Chapter 36: Drug Therapy for Weight Management PDF

Chapter 36 Drug Therapy for Weight Management  Widespread problems in the United States Overweight and oAffects 42.4% of population in the United Obese Adults States Considered major public health problems oHigh rates of...

Chapter 36 Drug Therapy for Weight Management  Widespread problems in the United States Overweight and oAffects 42.4% of population in the United Obese Adults States Considered major public health problems oHigh rates of morbidity and mortality Overweight: oBMI of 25 to 29.9 kg/m2 Obese: oBMI  30 kg/m2 Copyright © 2025 Wolters Kluwer. All rights reserved. 2  Is the following statement True or False? Question #1 A body mass index (BMI) over 25 indicates excessive weight. Copyright © 2025 Wolters Kluwer. All rights reserved. 3  True Answer to Question #1 Rationale: A body mass index (BMI) over 25 indicates excessive weight. BMI below 18.5 indicates underweight; BMI over 30 is considered obese. BMI reflects weight in relation to height and is a better indicator than weight alone. Copyright © 2025 Wolters Kluwer. All rights reserved. 4  Occurs in anyone, but more likely in Obesity #1 oFemales, minority groups, poor people Results from consistent ingestion of more calories than used for energy, exercising less, or a combination of both Substantially increases risks for development of numerous health problems Copyright © 2025 Wolters Kluwer. All rights reserved. 5  Prevalence Obesity #2 oDramatically increased in past 25 years oEstimated 68% of American adults are overweight and 34% have obesity oDifferences by gender, ethnicity, socioeconomic status Copyright © 2025 Wolters Kluwer. All rights reserved. 6  Physiologic factors Obesity #3 oEnergy imbalance Intake > expenditure Eating more calories; exercising less Combination of the two oExcessive intake  fat cells increase in size and number. Copyright © 2025 Wolters Kluwer. All rights reserved. 7  Genetic factors Obesity #4 oSimilar body types Environmental factors (promotion of overeating) oRelatively low cost of wide variety of foods oLarge portion size; high-calorie foods oDecreased physical activity Copyright © 2025 Wolters Kluwer. All rights reserved. 8  Environmental factors (cont.) Obesity #5 oADLs, work activities require little energy expenditure. oFew Americans exercise optimally. oIncreased couch potato opportunities TV, video/computer games, computer use Copyright © 2025 Wolters Kluwer. All rights reserved. 9  Psychosocial factors Obesity #6 oDepression oSexual, physical, or emotional abuse Other factors oDisease processes may contribute oPrescription medications Copyright © 2025 Wolters Kluwer. All rights reserved. 10  Is the following statement True or False? Question #2 Estimates indicate that 68% of American adults are overweight and 34% have obesity. Copyright © 2025 Wolters Kluwer. All rights reserved. 11  True Answer to Question #2 Rationale: Some authorities estimate that 68% of American adults are overweight and 34% have obesity. Differences exist in prevalence by gender, ethnicity, and socioeconomic status. Copyright © 2025 Wolters Kluwer. All rights reserved. 12  Almost 19.3% U.S. children and adolescents Overweight/ oOverweight: BMI > 85th percentile for age Obese Children oObese: BMI > 95th percentile for age Public health concern oRisk of developing hypertension, dyslipidemias, type 2 diabetes May lead to major disability and death at younger age than nonobese children oIncreases risk for adult obesity Mainly attributed to poor eating habits and too little exercise Copyright © 2025 Wolters Kluwer. All rights reserved. 13  Increased body weight, excess body fat, and a Clinical BMI score of 25 kg/m2 or greater. Manifestations of Obesity Other physical findings include abnormal levels of lipids and lipoproteins, elevated serum levels of insulin, elevated blood pressure, and respiratory difficulties. These metabolic abnormalities place overweight and obese people at a significantly higher risk for hypertension, heart disease, diabetes, joint problems, and sleep apnea. Copyright © 2025 Wolters Kluwer. All rights reserved. 14  Stimulates the release of norepinephrine and Drug Therapy: dopamine Anorexiants Prototype: phentermine oMost frequently prescribed adrenergic anorexiant oInhibits the reuptake of both serotonin and norepinephrine Causes appetite suppression, resulting from direct stimulation of the satiety center in the hypothalamic and limbic region Adverse effects include nervousness, palpitations, tachycardia, primary pulmonary hypertension, hyperactivity, dry mouth, constipation, and systemic hypertension. Impotence, insomnia, and unpleasant taste may also occur. Copyright © 2025 Wolters Kluwer. All rights reserved. 15  Orlistat (prototype) binds to gastric and Drug Therapy: pancreatic lipases in the GI tract; can prevent Lipase Inhibitors 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 presumably independent of weight loss effects Main adverse effects are GI symptoms: abdominal pain, oily spotting, fecal urgency and incontinence, flatulence with discharge, fatty stools, and increased defecation. Copyright © 2025 Wolters Kluwer. All rights reserved. 16  Assess usual drinking and eating patterns, Assessment #1 including healthful (e.g., whole-grain breads and cereals, fruits, vegetables, low-fat dairy products) and unhealthful (e.g., sugar- containing beverages and desserts, fried foods, saturated fat, fast foods, high-calorie snack foods) intake. The best way is to ask the patient to keep a food diary for 2 or 3 days. If food intake is not written down, people tend to underestimate the amount and caloric content. Copyright © 2025 Wolters Kluwer. All rights reserved. 17  Assess any obviously overweight patient for Assessment #2 health problems caused or aggravated by excessive weight (e.g., elevated blood pressure, other cardiovascular problems, diabetes mellitus, sleep apnea, osteoarthritis, and other musculoskeletal disorders). Calculate the BMI and measure waist circumference. Copyright © 2025 Wolters Kluwer. All rights reserved. 18  Check available reports of laboratory tests. Overweight Assessment #3 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. Copyright © 2025 Wolters Kluwer. All rights reserved. 19  Assess usual patterns of physical activity and Assessment #4 exercise, including work and recreational activities. Assess motivation to develop and adhere to a weight management plan. Ask if there are concerns about weight; if there is interest in a weight management program to improve health; and what methods, over-the-counter products, or herbal or dietary supplements have been previously used to reduce weight, if any. Copyright © 2025 Wolters Kluwer. All rights reserved. 20  Support programs/efforts to help promote a Interventions #1 healthful lifestyle and prevent obesity (e.g., 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. Copyright © 2025 Wolters Kluwer. All rights reserved. 21  For a patient who is obese patient reports Interventions #2 interest and motivation in losing weight, 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 the medical problems associated with being overweight. Copyright © 2025 Wolters Kluwer. All rights reserved. 22  Assist patients to identify factors that support Interventions #3 weight loss efforts (e.g., family and friend encouragement) and factors that sabotage weight loss efforts (e.g., having high-calorie foods readily available, frequently eating at fast-food restaurants). Promote exercise and activity. For patients who are overweight and obese, exercise may decrease appetite and distract from eating behaviors as well as increase calorie expenditure. For very sedentary, physically unfit patients, emphasize that any exercise can be beneficial and to start slowly, increasing the amount and intensity as physical condition improves. Copyright © 2025 Wolters Kluwer. All rights reserved. 23  Encourage any efforts toward improving diet Interventions #4 and increasing exercise to improve health. Weigh patients at regular intervals and measure waist circumference periodically. Copyright © 2025 Wolters Kluwer. All rights reserved. 24