Obesity/Nutrition

Obesity/Nutrition – Nina Hill

Background

  • BMI = Body Weight (kg) + Height (meters) squared
  • Overweight = BMI 25.0-29.9
  • Obesity:
    • Class I 30-34.9
    • Class II 35-39.9
    • Class IIIA 40-44.9
    • Class IIIB 45-49.9
    • Class IIIC 50+

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Management

  • Goals: Target initial weight loss of 5-7% body weight, schedule frequent follow up to assess progress. Request pts send 48 hr food log. Encourage accountability “buddies.” Consider weight loss apps: My Fitness Pal, Lose it
  • Diet:
    • Calorie restriction > macronutrient composition (e.g., low fat, low carb)
    • Mediterranean: high in unsaturated fats, fruit/veg, legumes, grains; moderate dairy & EtOH; less meat (decreased overall mortality and CV mortality; may decrease diabetes incidence independent of weight loss)
    • Dot phrases below for pictoral representation of cultural diets adapted to fit Mediterranean guidelines (Asian, African, Latin American)
  • DASH: High in fruits/vegetables, moderate dairy, < 25% caloric intake from fat (decreases SBP/DBP)
  • Exercise: >30 min, 5-7 days per week, ideally a combo of aerobic + resistance training.
    • ​​​​​​​Exercise alone is not sufficient for weight loss.
    • Medications: If BMI ≥30 or BMI ≥27 with ≥1 comorbidity. Significant short term weight loss (~ 5-15 lbs), but weight is typically gained back when stopped
  • Referral to medical weight loss: If BMI ≥ 30 or BMI ≥27 with comorbid conditions (fatty liver disease, diabetes mellitus, HTN, OSA)
  • Referral to surgical weight loss: If BMI ≥40 or BMI ≥35 with comorbid conditions

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Medication

Mechanism

Common Side Effects

Orlistat (Xenical)

Reduces fat adsorption

Diarrhea, gas, leakage of oily stools, stomach pain

Phentermine-topiramate (Qsymia)

Phentermine: appetite suppression

Topiramate (anticonvulsant, migraine txt): ?appetite suppression, ?altered satiety perception

Constipation, dizziness, dry mouth, taste changes, tingling of hands and feet, insomnia

Naltrexone-bupropion  (Contrave)

Naltrexone (partial opioid antagonist; used for alcohol dependence): ?altered satiety perception

Bupropion (antidepressant): ?altered satiety perception

Constipation, diarrhea, dizziness, dry mouth, headache, BP, tachycardia, insomnia, liver damage, nausea/vomiting

Liraglutide  (Saxenda)

Appetite suppression; quickens satiety

(Victoza: lower dose formulation, FDA-approved for T2DM)

Nausea, diarrhea, constipation, abdominal pain, headache, tachycardia

Phentermine (Ionamin)

Reduces appetite
Note: FDA-approved only for short-term use—up to 12 weeks

Dry mouth, constipation, insomnia, dizziness, nervousness/ restlessness headache, HTN, tachycardia

Semaglutide (Ozempic/Rybelsus)

Glucagon-like peptide-1 receptor agonist; reduces appetite

Nausea, vomiting, diarrhea, abdominal pain, constipation