33 - Obesity Flashcards
Obesity is defined as what BMI ?
BMI > 30 kg/m^2
What waist circumference for men and women are markers of an increased cardiometabolic risk?
> 120 cm for men and > 88cm for women
Reducing weight by ___% can result in important health benefits
5-10
What are the 5 A’s of obesity management?
- Ask
- Assess
- Advise
- Agree
- Assist
What are the 2 distinct phases of weight loss?
- Induction of weight loss
- Prevention of weight gain
Phase 1 - Induction of Weight Loss:
A negative energy balance of about ____ cal/day results in weight loss of about 1-2 kg (2-4 lb) per month
500
Phase 1 - Induction of Weight Loss:
1 kg of fat = ______ kcal
7780
Phase 1 - Induction of Weight Loss:
1 lb of fat = _____ kcal
3500
Phase 1 - Induction of Weight Loss:
How should they prevent the loss of lean body mass?
by ensuring the intake of high quality protein and doing resistance training
Phase 1 - Induction of Weight Loss:
How long does this phase last?
until the patient achieves the weight loss plateau (usually about 3-6 months) at which time the focus of tx changes to phase 2
Phase 2 - Prevention of Weight Regain:
Describe what the patient must do in this phase
- patient has to continue restricting energy intake indefinitely to the same level as was consumed at the time of weight loss
- any increase in energy intake will result in weight regain
What meds are associated with weight gain?
- TCA’s, mirtazapine, MAOi’s
- VPA, tamoxifen, CBZ
- insulin, meglitinides, SUs, TZDs
- lithium
- FGAs, SGAs
- Dexamethasone, prednisone
- Hormones (estrogen, progesterone, testosterone or other anabolic/androgenic steroids)
- flunarizine, pizotifen
Non-pharms for weight loss
diet, exercise, behavioral strategies
carb intake > 100g/day, protein > 1 g/kg/day, fat intake should not exceed 30-35% of total calories consumed with < 10% from trans and saturated fats
When should you consider bariatric surgery?
when BMI > 40 or > 35 if there are morbidities
What types of drugs should you avoid after bariatric surgery?
NSAIDs and oral bisphosphonates (GI irritants)
What are the 3 classes of meds used for obesity?
- Appetite suppressants
- Incretins
- Lipase inhibitors
Appetite suppressants:
What is the antidepressant used for obesity?
bupropion - although not approved for obesity
Appetite suppressants:
Contrave (bupropion/naltrexone XL) - who is it indicated for?
for those with BMI > 30 or BMI > 27 with at least 1 weight related comorbidity
Appetite suppressants:
What is Lorcaserin?
5-HT agonist - not available in Canada
Appetite suppressants:
What are 2 other options approved for obesity in the US ?
- topiramate/phentermine
- phentermine
Incretins:
Which incretin is approved for obesity?
Liraglutide - GLP 1 agonist
Incretins: Describe Liraglutide (GLP 1 agonist)
SC injection
Incretins:
Liraglutide is proven to decrease ___ complications
CV
Incretins:
Who is liraglutide indicated for?
for those with BMI > 30 or BMI > 27 with at least 1 weight related comorbidity (such as DM, HTN, dyslipidemia)
Lipase Inhibitors:
Give the example
Orlistat
Lipase Inhibitors:
How does Orlistat work?
pancreatic and gastric lipase inhibitor that reduces dietary fat absorption by 30%, resulting in decreased 180 kcal/day
Lipase Inhibitors:
What kind of diet is poorly tolerated while taking Orlistat?
high fat intake is poorly tolerated on Orlistat therapy because of increased GI s/e
Lipase Inhibitors:
Who is Orlistat approved for?
approved for use in those with obesity and T2DM
What is the protocol for obese patients who are pregnant?
- do not try to lose weight while pregnant
- gain no more than 5-9.1 kg during pregnancy if they are obese
- eat healthy and exercise
Which of the medications mentioned before can be given during pregnancy?
bupropion (assess risk vs benefit tho)
Orlistat can cause ______ deficiencies
vitamin
Why is Orlistat not recommended during breastfeeding?
bc it can cause vitamin deficiences, even though small amount is transferred through breast milk
There were 2 cases of seizure in infants who were breastfed by a mom taking _____
bupropion
