Weight Loss
Obesity is a complex chronic disease that impairs health, increases the risk of long-term medical complications, and reduces lifespan (Wharton et al., 2020). Obesity has become a major public health issue that increases health care costs and negatively affects physical and psychological health. (Anis et al., 2010; and Guh et al., 2009.)
Although Body Mass Index (BMI) is widely used to assess and classify obesity, the current literature suggests that it is not an accurate tool for identifying adiposity-related complications. (Garvey & Mechanick, 2020.) Rather, a combination of BMI and waist circumference may be a better indicator for the identification of the obese individual. (Ross et al., 2020.)
The prevailing theory is that obesity management should be about improved health and well-being, and not just weight loss. (Wharton et al., 2020.) Medical nutrition therapy is a foundation for the management of many chronic diseases including obesity management. (Raynor & Champagne, 2016.) However, medical nutrition therapy should not be used in isolation. (Wharton et al., 2020.) Instead, medical nutrition therapy, in combination with other interventions (psychological, pharmacologic, surgical), should be tailored to meet an individual’s health-related outcomes. (Raynor & Champagne, 2016.)
The performance of a documented initial assessment/evaluation and development of a treatment plan is a prerequisite for the implementation of any treatment or therapy. When prescribing of controlled substances, Kentucky Revised Statutes (KRS) Chapter 218A require a good faith prior examination by a “practitioner” with scope of practice to examine, assess, and diagnose as part of the standard of care for all diagnoses and care plans. "Good faith prior examination", is
an in-person medical examination of the patient conducted by the prescribing practitioner or other health-care professional routinely relied upon in the ordinary course of his or her practice, at which time the patient is physically examined and a medical history of the patient is obtained. "In-person" includes telehealth examinations.
See
KRS 218A.010(18). Best practice guidelines recommend that the health care provider obtain a comprehensive history to identify the root causes of weight gain, as well as physical, mental, and psychosocial barriers. A physical examination, laboratory testing, diagnostic imaging, and other investigations should be carried out based on clinical judgment. It is also recommended that the clinician measure blood pressure in both arms and obtain fasting glucose or glycated hemoglobin values and a lipid panel to determine cardiometabolic risk, and when indicated, alanine aminotransferase to screen for nonalcoholic fatty liver disease. (Wharton et al., 2020.)
Upon initiation of weight loss therapy, it is important to emphasize that drugs can work differently in every patient. Additionally, the response and side effects can vary significantly. Patients also need to understand that it is common to achieve a plateau after the initial weight loss, and often when drug treatment is interrupted, weight regain can be expected (Rodrigues et al., 2022).
References
- Anis AH, Zhang W, Bansback N. (2010). Obesity and overweight in Canada: An updated cost-of-illness study. Obesity Reviews; 11:31–40. https://doi.org/ 10.1111/j.1467-789X.2009.00579.x.
- Garvey WT & Mechanick JI. (2020). Proposal for a scientifically correct and medically actionable disease classification system (ICD) for obesity. Obesity; 28:484–92. https://doi.org/10.1002/oby.22727.
- Guh DP, Zhang W, & Bansback N. (2009). The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC Public Health, 9:88. https://doi.org/10.1186/1471-2458-9-88.
- Raynor HA & Champagne CM. (2016). Position of the academy of nutrition and dietetics: Interventions for the treatment of overweight and obesity in adults. J Acad Nutr Diet; 116:129–47. https://doi.org/10.1016/j.jand.2015.10.031.
- Rodrigues, L., Sombra, S., & Anastasopoulou, C. (2022) Pharmacologic therapy for obesity. National Library of Medicine . https://www.ncbi.nlm.nih.gov/books/NBK562269/
- Ross R., Neeland IJ., & Yamashita S. (2020). Waist circumference as a vital sign in clinical practice: A consensus statement from the IAS and ICCR working group on visceral obesity. Nat Rev Endocrinol 16:177–89. https://doi.org/10.1038/s41574-019-0310-7.
- Wharton, S., Lau, D., Vallis, M. (2020). Obesity in adults: A clinical practice guideline. National Library of Medicine v.192(31). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828878/
Semaglutide
Information related to prescriptive authority may be reviewed on the Kentucky Board of Nursing website [https://kbn.ky.gov/advanced-practice-registered-nurse/Pages/aprn-prescriptive-authority.aspx].
An APRN may only dispense labeled pharmaceutical legend medications if they are 1) samples; or 2) if they are from a local, district, and independent health department. Other than these specific exceptions, APRNs do not have the legal authority to dispense medications
See APRN Dispensing.
An APRN may prescribe medication provided the APRN has entered into a “collaborative agreement for prescriptive authority” (CAPA) for non-scheduled-legend medications or controlled medications, or if the APRN has obtained independent prescribing authority. See KRS 314.042. If a patient grants permission, the patient’s medication, may be dispensed by a pharmacy to the provider’s office. When the APRN’s office accepts and acknowledges receipt of the medication, the office (and staff) become custodians of the medication for the patient. Accepting and storing the medication for the patient at the provider’s office is acceptable if the office follows state and federal guidelines for the storing of such medications. The medication may be directly administered to the patient by a RN, LPN, or delegated to unlicensed person (UAP), see Kentucky Administrative Regulations 201 KAR 20:400, according to the provider’s orders; or the patient may be provided the education necessary to self-administer a medication such as Semaglutide.
The FDA has received adverse event reports after patients used compounded semaglutide. Use caution in prescribing of a compounded drug if an approved drug is not available to treat a patient. Health care professionals should understand that the FDA does not review compounded versions of these drugs for safety, effectiveness, or quality. Providers should be aware that some products sold as ‘semaglutide’ may not contain the same active ingredient as FDA-approved semaglutide products and may be the salt formulations. Products containing these salts, such as semaglutide sodium and semaglutide acetate, have not been shown to be safe and effective.
Provided below are weblinks to information on semaglutide from the FDA website.