Term
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Definition
| results from energy imbalance where more calories are consumed than used; it is a complex multifactorial chronic disease that includes genetic, environmental, and physiological factors |
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Term
| Genetic Factors that contribute to Obesity |
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Definition
| correlation in body weight between parents & children & siblings; single-gene mutations have been identified; still determining # & identity of contributing genes |
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Term
| Environmental Factors that contribute to Obesity |
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Definition
| sedentary lifestyle; unhealthy food choices; large portion sizes; socioeconomic barriers |
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Term
| Medications associated with Weight Gain |
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Definition
| Psychotropic agents: tricyclic antidepressants (amitriptyline, nortriptyline), monoamine oxidase inhibitors (MAOIs - selegiline, phenelzine), antipsychotic drugs (clozapine, olanzapine), lithium; Anticonvulsant agents: valproic acid, carbamazepine; Steroid Hormones: corticosteroids (prednisone), estrogen, progesterone, testosterone; Insulin & most oral hypoglycemic agents EXCEPT Metformin |
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Term
| Medical Conditions Associated with Weight Gain |
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Definition
| hypothyroidism, Cushing's disease, hypothalamic lesions, psychosocial disorders |
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Term
| Conditions more prevalent in Obese Populations |
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Definition
| HTN, stroke, CHF, CAD, sleep apnea, pulmonary HTN, type 2 DM, dyslipidemia, osteoarthritis |
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Definition
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Definition
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Term
| Class III Extreme Obesity BMI |
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Definition
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Term
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Definition
| measure of abdominal fat; >40 inches in men & >35 inches in women associated with an increased risk for type 2 DM, dyslipidemia, HTN, and CVD |
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Term
| Goals of Initial Weight Loss |
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Definition
| initially, should be 5-10% of body weight over a 6 month period at a rate of approximately 1-2 lbs per week |
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Term
| Other Goals of Weight Management |
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Definition
| to prevent further weight gain; to safely lose weight; to maintain lower body weight; to reduce the risk of obesity-related disorders; prevent or minimize weight regain over long-term while minimizing treatment-related adverse effects & improving quality of life |
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Term
| Non-pharmacological Therapies |
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Definition
| reduce diet; increase physical activity; behavior modification; bariatric surgery |
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Term
| Goals of Reducing Diet in Treatment of Obesity |
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Definition
| reduce calorie intake by 500-1,000 kcal/day; reduce portion sizes; limit alcohol consumption; less than 30% from fat, 0.8 g protein/kg of desirable body weight |
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Term
| Goals of Physical Activity in Treatment of Obesity |
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Definition
| at least 30 min of moderate-intensity physical activity on most or all days of the week (can be broken down into 10 min increments); includes common chores & sporting activities; use a gradual increase in order to avoid injuries; must obtain Physician authorization prior to start of regimen |
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Term
| Goals of Behavior Modification in Treatment of Obesity |
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Definition
| patient motivation critical; self-monitoring; rewards; stimulus control; social support; frequent contact; stress management |
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Term
| Bariatric Surgery in treatment of Obesity |
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Definition
| only indicated in pts with a BMI > 40 kg/m^2 or a BMI > 35 kg/m^2 with comorbid conditions when all other treatment methods have failed |
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Term
| Major Types of Bariatric Procedures |
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Definition
| stapled gastroplasty; adjustable gastric banding; conventional Roux-en-y gastric bypass (RGB) |
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Term
| Adjustable Gastric Binding |
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Definition
| bariatric procedure that "restricts" amount of food stomach can hold by reducing stomach size |
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Term
| Conventional Roux-en-y Gastric Bypass |
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Definition
| restricts amount of food stomach can hold by reducing size & by bypassing portions of small intestine to decrease absorption of calories & nutrients; MOST COMMON procedure; MOST EFFECTIVE procedure; possible adverse outcomes (surgical complications, gallbladder disease, impaired digestion) |
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Term
| Indications for Pharmacotherapy in Treating Obesity |
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Definition
| low-calories diet, increasing physical activity, and behavior therapy maintained for at least 6 months prior to carefully considering this long-term treatment plan; long term use should be considered in pts with a BMI of > or = 30 kg/m^2 or a BMI of > or = 27 kg/m^2 with concomitant obesity-related risk factors or diseases; used as an adjunct to a low-calorie diet, increased physical activity, and behavior therapy |
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Term
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Definition
| RX only; MoA: inhibits neuronal reuptake of NE, SE, & DA; induces weight loss by decreasing appetite and maintaining or increasing thermogenesis; Indication: long-term treatment of overweight & obesity |
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Term
| Adverse Effects of sibutramine (Meridia) |
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Definition
| HTN, tachycardia, anorexia, insomnia, constipation, dry mouth, dizziness, & nausea |
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Term
| Contraindications for Sibutramine (Meridia) |
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Definition
| Don't take if: receiving MAOIs, taking other centrally-acting appetite suppressant drugs, that have anorexia nervosa, with uncontrolled or poorly controlled HPN, history of CAD, CHF, arrhythmias, or stroke |
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Term
| orlistat (Xenixal [RX], alli [OTC]) |
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Definition
| inhibits gastrointestinal lipases; prevents enzymes from hydrolyzing dietary fat into FFAs, decreasing systemic absorption of dietary fat contributing to reduced caloric intake; Indications: long-term treatment of overweight & obesity; Take WITH EACH MAIN MEAL CONTAINING FAT; Take vitamin supplement containing fat-soluble vitamins AT BEDTIME |
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Term
| Adverse Effects & C/I of orlistat (Xenical, alli) |
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Definition
| flatus with discharge, fecal urgency, fatty/oily stool, increased defecation, fecal incontinence, abdominal pain, decreased absorption of fat-soluble vitamins, & increased levels of urinary oxalate; Pts with chronic malabsorption syndrome or cholestasis or pts with history of kidney stones |
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Term
| Drug Interactions with orlistat (Xenical, alli) |
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Definition
| reduction in cyclosporine plasma levels; monitor changes in coagulation parameters for pts on chronic, stable doses of warfarin; thyroid hormones (levothyroxine - separate by at least 2 hrs) |
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Term
| phentermine-fenfluramine combo (Phen-Fen) |
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Definition
| caused numerous cases of valvular heart damage and pulmonary HTN, removed from market in 1997 |
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Term
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Definition
| OTC herbal product that contains ephedrine; suppresses appetite by increasing NE relase, also increases thermogenesis; often combined with caffeine to enhance weight loss; currently BANNED by FDA due to serious adverse events |
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Term
| Bitter Orange and Country Mallow (Heartleaf) |
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Definition
| sources of ephedrine & related compounds to avoid their use |
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Term
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Definition
| heavily marketed as "fat blocker", claims it binds to dieatary fat & prevents absorption; studies show it is CLINICALLY INEFFECTIVE |
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Term
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Definition
| made from a protein in white kidney beans; lack of reliable research to support claim of reducing carb breakdown & absorption by inhibiting alpha-amylase in GI tract |
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Term
| phentermine CR/topiramate CR (Qnexa) |
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Definition
| combo product; one drug already marketed as anticonvulsant & for prophylaxis of migraines; received FDA approval in Sept 2009 |
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Term
| Future Directions in Pharmacotherapy in Obesity |
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Definition
| CCK and SE; leptin; neuropeptide Y |
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Term
| Pharmacist's Role in treatment of Obesity |
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Definition
| highly accessible; have knowledge & skills to provide care services in weight management; help determine if any of pt's current meds are causing weight gain; counsel pts on non-pharm and pharm therapies; recommend & monitor pharmacotherapy |
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