buchwald H.
        • Avidor Y.
        • Braunwald E.
        • et al.
        Bariatric surgery: a systematic review and meta-analysis.
        JAMA. 2004; 292: 1724-1737
        • Flum D.R.
        • Belle S.H.
        • King W.C.
        • et al.
        Perioperative safety in the longitudinal assessment of bariatric surgery.
        N Engl J Med. 2009; 361: 445-454
        • Schauer P.R.
        • Bhatt D.L.
        • Kirwan J.P.
        • et al.
        Bariatric surgery versus intensive medical therapy for diabetes: 3-year outcomes.
        N Engl J Med. 2014; 370: 2002-2013
        • Demaria E.J.
        • Winegar D.A.
        • Pate V.W.
        • et al.
        Early postoperative outcomes of metabolic surgery to treat diabetes from sites participating in the ASMBS bariatric surgery center of excellence program as reported in the Bariatric Outcomes Longitudinal Database.
        Ann Surg. 2010; 252: 559-567
        • Camilleri M.
        • Toouli J.
        • Herrera M.F.
        • et al.
        Selection of electrical algorithms to treat obesity with intermittent vagal block using an implantable medical device.
        Surgery for Obesity and Related Diseases. 2009; 5: 224-230
        • Camilleri M.
        • Toouli J.
        • Herrera M.F.
        • et al.
        Intra-abdominal vagal blocking (VBLOC therapy): clinical results with a new implantable medical device.
        Surgery. 2008; 143: 723-731
        • Shikora S.A.
        • Wolfe B.M.
        • Apovian C.M.
        • et al.
        Sustained weight loss with vagal nerve blockade but not with sham: 18-month results of the ReCharge trial.
        J Obesity. 2015; 2015: 365604
        • Ikramuddin S.
        • Blackstone R.P.
        • Brancatisano A.
        • et al.
        Effect of reversible intermittent intra-abdominal vagal nerve blockade on morbid obesity: the ReCharge randomized clinical trial.
        JAMA. 2014; 312: 915-922
        • Sarr M.G.
        • Billington C.J.
        • Brancatisano R.
        • et al.
        The EMPOWER study: randomized, prospective, double-blind, multicenter trial of vagal blockade to induce weight loss in morbid obesity.
        Obes Surg. 2012; 22: 1771-1782
        • Brethauer S.A.
        • Hammel J.P.
        • Schauer P.R.
        Systematic review of sleeve gastrectomy as staging and primary bariatric procedure.
        Surgery for Obesity and Related Diseases. 2009; 5: 469-475
        • Garb J.
        • Welch G.
        • Zagarins S.
        • et al.
        Bariatric surgery for the treatment of morbid obesity: a meta-analysis of weight loss outcomes for laparoscopic adjustable gastric banding and laparoscopic gastric bypass.
        Obes Surg. 2009; 19: 1447-1455
        • Huang J.S.
        • Barlow S.E.
        • Quiros-Tejeira R.E.
        • et al.
        Childhood obesity for pediatric gastroenterologists.
        J Pediatr Gastroenterol Nutr. 2013; 56: 99-109
        • Barlow S.E.
        Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.
        Pediatrics. 2007; 120: S164-S192
        • Kuczmarski R.J.
        • Ogden C.L.
        • Guo S.S.
        • et al.
        2000 CDC growth charts for the United States: methods and development.
        Vital Health Stat 11. 2002; : 1-190
        • Kelly A.S.
        • Barlow S.E.
        • Rao G.
        • et al.
        Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches—a scientific statement from the American Heart Association.
        Circulation. 2013; 128: 1689-1712
      7. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents.
        Pediatrics. 2004; 114: 555-576
        • Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, National Heart, Lung and Blood Institute
        Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report.
        Pediatrics. 2011; 128: S213-S256
      8. Standards of medical care in diabetes-2015: summary of revisions.
        Diabetes Care. 2015; 38: S4
        • Schwimmer J.B.
        • Deutsch R.
        • Kahen T.
        • et al.
        Prevalence of fatty liver in children and adolescents.
        Pediatrics. 2006; 118: 1388-1393
        • Robinson S.
        Victimization of obese adolescents.
        J Sch Nurs. 2006; 22: 201-206
        • Epstein L.H.
        • Valoski A.
        • Wing R.R.
        • et al.
        Ten-year outcomes of behavioral family-based treatment for childhood obesity.
        Health Psychol. 1994; 13: 373-383
        • Quattrin T.
        • Roemmich J.N.
        • Paluch R.
        • et al.
        Treatment outcomes of overweight children and parents in the medical home.
        Pediatrics. 2014; 134: 290-297
        • Liese A.D.
        • D'Agostino Jr., R.B.
        • et al.
        • SEARCH for Diabetes in Youth Study Group
        The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study.
        Pediatrics. 2006; 118: 1510-1518
        • Barton M.
        • US Preventive Services Task Force
        Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement.
        Pediatrics. 2010; 125: 361-367
        • Ebbeling C.B.
        • Feldman H.A.
        • Chomitz V.R.
        • et al.
        A randomized trial of sugar-sweetened beverages and adolescent body weight.
        N Engl J Med. 2012; 367: 1407-1416
        • Cowell H.A.
        Physical activity guidelines for Americans and a review of scientific literature used.
        Nova Science Publishers, Hauppauge, NY2010
        • Chanoine J.P.
        • Hampl S.
        • Jensen C.
        • et al.
        Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial.
        JAMA. 2005; 293: 2873-2883
        • Inge T.H.
        • Courcoulas A.P.
        • Jenkins T.M.
        • et al.
        Weight loss and health status 3 years after bariatric surgery in adolescents.
