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Drug Therapy For Weight Management

Terms in this set (75)

Overweight & Obese Children
• Overweight: BMI above the 85th percentile for the age group and obesity as a BMI above the 95th percentile.
• At risk of developing HTN, dyslipidemias, type 2 diabetes m, & other disorders that lead to reduced quality of life, major disability, & death at younger adult ages.
• Due to poor eating habits & little/no exercises
• Obese after 6 years of age is highly likely to be obese adult & develop obesity-related health problems, especially if a parent is obese. Obesity in adults that began in childhood tends to be more severe.
• Treatment should focus on healthy eating & increasing physical activity; never put on "diet."
• For a child who is overweight, maintain weight or slow the rate of weight gain so that weight & BMI gradually decline as the child's height increases.
• If child has already reached his/her anticipated adult weight, maintenance of that weight & prevention of additional gain should be the long-term treatment goal. If the child already exceeds his/her optimal adult weight, the goal of treatment should be a slow weight loss of 10 to 12 pounds per year until this weight is reached.

Overweight and Obese Older Adults
• The numbers are still significantly lower than in young adults; socioeconomic factors plays a role. Does not appear to make a difference to risks of death but is major contributor to increased disability & reduced quality of life. Development of type 2 diabetes m. remains a risk. Excess weight reduces the loss of bone mass, & less likely to suffer hip fractures; health risks of obesity are greater than any advantages.
• Weight loss reduces health problems. Decrease BP if hypertensive; lower elevated levels of total cholesterol, low-density lipoprotein cholesterol, & triglycerides & raise low levels of high-density lipoprotein cholesterol if they are dyslipidemic; lower elevated blood glucose levels if they have type 2 diabetes.

• BMI used to assess overweight & obesity & estimate disease risks. Measure waist circumference initially & periodically to assess abdominal fat content. Weigh regularly to monitor body weight for gain, loss, or maintenance.

• Initial goal of weight loss therapy should be to reduce body weight by about 10% from baseline, at a rate of 1 to 2 pounds per week for 6 months. Steady weight loss over a longer period reduces fat stores in the body, limits the loss of vital protein tissues, & avoids sharp decline in metabolic rate that accompanies rapid weight loss. After weight loss, weight maintenance should be the priority goal; weight regain is a problem w/ all weight loss programs. After weight maintenance, additional losses may be desirable.

• Dietary recommendations: low-calorie diets for weight loss, mainly reducing caloric intake by 500 to 1000 cal daily. Reducing dietary fat can reduce calories. Reducing dietary fat w/out reducing total caloric intake does not produce weight loss. Vitamin/mineral supplements that meet age-related requirements are usually recommended with weight loss programs that provide <1200 kcal for women & 1800 kcal for men.

• Physical activity recommendations should be part of any weight management program because physical activity contributes to weight loss, may decrease abdominal fat, increases cardiorespiratory fitness, & helps w/ weight maintenance. Physical activity for 30 to 45 minutes, 3 to 5 days a week, is encouraged. On long term, adults should try to accumulate at least 30 minutes+ of moderate-intensity physical activity on most days of the week.

• Weight loss & weight maintenance programs should combine reduced-calorie diets, increased physical activity, & behavior therapy. After weight loss, maintenance w/ dietary therapy, physical activity, & behavior therapy should be continued indefinitely. Drug therapy can also be used. However, drug safety and efficacy beyond 1 to 2 years of total treatment have not been established.

• Behavioral modification can be helpful in a weight loss program. Goals are to help patients modify their eating, activity, & thinking habits. Techniques include identifying triggers that promote overeating & barriers that keep one from adopting a more healthful lifestyle. One strategy is keeping an accurate record of food/calorie intake & physical activity. Also, stress management, stimulus control, & social support help. Patients who eat more when stressed can learn to manage stress more healthfully. Counseling by behavioral therapist may be needed. Need social support.
General Considerations
• Because of extensive health problems associated w/ overweight & obesity, if your weight is w/in normal range, try to prevent excessive weight gain by practicing a healthful lifestyle in terms of diet and exercise. Try to:
- Manage weight by balancing calorie intake w/ physical activity.
- Increase intake of fruits, vegetables, low-fat & fat-free dairy products, whole grains, & seafood
- Limit intake of sodium, saturated & trans fats, cholesterol, refined grains, & foods w/ added sugars.
- Spread your intake of daily fat, carbohydrate, & protein over 3 meals.
• Further recommendations from the Dietary Guide-lines for Americans 2010, published by the U.S. Department of Health and Human Services and the Department of Agriculture in January 2011 (updated every 5 years) are available online at

• Take appetite suppressants in the morning to decrease appetite during the day & avoid interference w/ sleep at night.
• Do not crush/chew sustained-release products.
• With phentermine, monitor your blood pressure. As body weight decreases, BP usually decreases.

With orlistat (Xenical, Alli):
o Take one capsule w/ each main meal or up to 1 hour after a meal, up to 3 capsules daily. If you miss a meal or eat a meal w/ no fat, you may omit a dose of orlistat.
o Take multivitamin containing fat-soluble vitamins (A, D, E, & K) daily, at least 2 hours before or after taking orlistat. Orlistat prevents absorption of fat-soluble vitamins from food or multivitamin preparations if taken at the same time.
o Take the drug with a full glass of water.