Lifestyle Interventions
3 diet recommendations for patients
- Minimally processed foods
- Increase fruits and vegetables
- Whole grain foods
- Decrease calories
- Increase fiber
What is the difference between Mounjaro, Zepbound, Ozempic and Wegovy
Tirzepatide
- Mounjaro: DM2
- Zepbound: obesity with weight related comorbidities
Semaglutide
- Ozempic: DM2, decreases cardiovascular risk
- Wegovy: obesity
Which weight loss medication is a controlled substance
Phentermine-Topiramate (Qsymia)
What is the hormone that signals hunger?
Ghrelin
How many minutes of exercise per week is recommended for weight loss?
>150 mins/week of moderate intensity
What is the difference between MOA between Semaglutide and Tirzepatide
Semaglutide: GLP - 1 agonist only
Tirzepatide: GLP and GIP receptor agonist
Which medication is contraindicated in patients seizure disorder or history of seizures
Naltrexone-Buproprion
Buproprion lowers seizure threshold
Classes of obesity according to BMI
Class I: 30.0-34.9 kg/m²
Class II: 35.0-39.9 kg/m²
Class III: ≥ 40.0 kg/m²
Other factors which can cause difficulty to lose weight
- Stress (causes increase cortisol)
- Poor sleep (increases ghrelin and decreases leptin)
- Alcohol, tobacco use
Which medication is approved for OSA
Zepbound
Which medication is contraindicated in patients with cardiovascular disease/uncontrolled HTN
Phentermine-Topiramate
Name three hormones that increases satiety
Leptin, GLP-1, GiP, Amylin, Cholecystokinin, Peptide Y
True or False: Intermittent fasting causes more weight loss compared to continuous calorie restriction
False
Clinical trials showed similar weight loss outcomes with regular calorie restriction and intermittent fasting
Name 3 contraindications of prescribing GLP-1
- Family or personal hx of medullary thyroid cancer or MEN 2A or 2B
- Pregnancy
- Caution if hx of pancreatitis
- Severe IBD or gastroparesis
If stopped abruptly, which medication can cause seizures
Phentermine-Topiramate
Who is a candidate for medication?
- Patients who have not met weight loss goals (5% of total body weight at 3-6 months)
- BMI >30 kg/m²
- BMI >27 kg/m² with at least one weight related comorbidity (HTN, DM2, HLD, OSA, OA, CAD, etc)
A weight loss of this percentage of baseline body weight is typically recommended as the initial goal for patients with obesity.
5-10%
Name 3 medications approved for patients >12 yo
- Semaglutide
- Liraglutide
- Orlistat
- Phentermine/Topiramate
Which medication requires possible dose adjustment of warfarin?
Orlistat
Decreases absorption of fat soluble vitamin including vitamin K
Possibly reduce warfarin by 50%
Which medication is FDA approved for cardiovascular risk reduction?
Semaglutide: Wegovy