Weight Management

Obesity

• Major public health concern

• Health risks – Box 36.3 – name at least 9

• High rates of morbidity and mortality

• Overweight: BMI of 25 to 29.9 kg/m2

• Obese: BMI 30 kg/m2

• Children:

  • Overweight: 15% U.S. children • BMI >85th percentile for age group

  • Obese: (additional) 15% U.S. children • BMI >95th percentile for age group

• High Risk

  • Women, minority groups, low SES

• Results from consistent ingestion of more calories than used for energy

• Substantially increases risks for development HTN, cancer, dyslipidemia, type 2 diabetes mellitus, joint pain, sleep apnea

• Estimated 60% of American adults are overweight or obese

• Box 36.4 – know recommendations

Psychosocial Factors

• Depression/anxiety

• Sexual, physical, or emotional abuse

• Other factors

  • Disease processes

  • Prescription medications

• Box 36.2

  • Antidepressants

  • Antidiabetic drugs

  • Antiepileptic drugs

  • Antihistamines

  • Antihypertensive agents

  • Antipsychotic agents

  • Cholesterol-lowering agents

  • Corticosteroids

  • drugs

  • Hormones

  • Mood-stabilizing agents

Physiologic Factors

• Energy imbalance

  • Intake > expenditure

    • Eating more calories; exercising less

      • Combination of the two

    • Excessive intake → fat cells increase in size and number.

Environmental factors (promotion of overeating)

• Relatively low cost of wide variety of foods

• Large portion size; high-calorie foods

• ADLs, work activities require little energy expenditure

• Few Americans exercise optimally

• Increased couch potato opportunities: TV, video/computer games, computers

Phentermine (Adipex-P, Ionamin, Pro-Fast)

• Schedule 4

• Inhibits reuptake of serotonin and norepinephrine

• Sympathomimetic anorexiant - causes appetite suppression

• Direct stimulation of the satiety center in the hypothalamic and limbic region

• Recommended weight loss 1-2 lb/wk

Phentermine (Adipex-P, Ionamin, Pro-Fast) adverse rxn

nervousness, hyperactivity, dry mouth, constipation, hypertension, erectile dysfunction, insomnia, and unpleasant taste, habit forming, cardiomyopathy

Phentermine (Adipex-P, Ionamin, Pro-Fast) contraindications

HTN, CVD, hyperthyroidism, glaucoma, pregnancy, breast feeding, h/o drug abuse

Orlistat (Xenical, Alli)

• Decreased fat absorption leads to decreased caloric absorption, resulting in weight loss and improved serum cholesterol values

• binds to gastric and pancreatic lipases in the GI tract

• Prevents absorption of 30% of ingested fat

• Triglycerides, cholesterol, and fat-soluble vitamins from fat-containing foods pass through the intestines unchanged and are not absorbed

• Increasing the dose does not increase the percentage

Orlistat (Xenical, Alli) adverse rxns

GI symptoms: abdominal pain, oily spotting, fecal urgency and incontinence, flatulence with discharge, fatty stools, and increased defecation; rarely pancreatitis, liver failure