obesity and weight loss management

__% of adults are overweight/obese in aus

67

what is the BMI for underweight

18.5

what is the BMI for normal weight

+18.5 to 24.9

what is the BMI for overweight

25 to 29.9

what is the BMI for obese

over 30

what is obese class 1

30 to 34.9

what is obese class 2

35 to 39.9

what is obese class 3

over 40

a waist circumference of greater than ___ in men and ___ in women is considered elevated, increasing cardiometabolic risk

102cm, 88cm

what does excess weight in individuals result from

a prolonged period of energy imbalance

T/F a low birth weight can cause obesity + T2DM

T

which B-blocker is associated with weight gain

propranolol

what are some anticonvulsants good for weight loss

topiramate, zonisamide, lamotrigine

what are some antidepressants good for weight loss

bupropion, venlafaxine, desvenlafaxine

what is an antipsychotic good for weight loss

ziprasidone

what are some antipsychs that are weight neutral

haloperidol, aripiprazole

what is an alpha blocker that can produce weight gain

terasozin

causes of obesity

diet, exercise, genetic, psychological, behavioural eg. binge eating, social and environmental factors eg. junk food, economic eg. increased risk in lower socioeconomic areas

why doesn’t a diet work? what does the body do?

the body attempts to maintain energy balance and protect existing body weight through a complex negative feedback system involving hormones that:
increase hunger eg. ghrelin
inhibit food uptake in the short term eg. cholecystokinin, PYY, amylin, GLP1
Inhibit food intake in the long term eg. leptin and insulin
increase metabolic rate and energy expenditure eg. T3

how does the body defend itself against weight loss

increasing appetite, reducing energy expenditure if there is an energy deficit

what things can potentially increase someone at the risk of getting obese

highly processed foods/ sweetners affecting the gut microbiome, food emulsifiers can increase appetite, high fat diet in childhood causes inflammation and scarring in the brain (exercise can have a protective effect)

1 calorie is = to __ kilojoules

4.18

how much weight loss in clinically meaningful

5-10%

what are the 3 things to include when first starting obestiy treatment

lifestyle interventions, reduce energy intake, increase energy expenditure

how would you reduce energy intake

how is the rate of weight loss determined

the energy difference between the individuals energy intake and energy expenditure

____kcal/kg is required to maintain 1kg of body weight in a normal weight adult

22

a deficit of 500kcal/day = weight loss of

0.5kg /week

after 3-6 months of weight loss…what happens?

loss of lean mass slows the body weight response to the initial change in energy intake, thereby reducing ongoing weight loss. for weight loss to continue, further caloric restriction or increased caloric expenditure must occur

what is a RED diet

reduced energy diet. modest energy deficit of 2000-4000kj. encourage intake of veges, fruit, wholegrain, legumes, lean meat, nuts, fish eggs, cheese, low-fat milk

what is a LED diet

low energy diet. reduces total daily energy intake to 4200-5000kj. prescriptive diet of specific meal plans from commercial providers and substituting 1-2meals with 1-2 specifically formulated meal replacements

what is a VLED diet

very low energy diet. indicated in overweight/obese adults. reduces energy intake to less than 3300kj or 800kcal/day. partial = eat lean protein and veg for dinner, complete = all meals replaced but also eat vegetables. induces mild ketosis- drink water add fibre supplement. up to 12 weeks

what is something you need to remember to do when on a complete VLED diet

Need to add 1 tablespoon olive oil daily to contract the gallbladder and avoid gallstone formation

are VLED better than LED diets?

no for long-term weight loss, however greater short term weight loss

things to highlight about phentermine

increases energy expenditure, early food satiety, short-term use, may increase BP, may be subject to misuse, $90 + monthly

why was sibutramine withdrawn

higher risk of MI

why was phenylpropanolamine withdrawn

small risk of haemorragic stroke

how does orlistat work

prevent the absorption of dietary fat