Nutrition exam 2 Obesity

Madras and Khan combined

BMI equation

lb/(in²) * 703

BMI ranges

Underweight: <18.5

Normal 18.5-24.9

Over 25-29

Obesity >30

Exclusions to self treatment

Stroke

Sleep apnea

CV disease / HTN

Dyslipidemia

T2DM

Pregnancy / Breast feeding

Severe obesity >40

Risk factors

Stroke

Sleep apnea

CAD/HTN

Dyslipidemmia

T2DM

Infertility

Depression

Medications that cause

Antiretrovirals

Antipsychotics

• Risperidone

• Quetapine

• Clonazapine

• Olanzapine

Antieliptic

• valproic acid

• gabapentin

• pregabalin

Antidepressants

• mirtazipine

• amitriptyline

• nortriptylone

T2DM

• Insulin

• Sulffonylureas

• TZDs

• pioglitazone

Lithium

Hormones

Betablockers

Indications for obesity drugs

BMI >30 with NO obesity risk factors or diseases

BMI >27 with obesity risk factors or diseases

Peripherally acting drugs

Orlistat

Everything else central

Orlistat Brand name

Xenical - RX
Alli - OTC

Orlistat MOA

Inhibits GI lipase, resulting in decreased TG absorption (With low fat diet)

Orlistat ADRs

Fatty/Oil stool

Gas

Increase bowel movement

Orlistat C/I

Pregnancy

Malabsorption

Orlistat drug interactions

Decrease A, D, E, K

• Take multivitamins at night

Decrease cyclosporine and levothyroxine absorption

• Take 4 hours later

How to use Orlistate

Take with low fat containing meals (higher fat leads to increased GI effects)

When to skip Orlistat dose

When meal is skipped or contains no fat

GLP-1 agents

Liraglutride (Saxenda)

Semaglutide (Wegovy)

Tirzepatide (Zepbound)

NONE are for T2DM and ALL are subQ

GLP-1 MOA

Activates the GPCR GLP-1 receptors resulting in:

• increased insulin

• decreased glucagon

• slowed gastric emptying

  • GLP-1 in hypothalamus decreased food intake

GLP-1 ADRs

Suicidal thinking

Increased HR

Hypoglycemia

Nausea

Pancreatitis

Acute gall bladder diseases

GLP-1 Boxed warnings

Risks of thyroid C-cell carcinoma

MEN

Phendimetrazine and Diethylpropion Brands

Phendimetrazine (Bontril)

Diethylproprion (Tenuate)

Phendimetrazine and Diethylproprion MOA

Increased NE

Phendimetrazine and Diethylproprion Duration

Short term duration (<12 weeks)

Phendimetrazine and Diethylproprion ADRs

Mydriosis

Psychosis

Insomnia

Blurred vision

Tachycardia, HTN, palpitations

Phendimetrazine and Diethylproprion C/I

Hyperthyroidism

Glaucoma

Pregnancy

~14 days of MAOI

Phentermine Brand name

Adipex-P

Phentermine MOA

Increases NE release and decreases NE reuptake

Increased NE in the hypothalamus will decrease Appetite

Phentermine ADRs

Agitation

Psychosis

Insomnia

Blurred vision

Tachycardia, HTN, Palpitations

Phentermine C/I

Uncontrolled HTN

Hyperthyroidism

Glaucoma

Pregnancy

~14 days of MAOI

Phentermine-Topiramate ER Brand name

Qysmia

Topiramate effect

teratogenic

• Increased risk of congenital fetal oral-cleft formation

Phentermine-Topiramate ER ADRs

Insomnia

Vision problems

Tachycardia

Phentermine-Topiramate ER C/I

Hyperthyroidism

Glaucoma

Pregnancy

~ 14 days of MAOI

When to D/C Phentermine-Topiramate ER

Suicidal ideation

Phentermine-Topiramate ER D/I

MAOI

Phentermine

Phentermine-Topiramate ER Rebound effect

Taper off due to topiramate seizure risk

Naltrexone-Buproprion brand name

Controve

Naltrexone 

Opioid antagonist

Alcohol and opioid dependence

Bupropion

Reuptake inhibitor of NE and dopamine

Bupropion stimulates release of a-MSH from POMC in hypothalamus leading to decrease food

Naltrexone-Buproprion ADRs

Suicidal ideation

Seizures

Psychosis

Insomnia

Glaucoma

Increased BP and HR

• monitor

Naltrexone-Bupropion C/I

Chronic opioid use

Seizure disorder

Uncontrolled HTN

Pregnancy

Within 14 days of MAOIs

How to administer Naltrexone-Buproprion

With fatty meals

Naltrexone-Bupropion BBW

Suicidal thinking and behavior

Stemelanotide brand name

Imcrivee

Stemelanotide MOA

Peptide a-MSH analog that activates the GPCR receptor MC4

MC4 receptor

Decrease hunger and increase weight loss

Stemlanotide Indication

genetic deficiency related obesity

Stemlanotide ADRs

Injection site reactions

hyperpigmentation

HA

GI ADRs

Suicidal ideations