Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.

Chapter 82

Drugs for Weight Loss

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Obesity

May be associated with hypertension, coronary heart disease, stroke, type 2 diabetes, gallbladder disease, kidney stones, osteoarthritis, sleep apnea, dementia, and certain cancers, although underweight or normal-weight patients also suffer from these conditions

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Assessment of Obesity-Related Health Risk

Assessment: obesity1. Degree of obesity

Body mass index (BMI)

2. Pattern of fat distribution Waist circumference

3. Presence of risk factors Coronary heart disease, diabetes, hypertension Other atherosclerotic diseases, sleep apnea

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Overview of Obesity Treatment

Who might want to be treated? Body mass index (BMI) of 30 or more BMI of 25 to 25.9 plus two risk factors Weight circumference (WC) greater than 40

inches (in men) or greater than 35 inches (in women) plus two risk factors

Treatment goals

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Treatment Modalities

Nutritious diet Exercise Behavior modification Drug therapy Bariatric therapy

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Weight-Loss Drug

Only weight-loss drug currently approved for long-term use: Orlistat (Xenical, Alli)

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Sibutramine (Meridia)

Withdrawn in 2010 because of risk of stroke and myocardial infarction

Additional adverse effects included: Headache Dry mouth Constipation Elevated heart rate Insomnia Elevated blood pressure Nervousness and anxiety

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Orlistat (Xenical, Alli)

Acts in the GI tract to reduce absorption of fat Adverse effects

GI effects Fecal incontinence Fecal urgency Oily spotting Oily stools

Can be reduced somewhat with decreased fat intake and psyllium

Reduced absorption of fat-soluble vitamins Take vitamin supplement: 2-hour window

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Orlistat (Xenical, Alli)

● Cautions Vitamin K deficiency can intensify effects

of warfarin Associated with severe liver damage May cause hypothyroidism in patients

taking levothyroxine

9

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Miscellaneous Appetite Suppressants

Sympathomimetic amines Nonamphetamines Amphetamines

Bupropion Fluoxetine Topiramate and zonisamide