CSOWM
Management of BMI >/= 25 - ANS -Diet, Exercise, Behavior
Management of BMI >/=30 - ANS -Diet, exercise, behavior + pharmacotherapy
Management of BMI >/= 27 + comorbidity - ANS -Diet, exercise, behavior + pharmacotherapy
Management of BMI >/=35 + comorbidity - ANS -Bariatric surgery
Management of BMI >/=40 - ANS -Bariatric surgery
Comorbidities - ANS -T2DM
HTN
OSA and other respiratory disorders
NAFLD
OA
lipid abnormalities
gastrointestinal disorders
heart disease
Medication assessment - ANS -Every month x3 months, then every 3 months
Effective weight loss % - ANS ->/=5% in 3 months
Avoid these wt loss meds with HTN/HD - ANS -Sympathomimetics
(phentermine/diethylpropion)
Avoid these wt loss medications with CVV - ANS -Sympathomimetics
T2DM treatment + medications to support weight loss - ANS -GLP-1 analog (mitigates
associated weight gain due to insulin) or SGLT-2 inhibitors + metformin. If using insulin,
recommend basal instead of combo
Drugs that induce weight gain - ANS -Tricyclic antidepressants (Amitriptyline)
oral contraceptives (Ortho Tri-Cyclen, Yaz)
antipsychotics (Risperidone)
anticonvulsants
glucocorticoids (cortisol)
sulfonylureas- ( Glimepiride, Glipizide)
glitazones (Actos)
,B-blockers (Propranolol, Metoprolol, Atenolol)
Hormonal signals for appetite - ANS -CCK- duodenum
K cells- duodenum and jejunum: gastric inhibitory polypeptide
PYY- ileum and colon
GLP-1 -ileum
Pancreas- Insulin
Adipose tissue: Leptin
Liver- glucagon
GLP-1 - ANS -Secreted in response to glucose and promotes insulin release from pancreas
and satiety
Ghrelin - ANS -produced in the stomach, orexigenic
Leptin - ANS -proportional to fat mass, anorexigenic
Inhibits appetite
PYY - ANS -Ileum and colon, anorexigenic
CCK - ANS -duodenum, anorexigenic
Insulin - ANS -Pancreas, anorexigenic
Phentermine - ANS -noradrenergic, dopaminergic sympathomimetic amine
Start with 7.5-15 mg/d, increase only with no results
Do not prescribe for someone with hx of psych dz or substance abuse
Lorcaserin (Belviq) - ANS -Serotonin agent, stimulates serotonin type 2 receptor
Brand name: Phentermine/Topiramate - ANS -Qsymia
Phentermine/Topiramate (Qysemia) - ANS -Phentermine- stimulant
Topiramate- neuro stabilizer + anti seizure
Bupropion (Wellbutrin) - ANS -Dopamine + norepinephrine reuptake inhibitor
, Stimulates POMC neurons
Sibutramine (Meridia) - ANS -Discontinued-
Norepinephrine, Serotonin, and Dopamine Reuptake Inhibitor Anorectic
Approved for use in adolescents >/=16
Orlistat - ANS -blocks absorption of 25-30% of fat calories
SLGT-2 inhibitors (best for T2DM patients)- ex. Invokana - ANS -promote weight loss by
preventing the reabsorption of glucose as well as water
Band name: Victoza/Sandexa - ANS -Liraglutide
Liraglutide (Victoza/Sandexa) - ANS -Injectable, long acting GLP-1 receptor agonist
Diethylpropion - ANS -Anorexiants, Sympathomimetic Amine Anorectic
Cautions with use of Phentermine and Diethylpropion - ANS -may elevate mean BP and pulse
Do not use pets. with hx of CVD
Monitor patient with HTN
Caution with: HTN, cardiac arrhythmia, seizures
Better choice: Lorcaserin (Serotonin receptor agonist)
cautions with Obese patients on SSRI/SNRI - ANS -Do not use LORCASERIN (serotonin
syndrome)
Better choice- phentermine/topiramate (Qysemia) or phentermine alone or Orlistat
Appetite suppressant to avoid before/during pregnancy - ANS -Topiramate
Medication recs for CVD - ANS -Lorcaserin or Orlistat
Behavioral treatment of Obesity - ANS -Weekly: 4-6 months, then bi-weekly
Group: 10-15 participants
60-90 minutes
