JC Pharmacology Wk 7 Chapter 36

Overweight and Obese Adults

• Overweight and obesity are widespread problems in the United States, affecting 42.4% of the population.
• Overweight and obesity are considered major public health issues
• Obesity leads to high rates of morbidity and mortality.
• Overweight is defined as a BMI of 25 to 29.9 kg/m².
• Obese is defined as a BMI of 30 kg/m² or higher.

Question 1

• A body mass index (BMI) over 25 indicates excessive weight.
• The statement is true because a body mass index (BMI) over 25 indicates excessive weight.
• A BMI below 18.5 indicates underweight, and a BMI over 30 is considered obese.
• BMI reflects weight in relation to height and is a better indicator than weight alone.

Obesity #1

• Obesity can occur in anyone
• Predominantly affects females, minority groups, and people in poverty.
• Obesity results from consistent ingestion of more calories than used for energy, exercising less, or a combination of both.
• Obesity substantially increases the risks for development of numerous health problems.

Obesity #2

• The prevalence of obesity has dramatically increased in the past 25 years.
• Approximately 68% of American adults are overweight, and 34% are obese.
• The prevalence varies by gender, ethnicity, and socioeconomic status.

Obesity #3

• Physiologic factors include energy imbalance, where "Intake > expenditure.
• Intake exceeds expenditure due to eating more calories, exercising less, or both
• Excessive intake causes fat cells increase in size and number.

Obesity #4

• Genetic factors, such as similar body types, can contribute.
• Environmental factors promoting overeating include relatively low cost of a wide variety of foods, large portion sizes, high-calorie foods, and decreased physical activity.

Obesity #5

• ADLs and work activities require little energy expenditure, leading to decreased physical activity.
• Few Americans exercise optimally, leading to increased couch potato opportunities
• Couch potato opportunities include TV, video/computer games, and computer use

Obesity #6

• Psychosocial factors include depression and sexual, physical, or emotional abuse.
• Other factors include disease processes and prescription medications.

Question 2

• 68% of American adults are overweight, and 34% have obesity.
• The statement is True because some authorities estimate that 68% of American adults are overweight and 34% have obesity.
• Differences exist in obesity prevalence by gender, ethnicity, and socioeconomic status.

Overweight/Obese Children

• Almost 19.3% of U.S. children and adolescents are overweight or obese.
• Overweight is defined as a BMI greater than the 85th percentile for age.
• Obese is defined as a BMI greater than the 95th percentile for age.
• Overweight and obesity in children are a public health concern due to the risk of developing hypertension, dyslipidemias, and type 2 diabetes.
• Childhood obesity increases the risk for adult obesity, and may lead to major disability and death at a younger age than non-obese children
• Childhood obesity is mainly attributed to poor eating habits and too little exercise.

Clinical Manifestations of Obesity

• Clinical manifestations of obesity include increased body weight, excess body fat, and a BMI score of 25 kg/m² or greater.
• Other physical findings include abnormal levels of lipids and lipoproteins, elevated serum levels of insulin, elevated blood pressure, and respiratory difficulties.
• Metabolic abnormalities place overweight and obese people at a significantly higher risk for hypertension, heart disease, diabetes, joint problems, and sleep apnea.

Drug Therapy: Anorexiants

• Anorexiants stimulate the release of norepinephrine and dopamine.
• Phentermine is a prototype.
• Phentermine is the most frequently prescribed adrenergic anorexiant and inhibits the reuptake of both serotonin and norepinephrine.
• Anorexiants cause appetite suppression, resulting from direct stimulation of the satiety center in the hypothalamic and limbic region.
• Adverse effects of anorexiants include nervousness, palpitations, tachycardia, primary pulmonary hypertension, hyperactivity, dry mouth, constipation, and systemic hypertension
• Other reported symptoms are impotence, insomnia, and unpleasant taste.

Drug Therapy: Lipase Inhibitors

• Orlistat (prototype) binds to gastric and pancreatic lipases in the GI tract.
• Orlistat can prevent the absorption of 30% of ingested fat.
• Decreased fat absorption leads to decreased caloric intake, resulting in weight loss and improved serum cholesterol values.
• Improvement in cholesterol levels are independent of weight loss effects
• The main adverse effects are GI symptoms, including abdominal pain, oily spotting, fecal urgency and incontinence, flatulence with discharge, fatty stools, and increased defecation.

Assessment #1

• Assess usual drinking and eating patterns, including healthful and unhealthful intake.
• Healthful: whole-grain breads and cereals, fruits, vegetables, low-fat dairy products.
• Unhealthful: sugar-containing beverages and desserts, fried foods, saturated fat, fast foods, high-calorie snack foods.
• Ask the patient to keep a food diary for 2 or 3 days.
• People tend to underestimate the amount and caloric content if food intake is not written down.

Assessment #2

• Assess overwight patients for health problems caused or aggravated by excessive weight.
• Health problems include elevated blood pressure, other cardiovascular problems, diabetes mellitus, sleep apnea, osteoarthritis, and other musculoskeletal disorders.
• Calculate the BMI and measure waist circumference.

Assessment #3

• Check available reports of laboratory tests.
• Overweight patients may have abnormally high values for total and LDL cholesterol, triglycerides, and blood sugar and low values for high-density lipoprotein (HDL) cholesterol.
• If no laboratory reports are available, ask patients if a health care provider has ever told them they have high cholesterol or blood sugar.
• List all prescription and nonprescription medications the patient is taking and ask about vitamins, herbals, and other dietary supplements.
• Review the list for drugs used to treat health problems associated with obesity, drugs that may promote weight gain, and any products that may be used to promote weight loss.

Assessment #4

• Assess usual patterns of physical activity and exercise, including work and recreational activities.
• Assess motivation to develop and adhere to a weight management plan.
• Determine if there are concerns about weight and the patients interest.
• Methods, over-the-counter products, or herbal or dietary supplements previously tried should be assessed.

Interventions #1

• Support programs/efforts to help promote a healthful lifestyle and prevent obesity in families and schools.
• Serve as a role model by maintaining a healthful lifestyle and weight.
• Serve as a reliable source of information about weight loss and weight loss products and programs.

Interventions #2

• For weight loss patients, assist to formulate realistic goals.
• Patients often expect to rapidly lose large amounts of weight with little or no effort.
• Most treatment programs result in a weight loss of 10% of body weight or less.
• Discuss health risks of obesity and anticipated benefits of achieving and maintaining a healthier weight.
• Emphasize that losing 5% to 10% of body weight is a reasonable goal, and can significantly reduce medical problems associated with being overweight.

Interventions #3

• Assist patients to identify factors that support weight loss efforts and factors that sabotage weight loss efforts.
• Promote exercise and activity.
• Exercise may decrease appetite and distract from eating behaviors as well as increase calorie expenditure.
• For sedentary, physically unfit patients, emphasize that any exercise can be beneficial and to start slowly, increasing the amount and intensity as physical condition improves.

Interventions #4

• Encourage any efforts toward improving diet and increasing exercise to improve health.
• Weigh patients at regular intervals and measure waist circumference periodically.

Explore obesity classifications based on BMI, prevalence in the US, and physiological factors. Learn about the consequences of excessive calorie intake and associated health risks. Understand the mechanism and adverse effects of medications like phentermine.