Lecture 4 Flashcards
What are some common behavioral strategies to losing weight?
Setting realistic goals(% of body weight)
Self-monitoring
Stimulus control
Slowing eating style
Nutritional education
Meal planning
Stress reduction and problem solving
How much weight do you lose based on the types of changes?
5-7% from lifestyle changes
5-10% from lifestyle and meds
15-20% with bariatric surgery
How does exercise benefit other than losing weight?
Slow/prevent further weight gain
Reducing weight regain after successful weight loss
Doesn’t lose as much muscle mass from low diet
Improved physical functioning
Offsetting reduced BEE/BMR that occur with wt loss
Improved functional status
What types or exercises and how often do we need?
aerobic and resistance training
balance/flexibility for elderly
30mins/day 5x/week (may need to build up)
What do we check before a pt becomes active?
CV
Pulmonary
MSK
What are some principles for dieting?
Min/eliminate caloric beverages
Portion size control
Self-monitoring
View changes as long-term/lifelong
Whats the ultimate goal for dieting?
Reduce caloric intake
What do we need to consider when asking patients to diet?
Patient compliance
What diet has a more rapid initial weight loss?
Low-carb
What are the guidelines before prescribing a medication of weight loss?
Age restriction
Weight status
Duration of therapy
Cost of prescriptions
What anti-obesity Rx is approved for ages 12+?
orlistat(Xenical)
What BMI are usually most anti-obesity drugs approved for?
BMI of ≥ 30
BMI of ≥ 27 with obesity-related comorbidity
Phentermine (adieux)
MOA
SE
CI
DDI
MOA: Stimulate NE release
SE: Dry mouth, constipation, paresthesia
CI: substance use hx, hyperthyroidism, pregnancy
DDI: ETOH, anti-HTN, metformin, loop diuretics, insomnia rx, psych rx
Orlistat(Alli, Xenical)
MOA
SE
CI
DDI
MOA: dose dependent increase in fecal fat excretion. inhibits intestinal lipase (block fat absorption)
SE: GI: borborygmi(sound), flatus(sound), decrease fat-sol vit absorption, liver injury, stones
CI: pregnancy, stones, cholestatis
DDI: multivitamins, fat-soluble vitamins, warfarin, levothyroxine
Lorcaserin(Belviq) not in market
MOA
SE
MOA: serotonin agonist for serotonin 2C receptor(suppress appetite)
SE: HA, dizziness, nausea, URI
Colorectal, pancreatic, and lung cancer in trials
Liraglutide/Semaglutide (Saxenda/Wegovy)
MOA
SE
CI
DDI
MOA: agonist of GLP-1 receptors
SE: N/V/D
CI: pregnancy, family hx of medially thyroid cancer or MEN 2A/2B
DDI: Other hypoglycemic agents, serotonergic drugs, thiazides
Tirzapetide(mounjaro)
MOA
SE
CI
DDI
MOA: Agonist of GLP-1 and GIP receptors
SE: N/V/D
CI: pregnancy, family hx of medially thyroid cancer or MEN 2A/2B
DDI: Other hypoglycemic agents, serotonergic drugs, thiazides
Cellulose/Hydrogel(Plenity)
MOA
SE
CI
DDI
MOA: Expands GI tract to create sense of satiety
SE: Diarrhea, abdominal distention, pain
CI: pregnancy
DDI: none
Naltrexone SE/Bupropion SR (Contrave)
Not recommended first line
MOA
SE
CI
DDI
MOA: opioid antagonist/norepinephrine and dopamine reuptake inhibitor
SE: Nausea, constipation, HA
CI: pregnancy, HTN, anorexia
DDI: ETOH, psych meds, opiates, metoprolol, several others
Phentermine/Topiramate(Qsymia)
MOA
SE
CI
DDI
MOA: stimulates NE release
SE: dry mouth, constipation, paresthesia
CI: substance use history, hyperthyroidism, glaucoma
DDI: ETOH, psych rx, anti-HTN rx, insomnia rx, loop diuretics, metformin
Human Chorionic Gonadotropin (HCG)
MOA
MOA: alleged to increase metabolic rate and suppress appetite
however… you need to eat a very low cal diet
What are the OTC weight loss supplements that are not really reliable?
Green tea
Gardenia Cambodia (this a fruit)
Linoleum acid
Chitosan
Guar gum
Calcium
GGGLCC
Who’s eligible for bariatric surgery?
BMI ≥ 40
BMI ≥ 35 with 1+ obesity-related comorbidity
BMI ≥ 30 with severe/progressive comorbidity(sometimes)
and dumb insurance
What are CI to bariatric surgery?
Not obese - to tx of HLD, DM, or to reduce CV risk w/o obesity
Inability to comply with nutritional requirements
Age - not usually done in pts < 18 or > 65
Cardiac disease (cannot undergo anesthesia)
Coagulopathy
ETOH or drug use
Psych - uncontrolled/untreated depression, psychosis, eating disorders (especially bulimia)
NACCEP
