Obesity and Weightloss Flashcards
Body Mass Index (BMI): Calc + Classification
BMI = weight (lb) * 703 / height^2 (in^2) BMI = weight (kg) / height^2 (m^2)
- 1 kg = 2.2 lbs
- 1 in = 2.54 cm = 0.0254 m
< 18.5 : Underweight 18.5-24.9 : Normal 25 - 29.9 : Overweight 30 - 39.9 : Obese > 40 : Morbidly obese
Ideal Body Weight (IBW)
Men
- IBW : 50 kg + 2.3 kg * every in over 5 ft
Women
- IBW : 45.5 kg + 2.3 kg * every in over 5 ft
Weight Gain
- Energy intake > Energy Expenditure
* 1 lb of adipose tissue = 3,500 calories
Risk Factors
Environment • Lifestyle - Increased portion sizes and calories - Increased work hours - Decreased exercise - Decreased sleep
• Genetics
- Increased storage of body fat
- Hormones
- Leptin
- Ghrelin
Medication Causing Weight Gain
• Atypical and Typical Antipsychotics
- Clozapine
- Olanzapine
- Haloperidol
• Antidepressants
- Tricyclics
- Monoamine oxidase inhibitors
- Mirtazapine
• Insulin
• Corticosteroids
- Hormonal contraceptives
• Anticonvulsants
Weight Management: Exclusion for Self-Treatment
- Severe Obesity (BMI ≥ 40)
- Pregnancy or Breastfeeding
- Age (< 18 or > 65 years old)
- Cardiovascular Disease
- Hypertension, Diabetes, Dyslipidemia
- Eating Disorders
Dietary Change: Avg. for M/W, Caloric Restriction
• Average caloric intake for a 30-year old
- Men: 2,200-3,000 kcal/day
- Women: 1,800-2,800 kcal/day
• Restriction: ↓ 300-1000 kcal/day
• Low Calorie Diet (LCD): ↓ 1-2lbs/week
- 800-1,500 kcal/day
The Very Low Diets (Cals, Requirements, AE)
Very Low Calorie Diet (VLCD)
• < 800 kcal/day, at least 1g/kg protein
• Requires supervision/monitoring
Multivitamin for diets < 1,200 kcal/day
Starvation
• Depletes body of lean tissue (protein), electrolytes, and fat
Adverse Effects • Fatigue • Hair loss • Dizziness • Diarrhea • Constipation • Dry skin • Irregular menses • Gallstones
Calories
- Protein = 4 kcal/g
- Carbohydrates = 4 kcal/g
- Fat = 9 kcal/g
- 1 Calorie = 1 kcal
- 1000 calories = 1 kcal
Dietary Change: Altered Food Groups
NHLBI Recommendation
• Fat ≤ 30% (8-10% comes from saturated fat)
• Protein ≈ 15%
• Carbohydrates ≥ 55%
Glycemic Index
• Amount of rise in blood glucose after eating
Not All Additives Created Equal…
• Sugar alcohols (sorbitol, xylitol, maltitol)
(+) Does not contribute to tooth cavities
(±) Raises blood sugar (but less than ‘regular’ sugar)
(–) Bloating and diarrhea
• Example: Haribo Sugar-Free Gummy Bears
Weekly Physical Activity for Adults
150 minutes of moderate aerobic activity OR
75 minutes of vigorous aerobic activity
PLUS
Muscle-strengthening exercises 2+ days/week
start low go slow
Activity Classification
Moderate Aerobic
- Fast walking, water aerobics, biking on flat ground, doubles tennis, mowing the lawn
Vigorous Aerobic
- Jogging/Running, swimming laps, biking fast/on hills, singles tennis, basketball
Muscle strengthening
- Lifting weights, resistance bands, body weight exercises, heavy gardening, yoga
Behavioral Therapy
• Individual or group, counselor or alone
• Environmental
- Remove access to high-calorie foods
• Modify Thinking
- Set reasonable short-term goals
• Self-Efficacy
- Optimistic, positive approach
• Social Support
- Family, friends, healthcare providers
When to use medication?
• BMI ≥ 30
• BMI ≥ 27 with concomitant diseases/risk factors
- Diabetes, hypertension, dyslipidemia
• Used as adjunct to diet and physical activity
• Used at lowest effective dose
- Minimize adverse events
Orlistat (only Alli on dosing list)
• MOA: Blocks gastric and pancreatic lipases
- Prevents breakdown and absorption of dietary fats
• ↓ Weight (5-10 pounds in 6 months), LDL, BP
Xenical (Rx)
- Criteria: >= 12, BMI => 30, or BMI => 27 with risk factors
- Dose: 120 mg PO TID with meals
- Efficacy: decrease fat abs. by 30%
Alli (Non-Rx)
- Criteria: >= 18, ‘for overweight adults’, BMI => 25
- Dose: 60 mg PO TID with meals
- Efficacy: none
Orlistat Risks (AE, Avoid In, Contra)
• Adverse Events
- Headache
- GI (flatulence, oily spotting, loose stools, fatty stools, fecal urgency)
- Severe liver injury
AVOID IN – Thyroid disease – Cholelithiasis – Nephrolithiasis – Pancreatitis – Pregnancy
CONTRA:
– Malabsorption syndrome
– Cholestasis
Orlistat Counseling
• Supplement to lifestyle modification
- Helpful in initial weight loss and maintenance
• More carbohydrates, less fat
- Helps reduce unwanted GI side effects
- Don’t need to take if eating a fat-free meal
• Recommend taking with multivitamin
- ↓ absorption of fat-soluble vitamins (A, D, E, K)
• Drug interactions due to decreased absorption
- ↓ cyclosporine, levothyroxine, ↑ warfarin effects
Counseling Points
- Obesity results from numerous environmental and genetic factors
- Obesity results in many complications including cardiovascular disease, diabetes, and cancer
- Realistic weight loss goal is 10% in 6 months
- Diet and exercise are key to success
- Orlistat is the only FDA approved OTC weight loss medication
- Dietary supplements have not been proven to be effective and may cause several side effects
- GOAL: Achieve healthy weight and maintain it over the long term
