-
overweight BMI
25-29 kg/m2
-
class 1 obese BMI
30-35kg/m2
-
class 2 obese BMI
35-40kg/m2
-
class 3 obese (extreme obesity) BMI
40+ kg/m2
-
estimates central adiposity
waist circumference
-
"Obesity Paradox"
data suggests those who are obes have a survival advantage
-
sarcopenic
having low lean muscle mass
-
gynecoid distribution
- fat distributed gluteofemorally (pear-shaped)
- mainly subcutaneous fat
- lower risk of mortality
-
Thrifty gene theory
- evolutionary survival advantage to being able to store fat when food wasn't as readily available as it is now
- may contribute to etiology of obesity
-
percentage of weight loss assoc'd w/ benefits
3-5%
-
BMI indicated for bariatric surgery
40+ OR 35+ w/ comorbidity
-
% weight loss from bariatric surgery after 2-3 years
20-35%
-
small pouch created as stomach, bypassing most of stomach & duodenum
Roux-en-Y gastric bypass
-
procedure associated w/ T2DM remission before weight loss
Roux-en-Y
-
issues assoc'd w/ bariatric surgery
- gallstone formation
- cholecystitis
- food intolerance
- hyperinsulinemic hypoglycemia
- nutrient deficiency
-
difference in mean % loss from baseline active vs placebo (how much weight was lost on average?)
mean changes
-
proportion of subjects that lose at least 5% of their body weight active vs placebo
categorical changes
-
MOA of phentermine & diethylpropion
- sympathomimetic amine
- stimulates release of NE in CNS
-
duration of use for phentermine or diethylpropion
FDA approved for ST use (<12weeks)
-
MOA of orlistat
- reversible GI lipase inhibitor
- inactivates hydrolyzation of dietary fat
- prevents absorption of dietary fat by ~30%
-
duration of use of orlistat
approved for LT use (>12mos)
-
MOA of lorcaserin (Belviq)
- 5HT 2C-R agonist
- selectively activates serotonin 2C in hypothalamus to decrease food consumption & promote satiety
-
evaluation of lorcaserin @ 3mos
d/c if 5% wt loss not achieved
-
SE's of lorcaserin
primarily CNS - headache, dizzieness, nausea
-
population to use caution in w/ lorcaserin
pts w/ valvular heart disease
-
SE's assoc'd w/ Qsymia (phentermine/topiramate)
- dry mouth
- paraesthesia
- constipation
- (SE's dose related)
-
CI's w/ phentermine/topiramate (Qsymia)
- pregnancy
- glaucoma
- hyperthyroidism
- concomitant use of MAOI's
-
MOA of GLP1 agonists
dec gastric emptying, inc satiety
-
CAM appetite suppressants
- 5HTP
- hoodia
- St. John's wort
-
-
-
MOA of ephedrine, bitter orange
- CNS stimulant
- appetite suppressant
- thermogenic agent
-
possibly effective OTC agents
- dietary calcium (NOT supplemental)
- CLA (conjugated linoleic acid)
- green coffee extract (safest rec)
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