Vitamins/Dietary/Weight Loss Flashcards
BMI for obese patients
BMI ≥30
BMI for overweight patients
BMI 25 to 29.9
BMI for Extremely Obese patients
≥ 40
Normal BMI
18.5 – 24.9
Other factor besides BMI to consider
High risk waist circumference
High risk waist circumference
Men > 102 cm (> 40 in)
Women >88 cm (> 35 in)
Exclusions for self-treatment
a. BMI >40 (severe obesity)
b. Pregnancy, breast-feeding
c. 65 y/o
e. CV disease, diabetes, dyslipidemia, hypertension
f. Eating disorders
* **overuse/abuse of laxatives
Obesity is a Risk factor for many diseases including
type 2 diabetes, heart disease, hypertension, osteoarthritis, and some types of cancer
General self-care principles for obesity
a. Focus on improving and maintaining quality of life Lifestyle Change (is key) rather than a specific number on a scale
b. Losing as little as 5-10% is associated with health benefits with the goal of losing 10% of total body weight within 6 months
c. People are continually surrounded by conflicting information of various levels of quality
Non-pharmacologic therapy for obesity
i. Lifestyle changes need to be attempted for at least 6 months prior to starting pharmacologic therapy
1. Dietary changes (Commercial weight-loss programs, caloric restriction, dietary changes, altered proportions of food groups)
2. Exercise
Caloric restriction
i. Low-calorie diet: 1200-1500 kcal/day for women and 1500-1800 kcal/day for men
ii. Decrease daily calories by approximately 500 kcal/day to lose 1-2lb per week
iii. Very low-calorie diet: < 800 kcal/day
Dietary changes
i. Eat more vegetables, fruit, whole grains, lean meats
ii. Eat less processed food
iii. Eat small meals (200 kcal/meal) 5-6 times/day
iv. Cutting portions
v. Eating breakfast
Altered proportions of food groups
i. Low fat diets (< 30% of calories)
ii. Vegetarian diets
iii. High-protein, low-carbohydrate diets
iv. Food additives (sugar and/or fat substitutes)
Exercise goals
a. Goal 150 min/week (Aerobic: 30 minutes of activity/day most days of the week with no more than 2 consecutive days/wk, Resistance training 2 days/wk on non-consecutive days)
b. Weight loss: 60-90 minutes activity/day, most days
c. Men 40+, women 50+, medical evaluation prior to beginning exercise program
Pharmacologic therapy for obesity
- FDA recommends using only 1 drug at a time along w/ lifestyle modifications
- Pharmacologic intervention is a band-aid for weight-loss, producing a modes weight loss of 2-10 kg and weight tends to be regained after d/c the drug (where as low-calorie diet/dietary changes 8% weight reduction of total weight = more beneficial)
- Not generally recommended for most patients
- BMI ≥ 30 OR BMI ≥ 27 plus tried diet and exercise over 6 months
Orlistat (alli®) / Xenical
a. Take 1 capsule TID with a fat-containing meal. If a meal does not contain fat then skip dose.
b. OTC: 60 mg / Rx: 120 mg
OTC: for ≥ 18 y/o
Rx: for ≥ 12 y/o
c. Reversible lipase inhibitor
d. Flatulence with oily spotting/leakage, oily diarrhea, fecal urgency
e. Low-calorie, low-fat diet, & exercise recommended
50% additional weight loss
5-10 pounds over 6 months
Contraindications for Orlistat
i. Organ transplant OR taking cyclosporine
ii. Pregnant or breast-feeding
iii. Chronic malabsorption syndrome
iv. Cholestasis
If patient wants Orlistat - Refer to PCP if
i. Taking warfarin, medications for diabetes or thyroid disease or other weight loss products
- With warfarin, orilstat reduces the absorption of fat-soluble vitamins. Vitamin K is a fat soluble vitamin, reduced absorption reduced production of clotting factors increased potential for bleeding (esp if patient is on warfarin). Need to closely monitor INR
- Reduces absorption of medications to treat diabetes and thyroid disorders
- FDA recommends patients can only take 1 weight loss product at a time.
