Antiobesity

Categories:

  • Definitions
    • Normal Weight: 18.5-24.9 kg/m^2
    • Overweight: 25-29.9 kg/m^2
      • Measure waist + co-morbidities
      • 25-26.9 + co-morbidities: Lifestyle
      • 27-29.9 + co-morbidities: Lifestyle + Pharmacotherapy
    • Obese: ≥30 kg/m^2
      • Class 1: 30-34.9 kg/m^2
        • Lifestyle + Pharmacotherapy
      • Class 2: 35-39.9 kg/m^2
        • ≥5-10% over 6m goal
        • Healthy: Lifestyle + Pharmacotherapy
        • With co-morbidities: Bariatric Surgery
      • Class 3: ≥40 kg/m^2
        • Bariatric Surgery
  • Bariatric Surgery
    • Resolves T2DM in 73%, HTN 63%, OSA 78%, fertility, decreased 4.5y mortality
    • Roux-en-Y gastric Bypass = best, 1yr: 31.2% reduction of weight, 25.5% at 5y
    • Sleeve: 1yr: 25.2% reduction of weight, 18.8% at 5y
    • Adjustable gastric band: 1yr: 13.7% reduction of weight, 11.7% at 5y
    • Thiamine: 12-50mg daily, B12 500mcg daily or 1000mcg monthly, Folate: 400-800mcg daily, vitamin A:5000-10000 IU daily, Vitamin E: 15mg daily, VitK: 90-120mcg daily, D3: 3000IU daily, Calcium: 500-600mg TID, Iron: 18mg-60mg daily, Zinc: 8-22mg daily, Copper 1-2mg daily (8 to 1mg with zinc to prevent copper deficiency)
      • Labs 3-6m in 1st year, Q6 after
      • CBC, CMP, pre-albumin, b12, thiamine, folate, vitamin A and D, PTH, iron, ferritin
  • Lifestyle
    • Reduction in 500-750 kcal/day = 1-2 lbs per week
    • 150 up to 300 minutes per week
  • Orlistat (Xenical, Alli)
    • Indicated for use ≥3 months
    • Lipase Inhibitor
      • Lowers BP ~10mmHg, reduces total cholesterol, LDL, triglycerides, risk of progression to diabetes, reduces need for diabetes meds
    • 60mg TID to 120mg TID
    • -2.6kg at 6m, -2.9kg at 12m
    • SE: Liver injury, Diarrhea, flatulence, fecal urgency, dyspepsia
  • Phentermine/Topiramate (Qsymia/Qnexa)
    • Approved for use ≥3m and <3m
    • Appetite suppressant
      • Positive effect on CV outcomes, Lowers BP and decreases need for BP meds, increases HR slightly at max dose, reduces need for diabetes meds
    • 8mg TID to 37.5mg daily
    • 5/46mg daily recommended, 15/92mg daily max
      • 1kg at 12m at recommended, -10.2 kg at 12m at max
    • SE: constipation, xerostomia, dizziness, seizure, insomnia, depression, hypohidrosis, angle closure glaucoma, birth defects
  • Naltrexone/Bupropion (Contrave)
    • Approved for use ≥3m
    • Appetite suppressant, opioid antagonist/aminoketone antidepressant
      • No CV benefits, reduces waist circumference, triglycerides, and HDL, reduces need for diabetes meds
    • 16/180mg BID
    • -4.1kg at 12m
    • SE: Nausea, constipation, headache, vomiting, seizures, hepatotoxicity, increased BP and HR
  • Liraglutide (Saxenda)
    • Appetite suppressant; GLP-1 receptor agonist
      • reduces waist circumference, Lowers BP, reduces LDL and triglycerides, risk of progression to diabetes
    • Approved for use ≥3m
    • 3mg subq daily
    • -4.5kg at 12 months
    • SE: Nausea, hypoglycemia, diarrhea, constipation, headache, pancreatitis, GB disease, thyroid carcinoma, Thyroid tumors
  • Semaglutide (Wegovy)
    • Appetite suppressant; GLP-1 receptor agonist
    • Approved for use ≥3m
    • 4mg subq weekly
    • -15.3kg at 14 months
    • SE: Nausea, hypoglycemia, diarrhea, constipation, headache, pancreatitis, GB disease, thyroid carcinoma, Thyroid tumors
  • Diethylpropion
    • FDA approved for <3m
    • 25mg TID
    • SR: 75mg daily
  • Phendimetrazine
    • FDA approved for <3m
    • 5-70mg BID to TID
    • SR: 105mg daily
  • Benzphetamine
    • FDA approved for <3m
    • 20-50mg daily to TID
  • Cetilistat
  • Lorcaserin (Belviq)
  • Metformin
  • Exenatide

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