Obesity - Chronic
Rahul Soman, M. Pharm
Definition
Chronic, relapsing disease characterized by an excessive accumulation of body fat
Ongoing Assessment
Screening Criteria
Suspected or known hyperlipidemia or dyslipidemia
* Fasting lipid profile: A fasting lipid profile is the primary test for diagnosing, making management decisions, and monitoring treatment of dyslipidemia .
Suspected diabetes mellitus
* Plasma fasting glucose measurement: Fasting plasma glucose levels of 126 mg/dL (7 mmol/L) or greater are diagnostic of diabetes mellitus. In the absence of unequivocal hyperglycemia, results must be confirmed with repeat testing on another day .
Suspected impaired fasting glucose (IFG) (prediabetes)
* Plasma fasting glucose measurement: Impaired fasting glucose is defined as a fasting plasma glucose level of 100 to 125 mg/dL (5.6 to 6.9 mmol/L) and indicates prediabetes .
Medical History
* Gets no exercise
* Alteration in nutrition: more than body requirements
* Polycystic ovary syndrome [Polycystic ovary syndrome - Chronic]
* Abnormal hormone production
* Antipsychotic use
* Family history of Obesity
* Antidepressant use
* Smoking
Findings
* Weight increased
* Obese abdomen
* Increased blood pressure
* Depression - Chronic
* At risk for psychosocial dysfunction
Tests
Suspected or known hyperlipidemia or dyslipidemia
* Fasting lipid profile: A fasting lipid profile is the primary test for diagnosing, making management decisions, and monitoring treatment of dyslipidemia .
Suspected diabetes mellitus
* Plasma fasting glucose measurement: Fasting plasma glucose levels of 126 mg/dL (7 mmol/L) or greater are diagnostic of diabetes mellitus. In the absence of unequivocal hyperglycemia, results must be confirmed with repeat testing on another day .
Suspected impaired fasting glucose (IFG) (prediabetes)
* Plasma fasting glucose measurement: Impaired fasting glucose is defined as a fasting plasma glucose level of 100 to 125 mg/dL (5.6 to 6.9 mmol/L) and indicates prediabetes .
Suspected or known hypothyroidism
* Thyroid stimulating hormone measurement: Overt hypothyroidism is classified as a TSH above the upper limit of the reference range in the presence of a low serum free thyroxine (FT4) . Subclinical hypothyroidism is a laboratory diagnosis defined as a TSH above the upper limit of the reference range in the presence of a normal FT4.
Treatment
Drug Therapy
Patients with an initial body mass index (BMI) of 30 kg/m2 or greater or 27 kg/m2 or greater in the presence of other risk factors, such as hypertension, diabetes, dyslipidemia, coronary heart disease, or sleep apnea
ORLISTAT
Adults: 120 mg orally 3 times daily with meals
PHENTERMINE HYDROCHLORIDE
Adults: Short-term (a few weeks) adjunct: 37.5 mg orally daily before breakfast or 1 to 2 hours after breakfast or divided into 2 doses; some patients may only require 18.75 mg daily
DIETHYLPROPION HYDROCHLORIDE
Adults: Short term (a few weeks) adjunct: controlled release, 75 mg orally daily, take midmorning or immediate release, 25 mg orally 3 times a day, 1 hr before meals; may take 1 dose mid-evening, if desired, to overcome night hunger
SIBUTRAMINE HYDROCHLORIDE
Adults: Initial: 10 mg orally once daily; after 4 weeks may increase to a maximum dose of 15 mg orally once daily
Procedural Therapy
Adjunctive therapy of overweight and obese patients
* Behavioral therapy: Behavior therapy is important for the success of any weight loss program to facilitate changes in eating and activity behaviors .
Patients with a body mass index (BMI) of at least 40 kg/m2 or 35 kg/m2 with comorbid conditions and acceptable operative risks
* Gastric bypass surgery: Studies have shown that weight loss is greater with the gastric bypass procedure than with vertical-banded gastroplasty .
Non-Procedural Therapy
Treatment of overweight and obese patients
* Dietary Therapy
Treatment of overweight and obese patients
* Physical Activity
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