Weight management Flashcards
Discuss what is meant by high and low glycaemic index foods
High GI = food rapidly digested and absorbed and result in fluctuations in blood sugar levels
Low GI = slow digestion and absorption resulting in gradual rise in blood sugar and insulin
What is considered a high and low GI?
High = 70 or >
Low = 55 or <
What is BMI? How is it calculated?
Calculated: BMI = Weight (kg)/height (m^2)
Its an index of weight to height used to classify overweight, underweight or obesity in adults
What are some issues with BMI?
Body fat can be underestimated in older people due to muscle mass loss and decreased height
Body fat can be overestimated in muscular people
What is an underweight BMI?
<18.5
What is a normal BMI?
18.5 - 24.9
What is an overweight BMI?
> /=25
Pre-obese = 25 - 29.9
Obese I = 30-34.9
Obese II = 35-39.9
Obese III = >/=40
What is obesity? How is it determined?
Intra-abdominal fat (visceral fat) = packed between organs
Excess amounts - central obesity linked to chronic health conditions
Determined = BMI, waist circumference
What is waist circumference?
Is a practical measure of abdominal fat, shown to positively correlate to disease risk
What waist circumference indicates low health related risks?
Men - </=94cm
Women - </= 80
What waist circumference indicates high health related risks?
women = 88cm
men = 102cm
What factors contribute to weight gain?
Age
socioeconomic status
Level of education
ethnic origin
place of residence = remote areas have greater obesity rates
Diet
lifestyle
Which medications cause weight gain?
Benzodiazepines
Antiepileptics
Antipsychotics
TCAs
Corticosteroids
Sulphonylureas
insulin
What is the pharmacist role in weight management?
Education = lifestyle/ behavioural mod, energy intake, food labels, exercise, goal setting
Pharmaceutical services
OTC products with proven effectiveness
What are some goals for weight loss?
Patient needs to be willing to change
Goals need to be realistic and achievable
Gradual weight loss = approx 1kg/month
Common goal = loss of 5-10% of initial weight, not subsequent weight gain
What products are available to help weight loss?
Formulated supplementary foods -> lowest nutritional req, doesnt replace meal but adds nutrients
Formulated meal replacements (alpha slim, celerbitry shake, kate morgan)
Very low calorie diets = total diet replacement over short period (optislim, optifast)
Discuss very low calorie diets (VLCD)
For morbidly obese or obese individuals
Contain recommended daily req for = vits, minerals, trace elements, fatty acids, protein
Cause mild ketosis
Used under medical supervision, not for pregnant or lactating women, severe medical conditions, recurrent CV/cerebrovascular events, dysrhythmias, psychiatric disorders
What medications may need to be reduced when on VLCD?
Antihypertensive, sulfonylureas, or insulin
dyslipidaemia medicines
Monitor lithium and warfarin
What S4 oral drugs can be used for weightloss?
Phentermine = sympathomimetic amine similar to amphetamines –> CNS stim and elevation of BP
Buproprion + naltrexone = affects appetite regulatory system
What is the role of phentermine in weight loss?
Suppresses appetite, tolerance can develop
Useful for short term only (12 wks)
6-7kgs of weight loss
What are some considerations for phentermine use?
Many drug interactions = SSRIs, MAOI, Urinary acidifiers, alkanisers
Counselling points
- use for max 12 wks with drug-free period
- use exercise & calorie restrictions
W/drawal symptoms = drowsiness, severe fatigue, nausea, vomiting, trembling, insomnia
What S3 is available for weight loss? What does it do?
Orlistat
It is a lipase inhibitor –> inhibits absorption of dietary fat
Indicated for patients with BMI >30 or BMI >27 with other comorbidities
Discuss some considerations for Orlistat use
C/I = cholestasis, Maj GI surgery, chronic malabsorption syndrome, panceratic enz def, chronic hepatitis, preg/lactate
Precaution = bulmia, laxative abuse, fat soluble vit def, active peptic ulcer disease, anticoagulants, cyclosporin, hypoglycaemics, amiodarone
Req vit supplementation = Fat soluble vit A, D, E, K
What are some ADRs of orlistat?
Mild, transient GI symptoms
Fatty or oily stools
Abdominal pain, diarrhoea, dyspepsia, faecal incontinence, flatulence, headache
Red flag = blood in stool, cholethiasis, cholecystitis, diverticulilits, enteritis, hypoglycaemia
Discuss the use of bupropion + naltrexone in weight loss
Taken with food for people with BMI >30 or BMI >27 for people with CV risks
Modest weight loss after 1 year, weight loss plateau after 6 months
Discuss injectable weight loss drugs
Liraglutide (S4) = once daily injection, slows gastric emptying and suppress hunger. May experience nausea, diarrhoea, constipation
Semaglutide (Ozempic) (S4) = GLP1 agonist, weekly injection that slows gastric emptying and suppresses hunger. May experience nausea, diarrhoea, constipation
What is the pharmacists role in weight management?
Establish patient’s need, BMI & waist circumference
Assess comorbidities, assess readiness, motivation for weight loss
ID factors contributing to weight, determine level of intervention needed, devise goals of treatment strategies, provide regular monitoring
When is weight loss surgery appropriate?
18 years or older
BMI in 35, or BMI 30 w/ one or more related disease
overweight or obese for more than 5 years
Has serious attempts to lose weight but failed, not drinking excessive alcohol
Not suffering from illness caused by weight gain
