Obesity Management & Pharmacotherapy

Vocabulary flashcards covering definitions, risk classifications, lifestyle and pharmacologic therapies, drug specifics, surgical criteria, and postoperative considerations in obesity management.

Overweight

Excessive fat accumulation that does not yet qualify as obesity.

Obesity

Chronic, complex disease of excess body fat that impairs health and raises risk of diabetes, CVD, cancers, sleep and mobility disorders.

Body Mass Index (BMI) Formula

BMI = weight (kg) ÷ height² (m²).

Obesity Class I

BMI 30–34.9 kg/m²; moderate comorbidity risk; disease risk HIGH with normal waist, VERY HIGH with enlarged waist.

Obesity Class II

BMI 35–39.9 kg/m²; severe comorbidity risk; disease risk VERY HIGH regardless of waist size.

Obesity Class III

BMI ≥ 40 kg/m²; very severe comorbidity risk; disease risk EXTREMELY HIGH.

High-Risk Waist Circumference

40 in (102 cm) in men or > 35 in (88 cm) in women increases cardiometabolic risk.

Genetic Contribution to BMI

Accounts for roughly 40-50 % of body-fat distribution and weight variability.

Secondary Medical Causes of Obesity

Hypothyroidism, Cushing syndrome, GH deficiency, insulinoma, leptin deficiency, depression, binge-eating disorder, schizophrenia.

Drugs That Promote Weight Gain

Antipsychotics, certain diabetes medications, corticosteroids, tricyclic antidepressants.

Primary Treatment Goals

Reach and maintain a healthy weight; lower risk of obesity-related complications.

Caloric Deficit for Weight Loss

Reducing daily intake by 500-750 kcal ≈ 1 lb (0.45 kg) loss per week.

Recommended Daily Calories – Women

Typically 1 200-1 500 kcal/day for weight reduction.

Recommended Daily Calories – Men

Typically 1 500-1 800 kcal/day for weight reduction.

Evidence-Based Eating Plans

Mediterranean, low-carbohydrate, low-fat, volumetric diets tailored to patient preference.

Physical Activity Goal

≥ 150 minutes moderate exercise per week, on ≥ 3 days with ≤ 2 consecutive rest days, plus 2-3 resistance sessions.

Key Behavioral Strategies

Self-monitor intake, activity, weight; set goals; manage stress; control stimuli.

Criteria to Start Prescription Weight-Loss Drugs

BMI ≥ 30 OR BMI ≥ 27 with at least one comorbidity (e.g., T2DM, HTN, dyslipidemia, sleep apnea).

Drug Discontinuation Rule

Stop agent if < 5 % weight loss after 12 weeks at full dose.

Qsymia (phentermine/topiramate ER)

C-IV oral combo that releases norepinephrine and suppresses appetite; titrated up to 15 mg/92 mg AM; contraindicated in pregnancy, glaucoma, hyperthyroidism; requires REMS for teratogenicity.

Contrave (naltrexone/bupropion)

Oral combo that reduces cravings and appetite; avoid with opioids, uncontrolled HTN, seizures; do not take with high-fat meals.

Liraglutide (Saxenda)

Daily SQ GLP-1 agonist up to 3 mg that delays gastric emptying & increases satiety; boxed warning for thyroid C-cell tumors; GI side effects common.

Semaglutide (Wegovy)

Weekly SQ GLP-1 agonist titrated to 2.4 mg; similar warnings and GI profile as liraglutide; effective long-term therapy.

Tirzepatide (Zepbound)

Weekly SQ dual GIP/GLP-1 agonist up to 15 mg; enhances insulin secretion, slows gastric emptying; same thyroid warnings and GI effects.

Orlistat (Xenical/Alli)

Lipase inhibitor that blocks ~30 % fat absorption; causes oily stools; take multivitamin at bedtime; skip dose if meal contains no fat.

Sympathomimetic Appetite Suppressants

Phentermine, diethylpropion, phendimetrazine, benzphetamine; short-term (≤ 12 weeks) C-III/IV stimulants that raise norepinephrine to curb appetite.

Imcivree (setmelanotide)

MC4R agonist for rare genetic obesity (e.g., POMC deficiency); SQ daily; may cause depression, skin hyperpigmentation; requires confirmatory genetic testing.

OTC Stimulant Supplements

Products like yerba mate, guarana, green-tea powder; largely ineffective and potentially harmful, especially in CVD patients.

Avoided Drugs in Hypertension

Phentermine-containing Qsymia and bupropion-containing Contrave.

Avoided Drugs in Depression Risk

Contrave (suicide risk) and Imcivree (may worsen mood).

Avoided Drugs in Seizure Disorders

Contrave (lowers threshold) and abrupt Qsymia discontinuation (topiramate).

Avoided Drugs with Opioid Use

Contrave blocks opioid receptors, precipitating withdrawal.

Indications for Bariatric Surgery

BMI ≥ 40 kg/m², or BMI ≥ 35 kg/m² with obesity-related comorbidity.

Gastric Bypass Benefits

Restricts intake, reduces calorie absorption, alters gut hormones to enhance satiety and reverse metabolic syndrome.

Rapid Weight-Loss Gallstones

Common after bariatric surgery; prophylactic ursodiol (Actigall) may dissolve stones.

Post-Surgery Medication Concerns

May need crushed, liquid, or transdermal forms for ~ 2 months; dose reductions possible due to absorption changes.

Lifelong Vitamin Supplementation

All bariatric patients need B12, iron, calcium citrate, folate, and fat-soluble vitamins (A, D, E, K) to prevent deficiencies.