Department of Clinical and Experimental Medicine, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy.
Department of Clinical and Experimental Medicine, University of Messina, c/o AOU Policlinico G. Martino, Via C. Valeria Gazzi, 98125, Messina, Italy.
Biomed Pharmacother. 2020 Aug;128:110320. doi: 10.1016/j.biopha.2020.110320. Epub 2020 Jun 2.
Obesity is a worldwide growing problem for the health care systems and its treatment is strongly recommended. Orlistat, naltrexone/bupropion, and liraglutide are approved for weight loss in Italy in patients with a Body Mass Index (BMI) ≥ 30 kg/m or ≥ 27 kg/m with concomitant diseases. However, the prescription of these drugs is significantly low worldwide. General practitioners (GPs) play a key role in the early diagnosis and appropriate management of obesity. The aim of the study was to investigate the management of obesity and the prescriptive attitude of anti-obesity drugs in a general practice setting. All patients registered in lists of 8 GPs with a recorded diagnosis of obesity or BMI values ≥ 30 kg/m in the period 2017-2018, were recruited. A descriptive analysis of demographic and clinical characteristic was carried out. The Spearman's correlation rank test was applied to identify correlations between BMI and all the variables of interest. Among 1301 obese patients, only 66.1 % had been diagnosed and 29.4 % had no registered BMI value. Patients with recorded BMI, were overweight (7.8 %) or in the obesity class I (38.8 %), class II (14.1 %), and class III (7.1 %), respectively. The obese patients (class 1-3) were older [66 (55-76) vs 49 (32-59); p < 0.01], and had more concurrent diseases [5 (3-8) vs 4 (2-6); p < 0.01] than patients who reached a BMI < 30 Kg/m. Moreover, most of obese were high cardiovascular risk (HCVr) patients (67.0 % vs 31.9 %; p < 0.01). The BMI was directly related to age (r 0.14; p < 0.01), diabetes (r 0.19; p < 0.01), hypertension (r 0.14; p < 0.01), heart failure (r 0.09; p < 0.01), HCVr (r 0. 12; p < 0.01) and number of comorbidities (r 0.08; p = 0.01). No prescriptions of orlistat or naltrexone/bupropion were found. Liraglutide was prescribed only in 7 patients because of the concomitant presence of diabetes. Our results suggest a low adherence to guide line recommendations for obesity management and confirm an under-prescription of anti-obesity drugs in Italy.
肥胖是全球医疗体系面临的一个日益严重的问题，强烈建议对此进行治疗。奥利司他、纳曲酮/安非他酮和利拉鲁肽在意大利被批准用于体重指数（BMI）≥30kg/m2或≥27kg/m2 合并疾病的患者减肥。然而，这些药物在全球的处方量明显较低。全科医生（GP）在肥胖的早期诊断和适当管理中发挥着关键作用。本研究旨在调查在一般实践环境中肥胖的管理和抗肥胖药物的处方态度。在 2017-2018 年期间，从记录有肥胖诊断或 BMI 值≥30kg/m2 的 8 名全科医生名单中招募了所有登记的肥胖患者。对人口统计学和临床特征进行描述性分析。应用斯皮尔曼等级相关秩检验来确定 BMI 与所有感兴趣变量之间的相关性。在 1301 名肥胖患者中，只有 66.1%被诊断出患有肥胖症，29.4%没有登记 BMI 值。有记录 BMI 值的患者超重（7.8%）或肥胖 1 级（38.8%）、2 级（14.1%）和 3 级（7.1%）。肥胖患者（1-3 级）年龄较大[66（55-76）比 49（32-59）；p<0.01]，并发疾病更多[5（3-8）比 4（2-6）；p<0.01]比 BMI<30kg/m2 的患者。此外，大多数肥胖患者是高心血管风险（HCVr）患者（67.0%比 31.9%；p<0.01）。BMI 与年龄（r=0.14；p<0.01）、糖尿病（r=0.19；p<0.01）、高血压（r=0.14；p<0.01）、心力衰竭（r=0.09；p<0.01）、HCVr（r=0.12；p<0.01）和合并症数量（r=0.08；p=0.01）呈直接相关。未发现奥利司他或纳曲酮/安非他酮的处方。由于同时存在糖尿病，仅为 7 名患者开了利拉鲁肽。我们的结果表明，意大利对肥胖管理的指南建议的依从性较低，并证实了抗肥胖药物的处方不足。
