pharmacy practice III

• CVD
• type II DM
• respiratory problems
• gallbladder disease
• osteoarthritis

<17.5

17.5-18.4

18.5-24.9

25-29.9

> or = 30

• Waist circumference        40 inch (men) 35 inch (women)
• triglycerides                     >= 150mg/dL
• HDL                               men< 40mg/dL  women <50mg/dL
• blood pressure                >= 130/85 mmHg
• fasting blood glucose       >= 100 mg/dL

energy intake > energy expenditure

3500 calories

• activity level
• food availability
• increase in portion size and calorie density
• occupation
• sleep duration

• basal metabolism 60-70%
• thermogenesis 10%
• physical activity 15-30%

• leptin
• ghrelin
• GLP-1

• atypical antipsychotics (respiradone, quetiapine)
• hormonal contraceptives
• steroids 
• anticonvulsants (valporic acid, lithium)
• insulin

• reduce body weight by 5-10% over 6 months
• maitenance of weight loss
• prevent future weight gain

• severe obesity (BMI > 40)
• pregnancy or breast-feeding
• < 18 or > 65 years
• eating disorders

• dietary change
• physical activity
• behavior therapy

• BMI > 30
• BMI > 27 + co-morbidities
• short term vs long term
• single therapy vs. comination therapy
• lowest effective doses
• should be used with concomitant lifestyle changes

2200-3000 kCal/day

1800-2800 kCal/day

300-1000 per day

• 800-1500 kCal/day
• goal is to lose 1-2 lbs per wk

• < 800 kCal/day
• goal is to lose 2-4lbs/ wk
• must be conducted under supervisor

adults should exercise for at least 30 min and children for at least 60 min for most days

• 30% of total 
• 8-10% of total calories from saturated fat
• include more mono/polyunsaturated fats
• inadequate to lose weight (must be a reduce tot calories)

• possible benefit in patients with CHD
• must choose dietary fat carefully to avoid deficiency

• portion control
• usual serving = 200-300 calories
• -low fat selection
• -low carbohydrate selection
• replace 1-2 meals/day (eat reasonable 3rd meal)

children and adolescents >= 60 min of mod/vigorous activity every day

adults 150 min of moderate aerobic exercise or 75 min of vigorous physical activity 

• group or individual therapy (group may be better)
• face to face communication
• diet planning
• online food diary tracking
• environmental modification (eliminate high density cal food)
• thinking pattern modification
• optimistic approach
• encouragement from others

• Alli
• only FDA approved non Rx drug
• ages >= 18

• decreases fat absorption
• -inhibiting pancreatic and gastric lipases
• -inhibiting hydrolysis of FAs

• 60mg PO TID with meals (should contain fat)
• goal is 5-10 lb loss over 6 months

• flatulence 
• oily spotting
• loose/frequent, fatty stools
• fecal urgency and incontinence
• symptoms are worst over first two months then improve

• warfarin
• cyclosporine
• levothyroxine
• amiodarone
• oral hypoglycemic agents

• thyroid disease
• DM
• kidney stones (nephrolithiasis)
• gall stones (cholelithiasis)
• pancreatitis
• should not be used in patients with a malabsorption disorder

• take multivitamin at bedtime
• should be used in combination with lifestyle changes
• side effects can be minimized by reducing the amount of ingested fat

• phenylpropanolamine
• ephedra/ma huang
• Aloe + cascara sagrada