Obesity Management Flashcards
The different forms of lifestyle changes for obesity management include…
Dietary
Physical activity
Cognitive behavioural therapy
Traditional nutritional interventions have focused on weight loss via…
Caloric restriction (expenditure must be greater than intake)
There are dozens of proposed mechanisms - no best fit for eveyrone
With dietary restriction, most people return to baseline weight within ____ years. However…
1-2 years. However is not shown to be sustainable long-term
Due to biological mechanisms
Regarding nutritional interventions, we should…
Refer to a dietician when available - should be patient-specific and focus on changes that will improve health (not just weight changes)
Regular physical activity has shown improvement in…
Cardiometabolic risk factors
Overall QoL
Mood
Body image
Cognitive behavioural therapy involves…
Goal setting
Problem solving
Developing confidence
Overcoming barriers
Many supplements and natural health products claim to aid in weight loss. We should…
Ensure safety
Consult natural medicines database
The main pharmacotherapy options for weight loss include…
Orlistat
Liraglutide
Tirzapetide
Semaglutide
Naltrexone/bupropion
Pharmacotherapy is indicated for chronic weight management if…
BMi is over 30 kg/m^2, or over 27 kg/m^2 if there are co-morbidities associated with excess body fat
SHOULD be in conjunction with health behaviour changes
Function of lipases are to…
Hydrolyze dietary fats, converting them to monoglycerides and triglycerides
MOA of orlistat is to…
Inhibit lipases in the GI tract - inhibiting dietary fat absorption by about 30%
Specific dosing instructions for orlistat include…
Take with, or up to 1 hour after, each meal
Skip a meal (or meal has no fat), skip a dose
Follow mildly hypocaloric diet with less than 30% calories from fat
AE’s with orlistat include…
Flatulence (sometimes with discharge)
Loose, oily stools, diarrhea
Fecal urgency/incontinence
Abdominal discomfort
Orlistat is CI with…
Malabsorption syndromes
Cholestasis
Precaution with GI/hepatic disorders
DI’s with orlistat include…
Fat-soluble vitamins (A,D,E,K)
Separate from multivitamin by at least 2 hours. Decreased vitamin K absorption could increase anticoagulation with warfarin
May decrease absorption of cyclosporine, levothyroxine, anti-epileptic drugs, ARV’s - separate dosing times by 3-4 hours
MOA of naltrexone/bupropion is to…
Help induce satiety and decrease cravings via actions in the brain
Naltrexone/bupropion should be titrated to…
Minimize seizure risk and help with AE’s
Common AE’s that may occur with naltrexone/bupropion include…
GI - N/V/D, constipation
Headache, dry mouth, dizziness, insomnia
Rare AE’s with naltrexone/bupropion include…
Seizures
Worsening of depression
CI’s to using naltrexone/bupropion include…
Opioid usage
Uncontrolled HTN
Hx of, or risk factors for seizures
Bulimia/anorexia
Primary drug enzyme interactions with Contrave is with…
2D6
____ increases systemic absorption with naltrexone/bupropion, so this should be avoided…
High fat content meal
MOA of incretins for weight loss is to…
Enhance satiety
Decrease appetite
Delay gastric emptying
Decrease glucagon and increase insulin levels
GLP-1 agonists approved for weight loss include…
Liraglutide
Semaglutide
Indication for GLP-1 agonists is…
Adults: BMI above 30, or above 27 + one weight-related co-morbidity
12-18: inadequate response to diet/exercise, body weight above 60kg, and initial BMI above 30
Efficacy of the GLP-1 agonists should be evaluated via…
Seeing if weight loss is >5% by week 12. If not, then response is unlikely
Common AE’s with the GLP-1 agonists include…
N/V/D
Dose titration ideal to help with this
Rare AE’s with the GLP-1 agonists include…
Acute prancreatitis
Cholelithiasis
CI with the GLP-1 agonists include…
Personal history of thyroid cancers
GLP-1 agonists may affect absorption via…
Delaying gastric emptying; longer Tmax
Other medications that may cause some weight loss (but are not approved) include…
Bupropion
Fluoxetine
Topiramate
Methylphenidate
SGLT2 inhibitors, metformin
Obesity, similar to other chronic conditions, requires…
A long-term strategy to manage.
If an intervention is discontinued, weight will start to increase again
Pharmacotherapy is intended to be part of a long-term strategy. Ideally we should only stop pharmacotherapy if…
> 5% weight loss has not been achieved after 3 months on full/maximally tolerated dose
Tirzepatide class is unique in that it is both a…
GIP and GLP-1 receptor agonist
Works similary to GLP-1 agonists
Currently in Canada, still indicated only for adults with T2DM
The amount of weight loss acheieved with tirzepatide was comparable to…
Bariatric surgery
Nearly 40% of patients lost >25% of total body weight
Bariatric surgery should be considered…
IN those with BMI above 35, with appropriate patient selection, education, and follow-up
Had best outcomes with respect to QoL, long-term weight loss, and resolution of obesity related disease
Helping children maintain a healthy weight can include…
Healthy eating
Adequate physical activity
