Clinical Nutrition - Weight Assessment and Obesity

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jcu1
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215104
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Clinical Nutrition - Weight Assessment and Obesity
Updated:
2013-04-22 17:32:39
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GI
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Johnson
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  1. IBW thresholds for malnutrition
    • <80%
    • >120%
  2. Actual vs. IBW
    • ABW <69% IBW: severe malnutrition
    • ABW 70-79% IBW: moderate malnutrition
    • ABW 80-89% IBW: mild malnutrition
    • ABW 90-120% IBW: normal
    • ABW >120% IBW: overweight
    • ABW ≥ 150% IBW: obese
    • ABW ≥ 150% IBW:morbidly obese
  3. Actual vs. usual body weight
    • ABW < 70% UBW: severe malnutrition
    • ABW 75-84% UBW: moderate malnutrition
    • ABW 85-95% UBW: mild malnutrition
    • ABW >95% UBW: normal
  4. Percent change between usual and actual body that indicates severe malnutrition
    • 1-2% in one week
    • 5% in one month
    • 7% in 3 months
    • 10% in 6 months
  5. BMI equation


    • weight (kg)
    • height (m)
  6. BMI ranges in relation to malnutrition
    • <16: severe="" malnutrition="" br="">16-16.9: moderate malnutrition
    • 17-18.5: mild malnutrition
    • 19-25(21-27): healthy 19-34 yo (>35 yo)
    • 25-30(27.5-29.9): overweight 19-34 yo (>35 yo)
    • 30-40: moderate obesity
    • >40: severe or morbid obesity
  7. Official BMI classess
    • Overweight: 25 - 29.9
    • Obesity class I: 30-34.9
    • Obesity class II: 35-39.9
    • Obesity class III: >40
  8. at risk for mortality
    • overweight/obese with BMI ≥25
    • waist circumference (men >102 cm; women >88 cm)
    • risk factors: htn, hyper lipid, DM, sleep apnea, CV disorders
  9. secondary etiologies of obesity
    • hypothyroidism
    • binge eating/psychological
    • meds (corticosteroids, antidepressants, antipsychotics, sulfonylureas, insulin, birth control, beta blockers, lithium
  10. pharmacotherapy that is approved for short-term weight loss
    • phentermine
    • mazindol
    • benzpetamine
    • phendimetrazine
    • diethylpropion
  11. pharmacotherapy that is approved for long-term weight loss
    • orlistat
    • phentermine/topiramate ER
    • lorcaserin
  12. orlistat MOA, dosage
    • MOA: selective inhibitor of GI lipases
    • Rx: 120 mg TID before meals
    • OTC: 60 mg TID before meals
  13. Orlistat AEs
    • GI probs: soft stool, pain/colic, farting, fecal urgency or incontinence
    • malabsorption of fat-soluble vitamins (take MV at bedtime
  14. Orlistat DDIs
    • dec cylcosporing levels
    • theoretical interaction with warfarin (dec in absorption of Vit K)
    • leothyroxine doses separated from orlistat
  15. phentermine/topiramate ER MOA
    • schedule IV
    • phen MOA: activated adrenergic system --> NE released --> decreased appetite
    • topiramate MOA: appetite suppression and satiety enhancement
  16. phentermine/topiramate dosing
    • 2 weeks: 3.75 mg/23 mg qam
    • after 2 wks: 7.5 mg/46 mg qam
    • evaluate after 12 wks, if still hasn't worked, escalate dose and evaluate in 12 wks again, if still hasn't worked d/c
  17. phentermine/topiramate side effects
    paraesthesia, dry mouth, constipation, distorted sense of taste, insomnia, dizziness, anxiety, reduced sense of touch or sensation

    • inc HR
    • suicidal behavior
    • acute myopia and glaucoma
    • modd/sleep disorders
    • attention/memory disturbances
  18. phentermine/topiramate REMS Program
    • used bc of teratogenic risk
    • Preg Cat X
    • prescriber does training before starting therapy
    • sends Rx to special mail-order pharmacy
  19. phentermine/topiramate DDI
    • MAOIs: risk of htn crisis
    • oral contraceptives: irregular bleeding/spotting
    • CNS depressants: additive dizziness effect
    • non-K sparing diuretics: K wasting
  20. lorcaserin MOA, dosage
    • serotonin 2C receptor agonist: dec food consumption; promotes fullness
    • dosage: 10 mg po BID w/o regard to food (assess in 12 wks, if pt hasn't lost 5% of baseline, d/c)
  21. lorcaserin dosage adjustment
    • none
    • avoid in CrCl <30
  22. locaserin AEs
    • headache, dizziness, fatigue, nausea, dry mouth, constipation
    • cognitive impairement
    • priapism (prolonged erection)
    • selectivity for 5-HT2C might minimize AEs caused by nonselective agonists (pulmonary htn, heart valve disease, cardiac fibrosis)
  23. locaserin CIs
    • Preg X
    • use caution with other serotonergic drugs
  24. indication for bariatric surgery
    • ≥80-100 lbs overweight
    • BMI ≥40 OR
    • BMI 35 + medical condition linked to obesity
    • Also must have:
    • tried to and failed to lose weight with other methods
    • agree to lifelong changes
    • agree to medical follow-up
  25. two types of bariatric surgery
    • restrictive - small pouch
    • restrictive/malabsorptive combination - diversions
  26. examples of restrictive bariatric surgery
    • vertical banded gastroplasty
    • adjustable gastric banding
  27. examples of restrictive/malabsorptive combo bariatric surgery
    • biliopancreatic diversion
    • Roux-en-Y procedure
  28. meds to avoid after gastric surgery
    • NSAIDs
    • ER or SR poducts
  29. med recommendations after surgery
    • meds absorbed in sotmach or duodenum
    • oral abxs
    • chronic meds for multiple disease states
    • salt forms
    • lipid formulations

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