Obesity Flashcards
Tx:
Amphtamines: Sympathomimetic drugs that suppress appetite (phentermine, diethylpropion)
Orlistat, now available over the counter, is a lipase inhibitor that leads to fat malabsorption. In a recent meta-analysis on the pharmacologic treatment of obesity, the mean weight loss in patients treated with orlistat was 2.9 kg (6.4 lb) at 12 months [9%]. Secondary benefits included reductions in low-density lipoprotein cholesterol level and blood pressure and, in patients with diabetes, improvement in glycemic control. Approximately 15% to 30% of patients experience gastrointestinal side effects (flatus, abdominal cramps, fecal incontinence, oily spottage), especially while consuming high-fat diets. Orlistat has not been associated with serious cardiovascular side effects. However, a recently completed review by the Food and Drug Administration (FDA) noted rare reports of severe liver injury with orlistat. Malabsorption of fat-soluble vitamins A, D, and E has been reported, and vitamin supplementation is advisable while taking the medication.
Lorcaserin, a brain serotonin 2C receptor agonist, was approved by the for adults with BMIs greater than 30 or greater than 27 with obesity-related complications. In conjunction with a reduced-calorie diet and exercise counseling, lorcaserin was associated with an average weight loss of 3% at 1 year. Lorcaserin is as effective as orlistat but with fewer side effects, but long-term safety data are limited.
Sibutramine (Meridia) is a prescription serotonin/norepinephrine blocker.
Selective cannabinoid-1 receptor antagonist ( rimonabant) under investigation that looks promising,
Diet: Patients who follow a diet that reduces their caloric intake by 500 to 1000 kcal/d compared with their intake that is currently maintaining weight will lose an average of 0.45 to 0.91 kg (1-2 lb) per week. The initial goal should be a loss of 10% of total body weight.
Unfortunately, only 20% of patients will lose 20 lb and maintain the weight loss for 2 years using conventional dietary techniques. Only 5% can maintain a 40 lb weight loss.
Bariatric surgery is recommended as a treatment option for patients who have been unable to maintain weight loss with diet and exercise with or without drug therapy with class III obesity, defined as patients who have a body mass index (BMI) ≥40, or those with BMIs of 35 to 39.9 (class II) who have obesity-related comorbid conditions, such as hypertension, impaired glucose tolerance, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea. Cx: Common and occur with about 40% of the cases. Operative mortality is actually quite low 0% to 1% in the first 30 days.
Hx:
The history and physical examination are of utmost importance when evaluating the obese patient. Less than 1% of obese patients have a secondary nonpsychiatric cause for their obesity.
Hypothyroidism and Cushing syndrome are important examples that can generally be detected by history and physical.
A BMI greater than 25 kg/m<sup>2</sup> is classified as **overweight**. A BMI greater than 30 kg/m<sup>2</sup> is considered **obese**, a BM I greater than 35 kg/m<sup>2</sup> is considered “**class II obesity**,” and a BMI greater than **40 kg/m<sup>2</sup>** is considered “**class III obesity**” or **extreme obesity.**
