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What are the goals for lifestyle changes to lose weight?
- Dietary:
- 10% wt loss over 6mo
- 1-2 lbs per week
- decrease by 500-1000 kcals/d
- Exercise:
- 30min (or more) moderate intensity, at least 4d/wk
- Increase gradually
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What are the drugs used to lose weight?
- Orlistat
- Phentermine
- Buproprion
- Exenatide
- Pramlintide
- Topiramate
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How do you counsel someone for Orlistat?
- Wear dark clothing and bring a change of clothes with you when starting this med
- GI SE last 1-4wks
- Need a fat-soluble vitamin 2h before each dose
- Eat low fat meals to decrease SE
- If no fat in the meal, skip the dose
- Should be used in combination with lifestyle modifications
- Long-term use required
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How do you counsel someone for Phentermine?
- Should be used short-term (approx 3mo)
- Use with lifestyle modifications
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What are the SE of Phentemine?
- Insomnia
- Increased BP
- Palpitations
- Arrhythmias
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Which herbal supplements used for wt loss are safe?
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Which herbal supplements used for wt loss are effective?
- Maybe fiber
- Ephedra
- Maybe hydroxycitric acid
- Maybe Acai
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When is bariatric surgery appropriate?
- BMI > 40
- BMI > 35 with risk factors
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What supplements should be taken by those with bariatric surgery?
- MVI w/ iron: containing 200% of daily values
- Ca: 1500-2400 mg/d (citrate is preferred salt)
- B12: 350-500 mcg/d
- B1: 20-30 mg/d for eary sx of neuropathy; 50-100 mg/d for severe neuropathy
- Vitamin D: 2000 IU/d
- Vitamin A: 10,000 IU/d
- Vitamin K: 300 mcg/d
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What are the medication concerns associated with bariatric surgery?
- No extended or controlled release products
- No NSAIDs
- Avoid oral bisphosphonates if possible
- Avoid alcohol
- CCB, BBL, nitrates, TCAs, Antihistamines can cause GERD
- Gemfibrozil increases risk of gallstones
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When is pharmacologic treatment appropriate for wt loss?
- BMI > 30
- BMI > 27 with risk factors
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What are the risk factors in obesity?
- HTN
- Dyslipidemia
- CHD
- DM
- Sleep apnea
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What is the classification scale for obesity?
- Underweight: < 18.5
- Normal wt: 18.5-24.9
- Overweight: 25-29.9
- Obese: 30-34.9 = class I, 35 - 39.9 = class II
- Extremely obese: 40 or more = class III
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What is the equation to determine BMI?
[Wt(lbs) x 703]/Ht(in)2
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