Obesity Treatment: Pharmacological and Surgical Treatments Flashcards
BMI to start pharm
30-34.9
27-29.9 with comorbid
BMI for surgery
40
35-39 with comorbid
Pharmacological Treatment of Obesity
Current medications 5-12% wt loss
Benefits only last as long as patient takes the medication. Chronic treatment likely needed.
Drugs probably not paid for by insurance so cost is a big issue for patients.
Issues of FDA approval, long term safety, and efficacy.
Choice of mechanisms, OTC versus prescription, combinations?
Phentermine
Increases NE content in the brain
Chemically related to amphetamine, ‘not addictive’
Dose: 15-37.5 mg/d,
Cost: $15-25.00/month Cheapest
FDA approved for only 3 months use
5-8% weight loss
Side effects: hypertension, headache, nervousness
Increases NE content in the brain
Chemically related to amphetamine, ‘not addictive’
Dose: 15-37.5 mg/d,
Cost: $15-25.00/month Cheapest
FDA approved for only 3 months use
5-8% weight loss
Side effects: hypertension, headache, nervousness
Phentermine
Pancreatic Lipase inhibitor Inhibits fat absorption by 30% 120 mg three times per day Cost: $100.00/mo GI side effects: oily stools, urgency MVI to prevent fat soluble vitamin deficiency
Orlistat (Xenical)
Safest weight loss medication, approved for long term use, OTC form
Much greater weight loss (10-12%)
s/e: Dry mouth, paresthesias, insomnia, dizziness, anxiety, irritability, attention problems
Phentermine/topiramate
- Recently approved
- 4-5% weight loss (may be combined with phentermine in future to get greater combined loss)
- $220-$250/month
Lorcasarin
- Not systemically absorbed=no systemic side effects
- Oily stools, sense of urgency, diarrhea, oily leakage
- Fat soluble deficiency is not common, but still take multivitamin
- DDI: Increased INR with warfarin, decreased levels cyclosporine
Orlistat (Xenical) side effects
Orlistat
safest
May be useful in those with poorly controlled hypertension or psych problems
Phentermine
cheapest
Lorcasarin
Least side effects
minimal headache, dizziness and nausea
Cost: $220/mo
The most effective treatment we have for obesity.
The best treatment we have for type 2 diabetes
Bariatric Surgery
Benefits of Weight Loss Surgery
Sleep apnea: Improved in almost all
Hypertension: improved in half
Gastroesophageal reflux: improved in most
Urinary incontinence: improved in most
Comparison of Operations
Lap band: 20% weight loss, very low mortality, 1% serious or 2.4% any complication
Sleeve gastrectomy: 25% weight loss, 0.1% mortality, 2.4% serious or 6.3% any complication
Gastric bypass: 30% weight loss, 0.2% mortality, 2.5% serious or 10% any complication