        N Engl J Med. 2016; 374: 113-123
        • Inge T.H.
        • Krebs N.F.
        • Garcia V.F.
        • et al.
        Bariatric surgery for severely overweight adolescents: concerns and recommendations.
        Pediatrics. 2004; 114: 217-223
        • Michalsky M.
        • Reichard K.
        • Inge T.
        • et al.
        ASMBS pediatric committee best practice guidelines.
        Surg Obes Relat Dis. 2012; 8: 1-7
        • Calle E.E.
        • Rodriguez C.
        • Walker-Thurmond K.
        • et al.
        Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults.
        N Engl J Med. 2003; 348: 1625-1638
        • Jensen M.D.
        • Ryan D.H.
        • Apovian C.M.
        • et al.
        2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.
        Circulation. 2014; 63: 2985-3023
        • Aronne L.J.
        • Wadden T.A.
        • Peterson C.
        • et al.
        Evaluation of phentermine and topiramate versus phentermine/topiramate extended-release in obese adults.
        Obesity. 2013; 21: 2163-2171
        • Yanovski S.Z.
        • Yanovski J.A.
        Long-term drug treatment for obesity: a systematic and clinical review.
        JAMA. 2014; 311: 74-86
        • Gadde K.M.
        • Allison D.B.
        • Ryan D.H.
        • et al.
        Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial.
        Lancet. 2011; 377: 1341-1352
        • Smith S.R.
        • Weissman N.J.
        • Anderson C.M.
        • et al.
        Multicenter, placebo-controlled trial of lorcaserin for weight management.
        N Engl J Med. 2010; 363: 245-256
        • Greenway F.L.
        • Fujioka K.
        • Plodkowski R.A.
        • et al.
        Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial.
        Lancet. 2010; 376: 595-605
        • Hampel H.
        • Abraham N.
        • El-Serag H.
        Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications.
        Ann Intern Med. 2005; 143: 199-211
        • Singh S.
        • Sharma A.
        • Murad M.
        • et al.
        Central adiposity is associated with increased risk of esophageal inflammation, metaplasia, and adenocarcinoma: a systematic review and meta-analysis.
        Clin Gastroenterol Hepatol. 2013; 11: 1399-1412
        • El-Serag H.
        • Kvapil P.
        • Hacken-Bitar J.
        • Kramer J.
        Abdominal obesity and the risk of Barrett's esophagus.
        Am J Gastroenterol. 2005; 100: 2151-2156
        • Kubo A.
        • Corley D.
        Body mass index and adenocarcinomas of the esophagus or gastric cardia: a systematic review and meta-analysis.
        Cancer Epidemiol Biomarkers Prev. 2006; 15: 872-878
        • Kim H.
        • Yoo T.
        • Park D.
        • et al.
        Influence of overweight and obesity on upper endoscopic findings.
        J Gastroenterol Hepatol. 2007; 22: 477-481
        • Yang P.
        • Zhou Y.
        • Chen B.
        • et al.
        Overweight, obesity and gastric cancer risk: results from a meta-analysis of cohort studies.
        Eur J Cancer. 2009; 45: 2867-2873
        • Delgado-Aros S.
        • Locke G.
        • Camilleri M.
        • et al.
        Obesity is associated with increased risk of gastrointestinal symptoms: a population-based study.
        Am J Gastroenterol. 2004; 99: 1801-1806
        • Strate L.
        • Liu Y.
        • Aldoori W.
        • et al.
        Obesity increases the risks of diverticulitis and diverticular bleeding.
        Gastroenterology. 2009; 136: 115-122
        • Kim B.C.
        • Shin A.
        • Hong C.W.
        • et al.
        Association of colorectal adenoma with components of metabolic syndrome.
        Cancer Causes Control. 2012; 23: 727-735
        • Bardou M.
        • Barkun A.N.
        • Martel M.
        Obesity and colorectal cancer.
        Gut. 2013; 62: 933-947
        • Bellentani S.
        • Saccoccio G.
        • Masutti F.
        • et al.
        Prevalence of and risk factors for hepatic steatosis in Northern Italy.
        Ann Intern Med. 2000; 132: 112-117
        • Ioannou G.N.
        • Weiss N.S.
        • Kowdley K.V.
        • et al.
        Is obesity a risk factor for cirrhosis-related death or hospitalization? a population-based cohort study.
        Gastroenterology. 2003; 125: 1053-1059
        • Larsson S.
        • Wolk A.
        Overweight, obesity and risk of liver cancer: a meta-analysis of cohort studies.
        Br J Cancer. 2007; 97: 1005-1008
        • Chen S.
        • Xiong G.
        • Wu S.
        Is obesity an indicator of complications and mortality in acute pancreatitis? an updated meta-analysis.
        J Dig Dis. 2012; 13: 244-251
        • Aune D.
        • Greenwood D.
        • Chan D.
        • et al.
        Body mass index, abdominal fatness and pancreatic cancer risk: a systematic review and non-linear dose-response meta-analysis of prospective studies.
        Ann Oncol. 2012; 23: 843-852
        • Welbourn R.
        • Dixon J.
        • Barth J.H.
        • et al.
        NICE-accredited commissioning guidance for weight assessment and management clinics: a model for a specialist multidisciplinary team approach for people with severe obesity.
        Obes Surg. 2016; 26: 649-659
        • Cook S.
        • Kavey R.E.
        Dyslipidemia and pediatric obesity.
        Pediatr Clin North Am. 2011; 58 (ix): 1363-1373
        • Schauer P.R.
        • Ikramuddin S.
        • Gourash W.
        • et al.
        Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity.
        Ann Surg. 2000; 232: 515-529