Chapter 68: Weight Loss Flashcards
Obesity
May be associated with hypertension, coronary heart disease, stroke, type 2 diabetes, gallbladder disease, kidney stones, osteoarthritis, sleep apnea, dementia, and certain cancers, although underweight or normal-weight patients also suffer from these conditions
Major health concern in children and adult population in US
MBI >/= 30
Assessment of Obesity-Associated Health Risk
Assessment: Obesity
- Degree of obesity
Body mass index (BMI)
BMI of 30 or higher indicates obesity - Pattern of fat distribution
Waist circumference
>40 in men, >35 in women - Risk status
If pt has BMI of 25-34.9 –elevated RF for CV disease
BMI <25 low risk for chronic conditions
BMI <30 relatively low risk for chronic conditions
BMI >30 significant risk for chronic conditions
BMI >25 and high waist circ (listed) very high risk for chronic conditions
Who might want to be treated?
Individuals with a BMI of 30 or higher
Individuals with a BMI of 25 to 25.9 plus two risk factors
Individuals with a waist circumference (WC) greater than 40 inches (men) or greater than 35 inches (women) plus two risk factors
Obesity tx goals
Normal BMI
Treatment Modalities
Calorie restriction
- 500 to 750 a day
Exercise
150 min/week
To maintain wight loss should be between 200-300 min/week
Behavior modification
Track calorie intake, monitor weight (daily or couple times a week), food diary (what the ate and how Much)
Drug therapy
Anywhere from 4.4-22lb decrease to jumpstart weight loss
Has to be with calorie restriction and exercise
Bariatric therapy
Within 6m people can one 110-220lb
Challenge is maintenance
Weight-Loss Drug
Only weight-loss drug currently approved for long-term use:
Orlistat [Xenical, Alli]
Lipase Inhibitor: Orlistat
Acts in the GI tract to reduce absorption of fat ~30%
Orlistat ADR
GI effects
Recal leakage
20-30% of pt
Dose with bulk forming laxative
Possible liver damage
Acute pancreatitis
Kidney stones
Serotonin 5-HT2C Receptor Agonist: Lorcaserin [Belviq]
Chronic weight-loss therapy
Suppresses appetite and creates a sense of satiety
Activates the hypothalamic and mesolimbic pathways that control appetite
Sympathomimetic amines
Amphetamines: Not FDA approved for weight-loss therapy because they have a much higher abuse potential
Nonamphetamines: Diethylpropion and phentermine—CNS stimulants that suppress appetite by increasing the availability of norepinephrine (NE) at receptors in the brain
Glucagon-like peptide one agonist saxenda
Slows down gastric emptying, increase feeling of fullness –decrease food intake. Also works with DM II pt
A Note on Drugs for Weight Loss
Weight-loss drugs share a disturbing history: They receive regulatory approval, achieve widespread use, and then are withdrawn owing to the discovery of serious adverse effects
Use cautiously
Encourage weight loss without meds
