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Mackenzie Samson


  • BMI = Body Weight (kg) / Height (meters)2

  • Underweight = BMI \<18.5

  • Normal = BMI 18.5-24.9

  • 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+


  • 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

  • Dietary options:

    • Calorie restriction > macronutrient composition (e.g., low fat, low carb)

    • 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

    • 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. See table below

  • 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

  • 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

  • EPIC Dot phrases:







Last update: 2022-06-24 15:40:06