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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Medication-Induced Weight Gain in Neurology Patients: Health Dangers and Clinical Strategies


GOAL
To inform neurologists of the negative effects of therapeutically induced weight gain and to provide treatment strategies for at-risk patients.

TARGET AUDIENCE
This activity is designed for neurologists. No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, participants should be able to:

  • Acknowledge the risk of weight gain as a relevant issue in neurology patients.
  • Recognize patients who are at risk for weight gain, set treatment priorities, and apply weight surveillance as a consistent practice.
  • Implement treatments that do not induce weight gain when appropriate.
  • UIntegrate and coordinate efforts with primary care physicians and nurses to manage patients' weight changes.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The estimated time to complete this educational activity: 2 hours.

Release date: June 15, 2003. Expiration date: June 15, 2005.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an unrestricted educational grant from Ortho-McNeil Pharmaceutical, Inc.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, a division of Advanced Studies in Medicine, an HMG Company. PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2003 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC.

Full Disclosure Policy Affecting CME Activities:
As a sponsor accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. Program Director and Participating Faculty reported the following:

PROGRAM DIRECTOR

    Peter Kaplan, MBBS, FRCP
    Associate Professor of Neurology
    Johns Hopkins University School of Medicine
    Chairman of Neurology
    Director of Epilepsy and EEG
    Johns Hopkins Bayview Medical Center
    Baltimore, Maryland
    • Dr Kaplan reports receiving grant/research support from GlaxoSmithKline, Marion Merrill Dow, Pfizer/Parke-Davis, and UCB Pharma; serving as a consultant to Abbott Laboratories, Elan Corporation, GlaxoSmithKline, Novartis Corporation, Ortho-McNeil Pharmaceutical Inc, Pfizer/Parke-Davis, and UCB Pharma; serving on the speakers bureau for Abbott Laboratories, GlaxoSmithKline, Novartis Corporation, Pfizer/Parke-Davis, and UCB Pharma.

PARTICIPATING FACULTY

    Louis J. Aronne, MD
    Clinical Associate Professor of Medicine
    Weill Medical College of Cornell University
    Medical Director
    Comprehensive Weight Control Program
    New York, New York
    • Dr Aronne reports receiving grant/research support from Abbott Laboratories, Amgen Inc, Ortho-McNeil Pharmaceutical Inc, Regeneron Pharmaceuticals Inc, Roche Pharmaceuticals, and Sanofi-Synthelabo Inc; serving as a consultant to and/or receiving honoraria from Abbott Laboratories, Bristol-Myers Squibb Company, Ortho-McNeil Pharmaceutical Inc, Roche Pharmaceuticals, and TAP Pharmaceuticals.

    Zachary T. Bloomgarden, MD
    Associate Clinical Professor
    Mt Sinai School of Medicine
    New York, New York
    • Dr Bloomgarden reports receiving financial or material support from Eli Lilly and Company, GlaxoSmithKline, Merck & Co Inc, Novartis Pharmaceuticals Corporation, Novo Nordisk, Pfizer Inc, Takeda Pharmaceuticals Inc, and Wyeth.

    Lawrence J. Cheskin, MD
    Director, Johns Hopkins Weight Management Center
    Associate Professor of Medicine and Human Nutrition
    Bloomberg School of Public Health
    Johns Hopkins University
    Director, Gastroenterology Division
    Johns Hopkins Bayview Medical Center
    Baltimore, Maryland
    • Dr Cheskin reports receiving grant/research support from Medifast and Proctor & Gamble.

    Barry E. Gidal, PharmD
    Professor
    Department of Pharmacy and Neurology
    School of Pharmacy
    University of Wisconsin
    Madison, Wisconsin
    • Dr Gidal reports receiving grant/research support from GlaxoSmithKline and UCB Pharma; and serving as a consultant to and/or receiving honoraria from GlaxoSmithKline, IVAX Corporation, Novartis Corporation, and UCB Pharma.

Notice:
In accordance with the ACCME Standards for Commercial Support, the audience is advised that one or more articles in this continuing medical education activity may contain reference(s) to unlabeled or unapproved uses of drugs or devices.

Faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Weight Gain With Neurologic Agents
Peter Kaplan, MBBS, FRCP*

Recent reports in the lay press highlight what clinical researchers are finding about the state of our health: the US population is suffering from the scourges of excess weight and its associated diseases, namely type 2 diabetes and heart disease. Approximately two thirds of US adults are overweight or obese—the result of a striking increase over the last 20 years. These demographics are mirrored in nearly every neurology practice because some of the medications we commonly prescribe for the disorders we treat are associated with significant amounts of weight gain.

Neurologists have a wide array of drugs to treat diseases ranging from epilepsy to migraine to psychosis to neuropathic pain. Many of these drugs may be used to treat multiple disorders. Anticonvulsants and antidepressants have shown therapeutic benefit in migraine prophylaxis and psychosis, for example. When choosing a particular medication, efficacy is the first consideration; beyond that, neurologists will negotiate their way through side-effect profiles to avoid serious adverse events, such as renal failure or drug-drug interactions. An important adverse event, but one that has been often overlooked, is weight gain. Some neurologic agents are associated with significant weight gain (ie, >5–7 kg), contributing to some of the major health challenges faced by all types of physicians in the United States.

This issue of Advanced Studies in Medicine is based on a symposium for neurologists, titled "Therapeutically Induced Weight Gain in Neurology Patients: Metabolic Consequences and Management Strategies," held in New York City, October 24, 2002. The program was designed to emphasize the importance of recognizing weight gain associated with neurologic agents as a potentially serious adverse event that must be considered when evaluating treatment options. The faculty of this program present the possible causes of weight gain, the associated comorbidities and health risks associated with weight gain, the specific groups of neurologic agents notorious for causing weight gain, and practical strategies for neurologists to use in working with their patients to avoid or reverse weight gain.

Louis J. Aronne, MD, Chairman of the Development Committee for the Practical Guide to the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, discusses some of the latest research into the neuroendocrine contributions to weight gain and how they can upset the energy balance in each person. Although weight gain is ultimately the result of expending less energy than the amount of energy consumed, the process of energy storage and use by the body is clearly complex and varies with each person, making the process of weight loss more or less difficult, depending on the person's biology and genetics.

Zachary T. Bloomgarden, MD, provides a compelling overview of the myriad comorbidities with excess weight and their effect on life expectancy. There are clear risk factors for obesity and the health risks that can and should be measured and monitored by neurologists when these types of drugs are prescribed. The meaningful benefits associated with weight loss in overweight or obese persons also provide the rationale for a more proactive approach to weight management when weight-inducing drugs are used.

Barry E. Gidal, PharmD, discusses the most common culprits for weight gain among our pharmacotherapy choices and offers evidence of how they can change not only appetite, but also metabolic rates. For the physician focusing on treating the presenting disorder, weight gain may seriously affect adherence. As Dr Gidal discusses, many drugs are prescribed for long-term or even for lifetime use, so addressing weight issues early and actively can help to achieve successful outcomes.

Finally, Lawrence J. Cheskin, MD, offers practical information on the way in which neurologists can work with patients to prevent or manage weight gain with neurologic agents. As Dr Cheskin notes, neurologists need not be trained in obesity management to help their patients monitor and control their weight and to explain to their patients the importance of maintaining a healthy weight. Many of the methods he discusses can be implemented by the patient outside of a formal weight-loss program. The neurologist, as often the only physician some patients will see, can act as coach or mentor to guide the patient through this process.

Weight gain is an underrecognized and undertreated but common condition encountered by almost every physician. Because of the types of drugs neurologists commonly prescribe, overweight and obesity may be even more common in our patients. Because of the detriments to health and medication adherence with even modest amounts of weight gain, overweight and obesity should become one of the major considerations we take into account when prescribing a particular neurologic agent.

*Associate Professor of Neurology, Johns Hopkins University School of Medicine, Chairman of Neurology, Director of Epilepsy and EEG, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.