ii. Kidney stones
iii. Pancreatitis
iv. Gallbladder or liver problems
Weight Loss Supplements
a. Stimulants/thermogenic products (caffeine, ephedrine-off the market, bitter orange, Garcinia cambogia, green coffee extract, guarana, yerba mate)
b. Bitter orange - p-synephrine
c. Green coffee extract
d. Raspberry Ketone
Stimulants/thermogenic products (caffeine, ephedrine-off the market, bitter orange, Garcinia cambogia, green coffee extract, guarana, yerba mate)
i. Contains one or more sympathomimetic amine
iii. Claim to increase metabolic rate
iv. Avoid in those with underlying CV issues or other serious health conditions
v. FDA warns against using dimethylamylamine (DMAA) containing products
vi. Ephedra pulled from market due to risk of stroke, MI, & death
vii. Truth: may cause modest short-term weight loss, but not worth risks
Bitter orange - p-synephrine
i. Few documented CV events
ii. Modest effect in health individuals
Green coffee extract
i. Widely promoted for weight loss in the past 2-3 years
ii. Unclear MOA; chlorogenic acid (CGA)is thought to be active component
iii. May promote glucose absorption from distal GI tract leading to decreased caloric intake
iv. Usually studied in countries with a vastly different diet
v. No good quality studies available; possibly modest weight loss
vi. Dietary supplements should be produced in US, contain at least 45% CGA, and be low in caffeine
Raspberry Ketone
i. Raspberry ketone’s structure is similar to synephrine Recently promoted for weight loss
ii. Unknown MOA; possibly increased norepiephrine-induced lipolysis. This comes from lab animals…not humans.
iii. It’s safe when used in small amounts in foods…but the higher doses in supplements haven’t been tested in humans.
iv. Even though advocates call it “natural,” explain that raspberry ketone is usually made in a lab…not from real raspberries.
v. Limited studies; safety is a question; avoid recommending until more evidence available
Patients that are candidates for Bariatric surgery
i. BMI ≥ 40 OR BMI ≥ 30 + comorbid conditions
preferred source of vitamins & minerals
Foods
Who should take a supplement?
Inadequate dietary intake – alcoholics, impoverished, those who have eating disorders, or on fad/trendy diets
- Increased metabolic requirements – pregnant and breast feeding women, infants/children, post-surgical, cancer, or trauma patients
- Poor absorption – elderly, patients with GI disorders (diarrhea, constipation, IBS), celiac disease, those who’ve undergone gastric bypass
- Iatrogenic situations – patients taking prolonged ABX, those with drug-nutrient interactions, those receiving total parenteral nutrition
Fat Soluble vitamins
Vitamins A, D, E, K
Vitamin A (α and β-carotene, retinol)
i. Functions: Eyes; analogues for cancers, skin disorders
ii. Deficiency, s/sx: night blindness (usually seen first), dry eyes, dry skin, poor bone growth
iii. Safety: teratogenic effects at doses > 3 mg (3000 mcg)
Vitamin D
- Ergocalciferol (vit D2)
- Cholecalciferol (vit D3)
- Calcitriol
found in milk and OTC supplements
Ergocalciferol (vit D2)
synthesized in human skin through sun exposure; found in food from animal sources; often thought to be more potent/longer duration of action (DOA) and therefore found in more OTC supplements
Cholecalciferol (vit D3)
How is a. Vitamin D is synthesized in skin
a. Vitamin D is synthesized in skin when exposed to sunlight (UV radiation) into cholecalciferol (vitamin D3) (the prohormone) and converted by the liver 25 –hydroxycholecalciferol and then hydroxylated by the kidney to its active form, 1-25 dihydroxycholecalicferol
b. Generally want levels higher than 20-30 ng/mL
c. Estimated 41.6% of adults have 25OHD levels below recommended goal
active form of Vit D that regulates calcium and phosphorus in the body; only as Rx
Calcitriol
