Obesity and Overweight

Normal range of BMI

18.5-24.9

What is grade 1 overweight

25-29.9

grade 2 overweight

30 and 40

obesity BMI

30 +

severe obesity BMI (grade 3)

40+

BMI only accounts for what 2 factors

height and weight

Where is central fat

waist, deep visceral adipose

Where is inert subcutaneous adipose fat located

buttock or thigh

what is metabolic syndrome

1. Waist circumference >40’ in men or 35’ in women

2. serum triglycerides of 150 mg/dL or greater

3. HDL cholesterol < 40 mg/dL men or <50 mg/dL in women

4. BP>130 mm Hg systolic or 85 mmHg diastolic or higher

5. fasting serum glucose 100 mg/dL or greater

Which medications cause weight gain

• hormonal contraceptives

• systemic corticosteroids

• antidepressants

• anticonvulsants

• certain antidiabetics

which antidiabetics can cause weight gain

• some sulfonylureas- glimepiride

• thiazolidinediones- pioglitazone

• insulin

obesity can lead to which health problems

• Difficulty performing ADL

• HTN

• Dyslipidemia

• T2DM

• CVD

• etc

what are the 3 major approaches to weight loss

• healthy lifestyle

• pharmacologic therapy

• bariatric surgery

Obesity self-care exclusions

• severe obesity

• pregnancy or bf

• <18 yo or > 65 yo

• CVD, dyslipidemia, DM or HTN

• eating disorders

A reasonable initial weight loss goal is

5%-10% loss over 6 months

The first ____% loss carriers the greatest health benefits

10%

Mainstay of weight loss therapy is

• dietary modifications

• dietary restrictions

What change is most commonly used weight loss strategy

dietary change

caloric restrictions for older and younger populations

lower for older, higher for younger

diet supplying no more than ___of total calories from fats of which no more than ____ of total calories come from saturated fat

30, 10

diets should be (high or low) in saturated fats

low

low glycemic index promotes _____ and ______large fluctuations in insulin concentrations

satiety, prevent

what is glycemic index

refers to the amount of blood glucose rise over a set period of time after ingestion

describe meal replacement therapy

replace the first 2 meals with a liquid drink, snack bar, or some type of measured frozen meal

what is an important public health strategy for ALL age groups

encourage physical activity for preventing overweight and obesity

aerobic exercise for children/adolescents

>60 minutes moderate to vigorous daily, 3 times or more weekly

adult exercise recommmendation

150-300 minutes of moderate or 75-150 minutes exercise weekly done in > or equal to 10 minute episodes

weight loss medications and supplements should be used in conjunction with lifestyle interventions and should be assessed for these 3 factors

1. efficacy

2. safety

3. tolerability

True or false: ideal weight loss drug with no ADR exists

false

which OTC product is used for weight loss of a BMI of at least 25

orlistat (Xenical is Rx form)

Xenical 120mg approved for ages

12+

Alli 60mg is approved for ages

18+

Xenical requires a BMI of

30+ or BMI of 27 or higher with risk factors

recommended dosing for Xenical

120mg taken TID before meals containing at least 15 grams of fat

dosing for alli

60mg TID before meals containing at least 15 grams of fat

ADR of orlistat

• Decreased absorption of fat-soluble vitamins

• Take a multivitamin once at bedtime or separate by at least 2 hours from the dose

• GI side effects

• Liver injury

Adverse GI effects increases with ___ carb and ____ fat diet

low, high

drug-drug interactions with orlistat

• cyclosporine

• fat soluble vitamins

• levothyroxine

• warfarin

• amiodarone

• antiepileptic

• antiretroviral

complementary therapies (KNOW THE MOA)

• stimulants, energy, and thermogenic aids

• fat and carb modulators

• appetite suppressants and satiety promoters

• fat absorption blockers

• car absorption blockers

• laxatives and diuretics

MOA of stimulants, energy booster, and thermogenic aids

• increase basal metabolism

• increase energy

• counteract fatigue

agents that are stimulants, energy boosters, and thermogenic aids

• bitter orange

• caffine

MOA of fat, carb modulators

• alter fat or carbohydrates metabolism

• results in decreased fat mass

  • increased lean muscle mass

agents that are fat and carbohydrate modulators

• chromium

• cinnamon

• garcinia

• green tea

• pyruvate

• licorice

• turmeric or curcumin

MOA of appetite suppressants and satiety promoters

reduce caloric intake by suppressing appetite or promoting satiety

agents for appetite suppressants

• damiana

• guar gum

• hoodia

• glucomannan

• psyllium

MOA of fat absorption blockers

block intestinal absorption of dietary fat

fat absorption blocker agents

• chitosan

• green coffee

• raspberry ketone extract

MOA of cortisol blockers

block stress-induced release of cortisol to avoid cortisol induced increased appetite and fat storage

cortisol blocker agents

• beta- sitosterol

• phosphatidylserine

• theanine

Laxative agents

• cascara sagrada

• psyllium

diuretic agents

• dandelion

• caffeine