overweight and obesity

Weight gain =

energy intake > energy expenditure

1lb of adipose tissue =

3500 calories

genetic factors that affect weight:

- people who enjoy sugar and carbs

- balance of hormones and proteins

BMI =

weight (kg) / height squared (m^2)

or

lb/in^2 x 703

BMI may underestimate risk in what population?

in Asian and South Asian population

higher BMI is a risk factor for some diseases such as?

CVD, HTN, T2D, gallstones, breathing problems, and certain cancers

classification of BMI

BMI percentile in pediatrics and adolescents:

85th-95th percentile = overweight

>95 = obese

what is the waist circumference for both men and women that is associated with increased risk of T2DM and CVD?

>40 in men

>35 in women

What are some characteristics of metabolic syndrome? (need 3 or more of these to be diagnosed)

- HDL is less than 40mg/dL in men or less than 50 mg/dL in women

- BP level of 130/85 or higher

- the waist circumference measurement

- serum triglycerides of 150 mg/Dl or greater

- fasting serum glucose of 100 mg/dL

complications of being overweight/obese:

what are some pharmacotherapy management for weight loss?

- OTC agents and prescription agents

weight loss surgery includes:

gastric bypass and lap band

what is the initial goal of weight loss?

- reduce body weight by 5-10% over 6 months

- benefit of first 10% loss

what is the mainstay of weight loss therapy?

dietary modification

please refer to slides 20-22 for BEE expenditure stuff

tehe

low calorie diet (LCD):

800-1500 kcal/day

weight loss =1-2 pounds/week

very low calorie diet (VLCD):

- 800 or fewer calories

- patients with BMI>30 should at least contain 1g/kg of IBW of protein/day

- expected weight loss but comes with ADE

altered proportions of food groups:

this visual goes hard

meal replacement therapy:

Replace two meals daily with liquid drink, snack bar, or measured frozen meal

Eat "reasonable" third meal

Main advantage: portion control

Initial weight loss due to low sodium

how much physical activity is recommended for children and adolescents?

>60 mins of moderate or vigorous aerobic activity every day, including vigorous activity at least 3 days a week

how much physical activity is recommended for adults?

- 150 minutes of moderate aerobic activity or 75 minutes of vigorous physical activity a week

- Initially performed in ≥10 minute episodes

dietary products include herbals and other supplements regulated under DSHEA, and are recognized as SAFE unless

FDA says otherwise

OTC Orlistat (Alli) MOA

decreases absorption of dietary fats by inhibiting gastric and pancreatic lipases and inhibits hydrolysis of triglycerides

OTC Orlistat dosing:

60 mg TID before meals containing fat

Rx strength Orlistat dosing:

120 mg TID before meals

Orlistat may decrease absorption of what? and what is recommended?

- fat soluble vitamins

- MVI QD at bedtime or separated by at least 2 hours from Orlistat

Orlistat ADE

- increased levels of urinary oxalate

- flatulence with oily spotting

- loose and frequent stools

- fatty stools

- fecal urgency/incontinence

Orlistat drug interactions:

- Warfarin

- Cyclosporin - reduces concentration

Orlistat should be avoided in patients with?

malabsorption disorders

Who should consult MD before starting Orlistat?

those with HX of thyroid disease, cholelithiasis, nephrolithiasis, or pancreatitis

Patients should stop use of Orlistat and contact physician if there are signs and symptoms of?

liver injury, itching, yellow eyes or skin, dark urine, light colored stools, or loss of appetite

what meds are inappropriate for weight loss?

laxatives and diuretics

herbal supplements include stimulants, energy boosters, and thermogenic acids that claim to increase what?

basal metabolism, increases energy, and counteract fatigue

what is a common ingredient in herbal supplements?

Bitter orange

used in many reformulated products after ephedra ban

what are the active ingredients in bitter orange?

synephrine- similar to ephedrine

octopamine- similar to NE

have same risks to NE (HTN, CV toxicity, MI)

Bitter orange is often combined with?

caffeine

examples of fat and carb modulators:

- green tea

- chromium

- garcinia

large doses of chromium results in

rhabdomyolysis and renal failure

also increases insulin sensitivity

limited evidence of benefit

What are some risks associated with OTC weight loss products (stimulants such as caffeine)?

GI distress, nausea, dehydration, headaches, insomnia, nervousness, anxiety, heart, palpitations, increase in blood pressure, vertigo

OTC weight loss agents such as stimulants, energy boosters, and thermogenic agents such as caffeine should be used in caution with patients who have?

renal disease, panic disorder, hyperthyroidism, anxiety or spasms

Risks associated with appetite suppressants and promoters (glucomannan, guar gum, hoodia, plantain or psyllium):

flatulence, GI distress, nausea, vomiting

hoodia has no recent risks reported

laxatives and diuretics risks (cascara sagrada and dandelion):

ab pain, cramps, diarrhea, chronic use can lead to potassium depletion, disturbed heart function, muscle weakness

dandelion should be avoided in patients with

gallbladder or bile duct obstruction

are there any contraindications with Orlistat?

no, but monitor for side effects and counsel side effects and overall weight loss