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
Sleeve Gastrectomy
Where?
Weight loss?
Complications?
Location: greater sleeve of stomach
Loss: 60% of weight
Complications: Surgical site leak. hernias, staple disruption
Long-term: GERD
Nutritional: Iron, vit B12, folate, calcium, Vit D
How does bariatric surgery work?
Restriction of food
Malabsorption
Sometimes neurohormonal effect
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
Severe cardiac disease (cannot undergo anesthesia)
Severe coagulopathy
Current ETOH or drug use
Psych - uncontrolled/untreated depression, psychosis, eating disorders (especially bulimia)
Roux-en-Y gastric bypass
Where?
Weight loss?
Complications?
Location: gastric pouch anastomosed to the small bowel
Weight loss: 70%
Complications: peritonitis due to anastomotic leak; abdominal wall hernias; stenosis; staple disruption
Gallstones, neuropathy, ulcers
Iron, vit 12, folate, calcium, vit D
Laparoscopic adjustable gastric banding
Where?
Weight loss?
Complications?
Location: Adjustable prosthetic band on upper portion of stomach
Weight loss: 50%
Complications: band slippage, band erosion, mechanical failure
esophageal erosion, reoperation, weight regain
What is liposuction?
Sucking out that fat
w/ saline injection or aspiration of fat tissue
Cosmetic only
What is aspiration therapy?
Percutaneous gastrostomy tube is implanted endoscopically
where after meals you can drain food out
Basically, opening the door to let food out
What is Biliopancreatic Diversion with Duodenal Switch (BPD/DS)?
Mainly for BMI 50+
Lots of complications
Changes size of stomach and length of SI
What is a Intragastric Balloon ?
Saline-filled balloon placed endoscopically for max 6 month period
Reduce gastric volume and promotes satiety