Management of BMI >/= 25 - ANS -Diet, Exercise, Behavior
Management of BMI >/=30 - ANS -Diet, exercise, behavior + pharmacotherapy
Management of BMI >/= 27 + comorbidity - ANS -Diet, exercise, behavior + pharmacotherapy
Management of BMI >/=35 + comorbidity - ANS -Bariatric surgery
Management of BMI >/=40 - ANS -Bariatric surgery
Comorbidities - ANS -T2DM
HTN
OSA and other respiratory disorders
NAFLD
OA
lipid abnormalities
gastrointestinal disorders
heart disease
Medication assessment - ANS -Every month x3 months, then every 3 months
Effective weight loss % - ANS ->/=5% in 3 months
Avoid these wt loss meds with HTN/HD - ANS -Sympathomimetics
(phentermine/diethylpropion)
Avoid these wt loss medications with CVV - ANS -Sympathomimetics
T2DM treatment + medications to support weight loss - ANS -GLP-1 analog (mitigates
associated weight gain due to insulin) or SGLT-2 inhibitors + metformin. If using insulin,
recommend basal instead of combo
Drugs that induce weight gain - ANS -Tricyclic antidepressants (Amitriptyline)
oral contraceptives (Ortho Tri-Cyclen, Yaz)
antipsychotics (Risperidone)
anticonvulsants
glucocorticoids (cortisol)
sulfonylureas- ( Glimepiride, Glipizide)
glitazones (Actos)
,B-blockers (Propranolol, Metoprolol, Atenolol)
Hormonal signals for appetite - ANS -CCK- duodenum
K cells- duodenum and jejunum: gastric inhibitory polypeptide
PYY- ileum and colon
GLP-1 -ileum
Pancreas- Insulin
Adipose tissue: Leptin
Liver- glucagon
GLP-1 - ANS -Secreted in response to glucose and promotes insulin release from pancreas
and satiety
Ghrelin - ANS -produced in the stomach, orexigenic
Leptin - ANS -proportional to fat mass, anorexigenic
Inhibits appetite
PYY - ANS -Ileum and colon, anorexigenic
CCK - ANS -duodenum, anorexigenic
Insulin - ANS -Pancreas, anorexigenic
Phentermine - ANS -noradrenergic, dopaminergic sympathomimetic amine
Start with 7.5-15 mg/d, increase only with no results
Do not prescribe for someone with hx of psych dz or substance abuse
Lorcaserin (Belviq) - ANS -Serotonin agent, stimulates serotonin type 2 receptor
Brand name: Phentermine/Topiramate - ANS -Qsymia
Phentermine/Topiramate (Qysemia) - ANS -Phentermine- stimulant
Topiramate- neuro stabilizer + anti seizure
Bupropion (Wellbutrin) - ANS -Dopamine + norepinephrine reuptake inhibitor
, Stimulates POMC neurons
Sibutramine (Meridia) - ANS -Discontinued-
Norepinephrine, Serotonin, and Dopamine Reuptake Inhibitor Anorectic
Approved for use in adolescents >/=16
Orlistat - ANS -blocks absorption of 25-30% of fat calories
SLGT-2 inhibitors (best for T2DM patients)- ex. Invokana - ANS -promote weight loss by
preventing the reabsorption of glucose as well as water
Band name: Victoza/Sandexa - ANS -Liraglutide
Liraglutide (Victoza/Sandexa) - ANS -Injectable, long acting GLP-1 receptor agonist
Diethylpropion - ANS -Anorexiants, Sympathomimetic Amine Anorectic
Cautions with use of Phentermine and Diethylpropion - ANS -may elevate mean BP and pulse
Do not use pets. with hx of CVD
Monitor patient with HTN
Caution with: HTN, cardiac arrhythmia, seizures
Better choice: Lorcaserin (Serotonin receptor agonist)
cautions with Obese patients on SSRI/SNRI - ANS -Do not use LORCASERIN (serotonin
syndrome)
Better choice- phentermine/topiramate (Qysemia) or phentermine alone or Orlistat
Appetite suppressant to avoid before/during pregnancy - ANS -Topiramate
Medication recs for CVD - ANS -Lorcaserin or Orlistat
Behavioral treatment of Obesity - ANS -Weekly: 4-6 months, then bi-weekly
Group: 10-15 participants
60-90 minutes
