Question

Obesity: AZ is a 30-year-old woman who comes to your office seeking help for her weight.   She currently weighs 250 pounds and is 5’6” tall. She admits that her weight is related to poor eating habits. Her diet consists of fast food and highly processed foods (chips, crackers, donuts, candy, etc.). She finds herself eating when she is stressed, eating when bored and eating just because she cannot stop. She describes herself as “being obsessed with food, unable to control her urge to eat when the urge strikes.” She is single and has no children. Her father (age 69) is alive and well with HTN, and hyperlipidemia. Her mother is also alive (age 67) and well with type 2 diabetes, HTN, hyperlipidemia and a history of depression. AZ has a sedentary job at an insurance company. Her company recently offered an incentive for employees who meet certain health goals. She is also aware that her current metabolic status is putting her at risk of diabetes, HTN and hyperlipidemia, all of which run in her family. AZ has tried to lose weight through various dieting techniques (Atkins diet, Weight Watchers, increasing exercise, cutting back on calories, etc.). Her attempts have always been thwarted by her inability to refrain from “feeling the urge to eat all the time.” She is willing to try anything necessary to lose weight and assume a healthier life style. Other than her weight, she is in good health; her labs are within normal limits; physical exam is normal.

1. What therapeutic options exist for this patient? Identify three different options and explain how each works to help the patient lose weight.
2. Which option do you think would be most beneficial for the patient? Explain why.
3. Provide dosing instructions, monitoring parameters, and patient education necessary for the safe use of the selected medication.
4. What other non-pharmacological recommendations would you have for this patient to help her succeed in her weight loss efforts?

Answer 1

Answer:

a. The therapeutic option exists for this patient are

• change of diet: Reduce calories in the diet, restricted foods helps to overcome obesity.
• Exercise and activity: Regular daily exercise helps to burn out the extra calories and to manage the correct weight.
• Weight loss medication: helps to reduce the weight along with the exercise.
• Weight -Loss surgery: helps to reduce the most weight and weight-related problem.

b. Change of diet is the most beneficial for this patient. Because of the underlying cause of obesity for the patient is eating too much unhealthy food unnecessarily. She is an initial phase in weight reduction. So change of diet is initiated first to know the effectiveness of this phase. Carbohydrates should be reduced, pick up of healthy foods, restriction of certain foods, replacement of certain foods helps her to reduce her weight.

c. Weight loss medication:

• Orlistat: Lipase inhibitor helps to reduce fat absorption. Normal dosage 120mg. It increases the risk of liver injury.
• Qsymia: It is a combination of phentermine and Topiramate. It helps to reduce weight loss in a short period of time. Heart rate should be regularly monitored with the patient. It interacts with hyperthyroidism and glaucoma.
• Belviq: It controls appetite and metabolism. It increases the side effects of migraine, hypoglycemia, back pain, fatigue.
• Contrave: It is the extended release of the combination of Naltrexone Hydrochloride and Bupropion. It reduces appetite. It increases the side effects of nausea, vomiting, headache.

d. Non-pharmacological recommendations for weight loss include

• Cognitive -behavioral therapy to change the eating pattern and eating habits.
• Physical activity to maintain an ideal weight.
• Weight reduction program