Obesity Treatment Flashcards Preview

DEMS Unit 2 Part 2 > Obesity Treatment > Flashcards

Flashcards in Obesity Treatment Deck (17):
1

Currently available tx options

1. Accept weight where it is
2. Diet/Exercise (3-10%)
3. Drugs (5-12%)
4. Medically supervised/Combo of diet + drug (10-15%)
5. Surgery (15-30%)

Increasing effectiveness from 1-5
Risks/Time/Money increasing from 1-5

2

If you have a patient with a BMI of 36, is surgery indicated for Tx?

Yes if you have a co-morbidity

3

Obesity treatment pyramid

1 .Surgery
2. Pharmacotherapy
3. Lifestyle modification (diet + exercise)

4

Meds that may promote weight gain

1. Anti-diabetic meds (sulfonylureas, insulin, TZDs)
2. Mood stabilizers, antipsychotics
3. Birth control pills
4. Glucocorticoids

5

Pharmacologic Tx of Obesity

1. Current meds 5-12% wt loss
2. Benefits last as long as patient takes the med. Chronic tx is needed
3. Drugs probably not paid for by insurance so cost is a big issue
4. FDA approval, long term safety, and efficacy
5. Choice of mechanisms, OTC vs prescriptions or combos?

6

Phentermine

- increases NE content in the brain
- chemically related to amphetamine but is not addictive
- Dose: 15-37.5 mg/d
- Cost: $ 15-25/mo (CHEAP)
- FDA approved only for 3 month use
- 5-8% wt loss
- Side effects: HTN, headache, nervousness

7

Orlistat (Xenical; ally)

- Pancreatic lipase inhibitor
- Inhibits fat absorption by 30%
- 120 mg TID
- Cost $100/mo
- GI side effects: oily stools, urgency
- multivitamin needed
- May be used in those with poorly controlled HTN or psych problems

8

Benefits of each med

Phentermine: CHEAP (but not long term)
Orlistat: SAFEST (but limited wt loss and coverage)
Lorcasarin: LEAST SIDE EFFECTS (but only modestly effective)
Phentermine/Topiramate: MOST EFFECTIVE (but costs a lot)
Naltrexone/bupropion: intermediate

9

Lorcasarin (Belviq)

- Serotonin 2C receptor agonist
- Previous serotonin agonists caused cardiac valve disease
- 2C receptor only in the brain, not the heart
- Least side effects
- Cost $220
- no better wt loss than phentermine or orlistat

10

Phentermine/Topiramate compound

- Risk of birth defects: women need pregnancy test
- Reduces BP, glucose, insulin, TG, and raises HDL
- Unclear if will be prescribed off label
- Most effective med available 10-12% weight loss

11

Naltrexone SR/Bupropion SR

- Combo is hard to dose
- Stimulates hypothalamic propiomelanocortin (POMC) neurons to reduce food intake
- Naltrexone blocks opioid receptor-mediated POMC auto-inhibition, augmenting POMC firing in a synergistic manner. Alters reward pathways
- Intermediate in effectiveness and side effects
- Black box: for suicidal ideation
- Category X in pregnancy
- Stop if clinically significant increase in BP or pulse
- Stop if

12

3 surgeries

1. Lap band
2. Sleeve gastrectomy
3. Gastric bypass

Not super effective --> very effective from 1 ->3
Low to high risk from 1->3

13

Comparison of operations

1. Lap band - 20% wt loss, very low mortality and low complication
2. Sleeve gastrectomy - 25% wt loss, low mortality, slightly higher complication
3. Gastric bypass - 30% wt loss, slightly higher (barely any) mortality, and more complication rate

14

What can bariatric surgery help prevent the most? Why?

- Cancer!
- Reduce the activation of that mitogenic pathway from insulin signaling

15

Benefits of weight loss surgery

1. Sleep apnea improved
2. HTN improved in half
3. Gastroesophageal reflux: improved in most
4. Urinary incontinence: improved in most

16

Who is a good candidate?

- BMI > 35 with comorbidities, or > 40 without
- Age 20-60
- Comorbidities: diabetes, sleep apnea, reflux > HTN, DJD
- Failed other forms
- No serious cardiac, pulmonary or psych disease

17

Late risks of surgery

- B12 deficiency
- Fe++ deficiency
- Calcium/Vit D deficiency, osteoprorosis
- Ulcers or strictures with banding
- Band erosion/slippage
- Depression
- Avoid pregnancy for at least 1 yr
- Folate deficiency