1 - Obesity

How is obesity most often measured?

BMI

What obesity measurement is utilized as a “risk enhancer”?

waist circumference

What BMI is considered underweight?

<18.5

What BMI is considered normal?

18.5 - <25

What BMI is considered class 1 obesity?

30 - <35

What BMI is considered class 2 obesity?

35 - <40

What BMI is considered class 3 obesity?

40 or higher

What waist circumference is considered obese for men?

≧40in

What waist circumference is considered obese for women?

≧35in

What is the general treatment approach?

1. determine obesity category

2. lifestyle modifications

3. medications

When is lifestyle modification recommended as monotherapy?

BMI ≧25

In what conditions is lifestyle modification + pharmacotherapy used?

• BMI ≧30

• BMI ≧27 w/ comorbidities

• adolescents ≧12yo: BMI ≧95th percentile

In what conditions in bariatric surgery considered?

• BMI ≧40

• BMI ≧35 w/ comorbidities

• adolescents ≧12yo: BMI ≧120% of the 95th percentile

What are the goals of therapy in obesity?

• generally >5% reduction in body weight

• greater, sustained weight loss

What are the effects of >5% reduction in body weight?

• improves BP, glucose, lipids

• reduces risks of developing chronic disease

How must a medication be picked for obesity?

most options have similar efficacy, so choose based on ADE/contraindications

Which anti-obesity agent has the highest efficacy compared to others?

tirzepatide

Which anti-obesity agent is the cheapest?

phentermine

When should anti-obesity agents be discontinued?

guidance states discontinue or increase dose if <5% weight loss after 3 months

What is the brand name of naltrexone/buproprion ER?

contrave

What are the ADE of contrave?

• headache

• sleep disorder

• nausea/vomiting/constipation

What are the warnings/precautions of contrave?

• suicidal thinking/behavior

• opioid withdrawal/overdose

• CV disease

• seizures (worsened by alcohol use disorder)

What is the efficacy of contrave

-4.8% weight loss from baseline

What are the brand names of orlistat?

xenical, alli

What are the ADE of orlistat?

• GI

  • oily rectal leakage

  • abdominal distress/pain

  • increased bowel urgency/frequency/incontinence

• headache

• uri

What are the contraindications of orlistat?

• pregnancy

• chronic malabsorption syndrome

• cholestasis

What should be monitored when taking orlistat?

fat soluble vitamines (ADEK)

What is the efficacy of orlistat?

-3.1% weight loss from baseline

What is the brand name of adipex-p?

phentermine

What are the ADE of adipex-p?

• htn, tachycardia

• dizziness

• headache

• euphoria, insomnia

• tremor

What is the efficacy of phentermine?

-3.6% weight loss from baseline

What are the contraindications of phentermine?

• Hx of CVD

• hyperthyroidism

• glaucoma

• Hx of “drug abuse” or “agitated states”

• pregnancy

What should be monitored when taking adipex-p?

• BP, HR

• weight

What is the brand name of phentermine/topiramate ER?

qsymia

What are the ADR of qsymia?

• increased HR

• paresthesia

• insomnia

• constipation

What is the efficacy of phentermine/topiramate ER?

-8.8% weight loss from baseline

What are the contraindications qsymia?

• pregnancy

• history of CVD

What are is the brand name of orforglipron?

foundayo

What are the ADE of foundayo?

same as GLP-1s

What is the efficacy of orforglipron?

-11.2%

What are the ADE of injectables?

• nausea/vomiting/diarrhea/constipation

• injection site rxn

• headache

• acute pancreatitis

Why are name of injectables important?

drugs are not interchangeable between diabetes and obesity

What are the GLP-1 receptor agonists approved for weight loss?

• saxenda (liraglutide)

• wegovy (semaglutide)

What is the GLP-1/GIP receptor agonist approved for weight loss?

zepbound (tirzepatide)

What is the additional indication of wegovy?

reduce risk of CV events in patients with obesity + CV disease

What is the additional indication of tirzepatide?

treats obstructive sleep apnea in obesity

What is a nonpharm approach to treating obesity?

all patients should receive behavioral modification interventions

• healthy eating, physical activity

• utilize interprofessional resources

How should patients be assessed in treatment for obesity?

• previous success with behavioral modifications?

• significant weight-related comorbidities?

• contraindications to any medications?

• can patient afford the medication?

Without related diseases or complications, what medications should be used to achieve high (>10%) weight loss?

• tirzepatide

• semaglutide

Without related diseases or complications, what medication should be used to achieve moderate (5-10%) weight loss?

phentermine-topiramate

Without related diseases or complications, what medications should be used to achieve modest (<5%) weight loss?

• naltrexone-bupropion

• liraglutide

• orlistat

• phentermine

What weight-loss drugs are beneficial in prediabetes for preventing progression to T2D?

• tirzepatide

• semaglutide

What weight-loss drugs are beneficial in T2D for glucose lowering?

• tirzepatide

• semaglutide

• liraglutide

What weight-loss drugs are beneficial in hypertension for lowering BP?

• tirzepatide

• semaglutide

• orlistat

What weight-loss drug is beneficial in ASCVD for preventing major adverse CV events?

semaglutide

What weight-loss drug is beneficial in HFpEF for reducing HF events??

semaglutide

What weight-loss drug is beneficial in metabolic dysfunction-associated steatohepatitis for disease benefits?

semaglutide

What weight-loss drug is beneficial in obstructive sleep apnea to lower AHI?

tirzepatide

What weight-loss drugs are have potential benefit in osteoarthritis for reducing pain?

• semaglutide

• tirzepatide

• liraglutide