Weight management

Question 1

Discuss what is meant by high and low glycaemic index foods

Answer 1

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

Question 2

What is considered a high and low GI?

Answer 2

High = 70 or >

Low = 55 or <

Question 3

What is BMI? How is it calculated?

Answer 3

Calculated: BMI = Weight (kg)/height (m^2)

Its an index of weight to height used to classify overweight, underweight or obesity in adults

Question 4

What are some issues with BMI?

Answer 4

Body fat can be underestimated in older people due to muscle mass loss and decreased height

Body fat can be overestimated in muscular people

Question 5

What is an underweight BMI?

Answer 5

<18.5

Question 6

What is a normal BMI?

Answer 6

18.5 - 24.9

Question 7

What is an overweight BMI?

Answer 7

> /=25

Pre-obese = 25 - 29.9
Obese I = 30-34.9
Obese II = 35-39.9
Obese III = >/=40

Question 8

What is obesity? How is it determined?

Answer 8

Intra-abdominal fat (visceral fat) = packed between organs

Excess amounts - central obesity linked to chronic health conditions

Determined = BMI, waist circumference

Question 9

What is waist circumference?

Answer 9

Is a practical measure of abdominal fat, shown to positively correlate to disease risk

Question 10

What waist circumference indicates low health related risks?

Answer 10

Men - </=94cm

Women - </= 80

Question 11

What waist circumference indicates high health related risks?

Answer 11

women = 88cm

men = 102cm

Question 12

What factors contribute to weight gain?

Answer 12

Age

socioeconomic status

Level of education

ethnic origin

place of residence = remote areas have greater obesity rates

Diet

lifestyle

Question 13

Which medications cause weight gain?

Answer 13

Benzodiazepines
Antiepileptics
Antipsychotics
TCAs
Corticosteroids
Sulphonylureas
insulin

Question 14

What is the pharmacist role in weight management?

Answer 14

Education = lifestyle/ behavioural mod, energy intake, food labels, exercise, goal setting

Pharmaceutical services

OTC products with proven effectiveness

Question 15

What are some goals for weight loss?

Answer 15

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

Question 16

What products are available to help weight loss?

Answer 16

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)

Question 17

Discuss very low calorie diets (VLCD)

Answer 17

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

Question 18

What medications may need to be reduced when on VLCD?

Answer 18

Antihypertensive, sulfonylureas, or insulin

dyslipidaemia medicines

Monitor lithium and warfarin

Question 19

What S4 oral drugs can be used for weightloss?

Answer 19

Phentermine = sympathomimetic amine similar to amphetamines –> CNS stim and elevation of BP

Buproprion + naltrexone = affects appetite regulatory system

Question 20

What is the role of phentermine in weight loss?

Answer 20

Suppresses appetite, tolerance can develop

Useful for short term only (12 wks)

6-7kgs of weight loss

Question 21

What are some considerations for phentermine use?

Answer 21

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

Question 22

What S3 is available for weight loss? What does it do?

Answer 22

Orlistat
It is a lipase inhibitor –> inhibits absorption of dietary fat

Indicated for patients with BMI >30 or BMI >27 with other comorbidities

Question 23

Discuss some considerations for Orlistat use

Answer 23

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

Question 24

What are some ADRs of orlistat?

Answer 24

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

Question 25

Discuss the use of bupropion + naltrexone in weight loss

Answer 25

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

Question 26

Discuss injectable weight loss drugs

Answer 26

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

Question 27

What is the pharmacists role in weight management?

Answer 27

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

Question 28

When is weight loss surgery appropriate?

Answer 28

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