Abstract
Obesity affects more than 35% of Americans, increasing the risk of more than 200 comorbid conditions, impaired quality of life and premature mortality. This review aimed to summarize literature published over the past 15 years regarding the prevalence and impact of obesity in people with haemophilia (PWH) and to discuss implementing general guidelines for weight management in the context of the haemophilia comprehensive care team. Although few studies have assessed the effects of obesity on haemophilia-specific outcomes, existing evidence indicates an important impact of weight status on lower extremity joint range of motion and functional disability, with potentially important effects on overall quality of life. Data regarding bleeding tendency in PWH with coexisting obesity are largely inconclusive; however, some individuals may experience reduced joint bleeds following moderate weight loss. Additionally, conventional weight-based dosing of factor replacement therapy leads to increased treatment costs for PWH with obesity or overweight, suggesting pharmacoeconomic benefits of weight loss. Evidence-based recommendations for weight loss include behavioural strategies to reduce caloric intake and increase physical activity, pharmacotherapy and surgical therapy in appropriate patients. Unique considerations in PWH include bleed-related risks with physical activity; thus, healthcare professionals should advise patients on types and intensities of, and approaches to, physical activity, how to adjust treatment to accommodate exercise and how to manage potential activity-related bleeding. Increasing awareness of these issues may improve identification of PWH with coexisting obesity and referral to appropriate specialists, with potentially wide-ranging benefits in overall health and well-being.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 812-820 |
| Number of pages | 9 |
| Journal | Haemophilia |
| Volume | 23 |
| Issue number | 6 |
| DOIs | |
| State | Published - Nov 2017 |
Funding
S. Kahan serves on the Board of Directors (non-profit, unpaid) for the American Board of Obesity Medicine, Obesity Action Coalition and Obesity Treatment Foundation; has served as a consultant for Novo Nordisk, Takeda, Orexigen, Vivus and Eisai; and has received textbook royalties from Johns Hopkins University Press and Lippincott Williams & Williams. A. Cuker has served as a consultant for Biogen-Idec, Diagnostica Stago and Genzyme and has received research support from Biogen-Idec, Spark Therapeutics and T2 Biosystems. R. Kuskner has served on advisory boards for Novo Nordisk, Weight Watchers and Retrofit and has received research grants from Aspire Bariatrics. J. Maahs has no competing interests. M. Recht has received institutional research funding from Novo Nordisk and has served on a Novo Nordisk advisory board. T. Wadden has served on scientific advisory boards for Novo Nordisk and Weight Watchers and has received grant support, on behalf of the University of Pennsylvania, from Eisai Pharmaceutical and Novo Nordisk. T. Willis has no competing interests. S. Majumdar has no competing interests. D. Ungar and D. Cooper are employees of Novo Nordisk Inc.
Keywords
- comorbidities
- haemophilia
- health behaviour changer
- obesity
- overweight
- weight loss
ASJC Scopus subject areas
- Genetics(clinical)
- Hematology
