Weight Loss

How often is an assessment of BMI needed

Annually

Overweight BMI

25-29.9 kg/m^2

Obese BMI

Greater or equal to 30

List weight related conditions

T2DM

Cardiovascular disease

GERD

Depression

Sleep apnea

Medical conditions that can cause weight gain

Hypothyroidism

T2DM

Antiseizure medications that can cause weight gain

Valproate

Gabapentin

Pregabalin

Diabetic drugs that can cause weight gain

insulin

sulfonylureas

meglitinides

thiazolidinediones

Psychotic drugs that can cause weight gain

Antidepressants: TCAs, mirtazapine

Antipsychotics: clozapine, olanzapine, risperidone, quetiapine

Lithium

Other drugs that can cause weight gain

integrase inhibitors: dolutegravir

systemic steroids

oral contraceptives

Antiseizure medications that can cause weight loss

Topiramate

Fenfluramine

Diabetes medications that can cause weight loss

GLP-1 agonists

Tirzepatide

Psychotic medications that can cause weight loss

Antidepressants: Bupropion

ADHD drugs

Other medications that can cause weight loss

Phosphodiesterase inhibitors: Roflumilast, apremilast

Lifestyle interventions all patients should incorporate

Low calorie meal plan

Physical activity: Greater or equal to 150 min/week

Behavioral techniques

6 month weight loss goal

5-10% decrease in total body weight

OTC supplements for weight loss

bitter orange

caffeine

guarana

green tea powder

Are OTC supplements for weight loss

No

When are antiobesity medications recommended

Obesity or BMI greater or equal to 27 and at least one weight related condition

Preferred antiobesity medications

incretin based treatments (GLPs)

Which weight loss medication cannot be used alone long term

phentermine

Contraindication to all antiobesity medications

Pregnancy

When to d/c antiobesity medications

Do not produce at lest 5% weight loss after 12 weeks

GLP-1 agonist MOA

Decrease gastric emptying, which increases satiety

List GLP-1 used for antiobesity

Liraglutide (saxenda)

Tirzepatide (zepbound)

Semaglutide (wegovy)

Liraglutide brand

Saxenda

Semaglutide brand

wegovy

Liraglutide dosing

0.6 mg SC daily x 1 week, increase weekly by 0.6 mg SC daily

Target dose: 3 mg SC daily

Semaglutide dosing

0.25 mg SC weekly x 4 weeks, increase every 4 weeks

Target dose: 2.4 mg weekly

Dual GLP-1 and GIP agonist MOA

Decreases gastric emptying which increases satiety

List Dual GLP-1 and GIP agonist

Tirzepatide

Tirzepatide brand

Zepbound

GLP-1 boxed warning

risk of thyroid C-cell carcinomas

CI of GLP-1

Hx or family hx of medullary thyroid carcinoma, pts with MEN 2

GLP-1 warnings

pancreatitis

AKI

gallbladder disease

Caution if severe GI disease, gastroparesis

GLP-1 side effects

Nausea

Hypoglycemia

Phentermine MOA

sympathomimetic (stimulant) norepinephrine release stimulates the satiety center to decrease appetite

Topiramate MO

increase GABA and glutamate receptor blockade to increase satiety and decrease appetite

Phentermine/Topiramate ER CI

glaucoma

hyperthyroidism

Phentermine/Topiramate side effects

tachycardia

Insomnia

Vision problems

Phentermine/Topiramate notes

Must taper off due seizure risk

REMS drug due to teratogenic risk

Naltrexone MOA

decrease food cravings

Bupropion MOA

decrease appetite

Naltrexone/Bupropion boxed warning

Suicidal thinking

Naltrexone/Bupropion contraindications

Chronic opioid use

Uncontrolled HTN

Seizure disorder

Other bupropion containing products

MAO inhibitors within 14 days

Naltrexone/Bupropion warnings

Caution with psychiatric disorders

Naltrexone/Bupropion side effecgts

Dry mouth

Insomnia

Naltrexone/Bupropion issue with opioids

naltrexone blocks opioids which can lead to withdrawal

Lipase inhibitor MOA

decrease absorption of dietary fats by ~30%

List RX brand lipase inhibitor

Xenical

List OTC brand lipase inhibitor

Alli

Generic lipase inhibitor

Orlistat

Orlistat side effects

GI (flatus with discharge, fatty stool)

vitamins that must be taken more than 2 hours apart from orlistat or at bedtime

A D E K, and beta carotene

Diet that must be used with Orlistat

low fat, max 30% of calories come from fat

Appetite suppressants MOA

sympathomimetic (stimulants), norepinephrine release stimulates the satiety center, which decreases appetite

List appetite suppressants

Phentermine

Phentermine brand

Adipex-P

How long can phenteramine be used

short term up to 12 weeks

Phentermine contraindications

Cardiovascular disease

Hyperthyroidism

Glaucoma

History of drug abuse

Phentermine side effects

increased BP

tachycardia

Pulmonary htn (> 3 months of use)

Phentermine monitoring

Hr

BP

Dyspnea

Deficiencies from bariatric surgery

anemia from B12 and iron

What vitamins do bariatric patients need lifelong

A D E K

Common nutrient deficiency in bariatric surgery

calcium, give calcium citrate

Medication adjustments post bariatric surgery

May need to be crushed, dose change, put in liquid form up to 2 months post procedure

Drug that may be needed in bariatric patients due to rapid weight loss causing gallstone

Ursodiol