Weight Loss

—>Normal BMI: 18.5-24.9; Overweight BMI: 25-29.9; Obese BMI: >30

—>overweight + coronary heart disease, HTN, stroke, T2DM are risk factors
—>Drugs/Conditions that can cause weight gain: antipsychotics (clozapine, olanzapine, risperidone,
quetiapine); diabetes (insulin, sulfonylureas, thiazolidinediones, meglitinides); valproic acid/divalproex,
lithium, mirtazapine (Remeron), Steroids, Gabapentin, hormones, paroxetine, TCA, MAOI; hypothyroidism
—>goal is to reduce calories by 500-750 kcal and increase exercise to >150 min/week; self-monitor food
intake, exercise, diet (try low-carb, low-fat, high protein diets
—>Natural Products: bitter orange, caffeine, Yerba mate, guarana, green tea (contain stimulants, can be
harmful in patients with cardiovascular disease)
—>RX only indicated if BMI >30 or BMI >27 + dyslipidemia, HTN, diabetes and should be used with dietary/
physical activity plans. Discontinue therapy after 12 week if 5% weight loss not achieved
—>Drugs that cause weight loss: ADHD drugs, GLP-1, Pramlintides, SGLT2I, Topiramate, Bupropion, ACheI,
levothyroxine, hyperthyroidism, celiacs, IBD, GERD,PUD,TB,CF
—>avoid weight loss drugs in pregnancy; avoid Contrave w/uncontrolled BP, depression, seizure, opioids

Phentermine/Topiramate (Qsymia): Naltrexone/Bupropion (Contrave):

stimulant to increase satiety/
decrease appetite. Use in AM
—>CI: hyperthyroidism, MAOI use
—>SE: tachycardia, CNS effects,
constipation, dry mouth, seizure*
—>has a REMS dt teratogenic risk.
Liraglutide (Saxenda): increase satiety
—>0.6 daily up to 3mg daily
—>has a REMS due to medullary thyroid
carcinoma risk.
—>Warning/SE: pancreatitis,
hypoglycemia, gastroparesis (slowed
emptying), nausea, diarrhea, abdominal
pain
—>decrease diabetic dosing dt
Phentermine (Adipex, Lomaira); Diethylpropion: appetite
suppressant via stimulating NE release which decreases
appetite
—>CI: cardiovascular disease (uncontrolled HTN,
arrhythmia, HF, CAD, hyperthyroidism, glaucoma, PMH
drug abuse, MAOI use in 14 days
—>SE: tachycardia, agitation, increases BP/HR
—>take in the AM
Locaserin (Belviq): increased satiety
decrease cravings
—>Warning/SE: serotonin syndrome,
—>titrate up to BID after 4 weeks
increased psych disorder, priapism,
—>Boxed: not for major depressive
disorder; bupropion increases suicidal hypoglycemia, dry mouth,
thought, avoid in pediatrics constipation, nausea
—>CI: opioid use, uncontrolled HTN,
Orlistat (Xenical)(Alli)
seizures, other bupropion products,
MAOI use in 14 days. —>decreases fat absorption
—>SE: psychiatric disorders, —>must use with a low fat meal and
hepatotoxicity, dizziness, dry mouth, take ADEK +beta carotene
insomnia supplementation @ bedtime or
—>Naltrexone blocks opioids; D/C 2 separated by 2 hours
weeks before Contrave use —>CI: cholestasis, malabsorption
—>Warning/SE: liver damage, kidney
stones, hypoglycemia, GI, fatty stool
(steatosis), avoid w/cyclosporine or
separate by 3 hours; separate with
levothyroxine by 4 hours
Bariatric Surgery: BMI> 40 or BMI>35 + obesity related
condition. Essentially restricts food intake
—>must take calcium citrate, B12 & Fe. Separate out by 2
hrs prior or 4 hours post antacids. Take ADEK. Meds may
need to be crushed or use of transdermal 2 months post
surgery
—>Rapid weight loss can cause gall stones: use Ursodiol
to dissolve them.