Pharmacology for Obesity Management Flashcards
Why use pharmacology for management? ( 3)
- improvements in obesity related comorbidities
- behaviour changes alone only target 3-5% weight loss, which is not often sustained over long term
- pharmacology can facilitate weight management & optimize health
medications approved in Canada (4) + their average weight loss % in one year
- Orlistat (-10.2%= 4% BF lost)
- Liraglutide (-8.6%= 6% BF lost)
- naltrexone/bupropion (-6.1%=5% BF lost)
- semaglutide (-14.9%= 12% BF lost)
how medication acts on the body (4)
- Acts of the hypothalamus
- slows stomach emptying (CHO absorption is prolonged)
- reduces glucose production in the liver & increases uptake in sk. muscle
- raises insulin & lowers glucagon secretion after eating (results in improved insulin sensitivity)
what is the goal of treatment with medication?
To decrease the fat mass set point & re-regulate physiology. As set point decreases/resets so does weight loss.
Many medications work in the brain through neural mechanisms, which medication does not ?
Orlistat. And it does not impact the set point
Factors that drive up set points (environmental & genetic)
- various environmental factors
-diet
-unhealthy muscle
-sleep deprivation
-distruped carcadian rhythm
-sed. behaviour
-weight gain inducinh medications used to treat other diseases - Genetic factors
-hormones signals to the brain to let it know our energy state
-body determines what we eat, how much, when & what we crave.
-The brain determines & regulates the body fat mass set point
clinical considerations with pharmacology treatments
-it is intended to be long term & response to treatment will vary by individual
-identify individual goals of therapy prior to initiating
-set reasonable expectations & time required to see benefits
targets of treatment (5)
-weight loss
-improvement in health parameters not soley weight reduction
-weight maintenence in health parameters
-control cravings
-improvement in quality of life
other considerations for the use of pharmacology (9)
- goals of therapy
- patient values & preferences
- patient co morbidities
- mechanism of action
- side effects/tolerability
- safety
- existing medications
- mode & frequency of administration
- cost
common side effects: semaglutide
nausea, vomitting, diarrhea & constipation
common side effects: Liraglutide
nausea, vomitting, diarrhea & constipation
common side effects: Naltrexone/bupropion
nausea, vomitting, diarrhea & constipation, headache, drymouth, dizzy
common side effects: Orlistat
loose, oily stools & flatus
semaglutide as a treatment (4)
- an effective approach to treating obesity
- focus should be on improving health parameters > soley weight reduction
- intended as part of a long term strategy
- demonstrates higher efficacy than any other previously approved anti-obesity med. Effects on lean body mass have not been studied
what is bariatric surgery
gastrointestinal surgical intervention conducted to produce sustainable weight loss
- currently the best theraputic modality that can truely claim to produce sustainable weight loss
who qualifies for bariatric surgey?
- BMI >40 (class 3)
- BMI >35 (class 2) & severe weight related co-morbidities
- BMI >30 (class 1) if coupled w/ T2D may be considered
other eligabilities for bariatric surgery (4)
-pre op testing & consult
- mentally & emotionally prepared
-support system in place
-committed to life long adherence
eligabilities for anti obesity medications
- BMI >30
OR - BMI >27 with comorbidities
what is gastric sleeve surgery
-restrictive intervention
-longitudinal resection of the stomach. Takes out 85% of stomach.
-reduces functional capacity of the stomach & eliminates the ghrelin rich gastric fluids
-results in 33% weight loss per year
-small capacity/resistant to stretching
what is Roux en Y gastric bypass
-combination intervention
-Ingested food by passes 95% of the stomach
-entire duodenum & portion of jejunum
-limited nutrient absorption, have to take supplements (B Vit & iron) for the rest of your life
-Probably not ideal if you are looking to get pregnant
-low ability to cheat (drink their calories)
-good surgery for food addictions due to malabsorption of nutrients
what is Biliopancreatic Diversion surgery
-combination intervention
-less common & more risky. Prone to serious malnutrition & deficiences
-stomach & small intestine surgically reduced so nutrients absorbed only in50cm common limb
gastric bypass: pro (6)
-covered by MSP
-average weight loss is 75% of excess weight
-weigt loss occurs rapidly in first 12 months
-96% of associated health conditions are improved
-early & late complication rates are low
-patient returns to eating normal but at low quantities
Gastric bypass: cons (5)
-poor absorption of iron & calcium due to by passed duodenum
-no iron/calcium can lead to anemia
-vitamin B12 deficiency may occur
-Women should be careful since they are already at risk for osteoporosis
-Dumping syndrome: due to rapid emptying of the stomach into small intestine (triggered with too much sugar/food)
-ulcers/bleeding may occur if poor vision while in surgery
typical patient for bypass surgery
women in her 40’s who has obesity & other conditions
risks of bariatric surgery (3)
-complications & readmission rates have decreased and are rare
-complications are less than hip surgery
-readmission rates are similar for surgical patients all over canada
non fatal (general) complications with bariatric surgery (9)
-dumping syndrome
-vitamin/mineral deficiency
-vomitting/nausea
-staple line fracture
-infection
-stenosis/bowel obstruction
-ulceration
-bleeding
-splenic surgery
benefits of bypass surgery
-reduces onset diabetes
-remission of existing diabetes
-lower mortality rate
what to consider when thinking about bypass surgery? (5)
- accessibility
- expectations
- psychological impact? (marriage, relationships can be neg. impacted)
- post operative plastic surgery (remove extra skin)
- side effects (expected/unexpected)
