Obesity/Nutrition¶
Mackenzie Samson
Background¶
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BMI = Body Weight (kg) / Height (meters)2
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Underweight = BMI \<18.5
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Normal = BMI 18.5-24.9
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Overweight = BMI 25.0-29.9
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Obesity:
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Class I 30-34.9
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Class II 35-39.9
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Class IIIA 40-44.9
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Class IIIB 45-49.9
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Class IIIC 50+
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Management¶
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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, Noom
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Dietary options:
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Calorie restriction > macronutrient composition (e.g., low fat, low carb)
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Mediterranean: high in unsaturated fats, fruit/veg, legumes, grain, moderate dairy & EtOH, less meat. Adherence leads to decreased overall mortality and CV mortality; may decrease diabetes incidence independent of weight loss
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Dot phrases below for pictoral representation of cultural diets adapted to fit Mediterranean guidelines (Asian, African, Latin American)
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DASH: High in fruits/vegetables, moderate dairy, \< 25% caloric intake from fat (decreases SBP/DBP)
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Exercise: >30 min, 5-7 days per week, ideally a combo of aerobic + resistance training.
- Exercise alone is not sufficient for weight loss
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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. See table below
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Referral to medical weight loss: If BMI ≥ 30 or BMI ≥27 with comorbid conditions (fatty liver disease, diabetes mellitus, HTN, OSA)
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Referral to surgical weight loss: If BMI ≥40 or BMI ≥35 with comorbid conditions
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VA: consider referral to MOVE program (in person/telehealth options)
| 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 |
Additional Information¶
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EPIC Dot phrases:
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.NHFOODINSECURITY
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.NHFOODASIANDIET
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.NHFOODLATINDIET
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.NHFOODAFRICANDIET
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.NHFOODHEALTHYPLATE
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.NHOBESITYYMCA
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