Obesity

Question 1

How is obesity defined?

Answer 1

• body weight > 120%

- BMI > 30

Question 2

What are the limitations of BMI measurements?

Answer 2

• overestimates fat in muscular people

- overestimates muscle mass in older adults

Question 3

What is considered a high weight circumference?

Answer 3

> 40 in men

>35 in women

Question 4

What are some health risks associated with obesity?

Answer 4

• DM, HTN, hyperlipidemia
• coronary heart disease
• cancer
• osteoarthritis
• depression
• sleep apnea
• gout, GB disease, hirsutism

Question 5

What % weight reduction can improve obesity-related health risks?

Answer 5

5-10%

Question 6

What are the goals of obesity treatment?

Answer 6

• set realistic weight goal 5-10%
• appropriate weight loss (1-2 lbs/wk)
• maintain a lower body weight over the long term
• prevent further weight gain

Question 7

What is done in the assessment of an obese pt?

Answer 7

1. measure height, weight, waist circumference
2. assess and treat risk factors for CVD and obesity-related co-morbidities
3. assess need for weight loss and patient readiness

Question 8

What is used in management of an obese pt?

Answer 8

1. comprehensive lifestyle changes: diet, physical activity, behavior therapy
2. pharmacotherapy
3. surgery

Question 9

When should anorexiant medications be considered?

Answer 9

-BMI > 30 and/or increased waist circumference or BMI > 27 in presence of obesity related risk factors or diseases

Question 10

How does Orlistat work?

Answer 10

• gastric and pancreatic lipase inhibitor

- decreases dietary fat absorption

Question 11

Drug Interactions of Orlistat

Answer 11

-modest increase in bioavailability and lipid lowering effect of pravastatin

Question 12

CIs of Orlistat

Answer 12

• pregnancy
• chronic malabsorption syndrome
• cholestasis

Question 13

AEs of Orlistat

Answer 13

• GI: oily/loose stools, fecal urgency/incontinence, bloating and gas
• interference with absorption of fat soluble vitamins
• rare cases of severe liver injury or acute hepatic failure

Question 14

What should patients take when on Orlistat?

Answer 14

• multivitamin

- psyllium to decrease GI side effects

Question 15

What should patients take when on Orlistat?

Answer 15

• multivitamin

- psyllium to decrease GI side effects

Question 16

AEs of Phentermine and Diethylpropion

Answer 16

• CNS stimulation: restlessness, insomnia, tremor, dizziness, HA, euphoria/dysphoria
• dry mouth, unpleasant taste
• D/V
• palpitations, tachycardia, HTN
• urticaria
• impotence and decreased libido

Question 17

Drug Interactions of Phentermine and Diethylpropion

Answer 17

• don’t use with other CNS stimulants

- don’t use within 14 days of MAOI

Question 18

CIs of Phentermine and Diethylpropion

Answer 18

• hypersensitivity
• severe HTN
• symptomatic CV disease
• hyperthyroidism
• glaucoma
• MAOI, EtOH, or drug use/abuse

Question 19

Precautions for Phentermine and Diethylpropion

Answer 19

• insulin requirements may decrease b/c the drug suppresses appetite so less CHO consumed
• diethyl may increase seizures in some sz disorders

Question 20

Dose of Phentermine

Answer 20

15-30 mg qam

-only approved for short term use

Question 21

AEs of Phentermine/Topiramate

Answer 21

• dizziness
• insomnia
• tingling in hands/feet
• impaired cognition

Question 22

CIs of Phentermine/Topiramate

Answer 22

• pregnancy
• glaucoma
• hyperT
• within 14 days of MAOI

Question 23

Precautions of Phentermine/Topiramate

Answer 23

• may increase resting HR, suicidal ideation/behavior, mood and sleep disorders, cognitive impairment
• adjust dose for hepatic or renal dysfunction

Question 24

What is important to remember about discontinuing Phentermine/Topiramate?

Answer 24

• dose is titrated at beginning of therapy

- discontinue gradually over time to avoid causing a seizureq

Question 25

Lorcaserin/Belviq AEs

Answer 25

• HA, dizziness
• fatigue
• dry mouth
• constipation, nausea

Question 26

Lorcaserin/Belviq CIs

Answer 26

pregnancy

Question 27

Lorcaserin/Belviq Precautions

Answer 27

-may cause serotonin syndrome, neuroleptic malignant syndrome, valvular heart dz, cognitive impairment, euphoria and dissociation, depression, priapism

Question 28

Naltrexone/Bupropion AEs

Answer 28

• N/C/V
• HA
• dizziness

Question 29

Naltrexone/Bupropion CIs

Answer 29

• medullary thyroid CA hx

- multiple endocrine neoplasia type 2

Question 30

What miscellaneous weight loss agents are available and when should they be considered?

Answer 30

• exenatide (Byetta) and pramlinitide (Symlin)

- recommended for obese pts with diabetes

Question 31

What miscellaneous weight loss agents are available and when should they be considered?

Answer 31

• exenatide (Byetta) and pramlinitide (Symlin)

- recommended for obese pts with diabetes

Question 32

What role do herbal products play in obesity management?

Answer 32

-no evidence to support safety or efficacy for weight loss

Question 33

What role does calcium play in obesity management?

Answer 33

-increased calcium consumption from dairy products seems to increase weight loss, lean body mass and body fat loss

Question 34

What drugs contribute to weight GAIN?

Answer 34

• anticonvulsants and mood stabilizers: CBZ, gabapentin, VPA, lithium
• antidepressants: MAOI, SSRI, TCA
• antidiabetics: insulin, sulfonylureas, thiazolidinediones
• atypical antipsychotics: clozapine, risperidone

Question 35

What 2 things are required for successful weight loss?

Answer 35

• decreased caloric intake

- increased exercise