2. EATING DISORDERS
• Obesity (55% of U.S. population)
-Second leading preventable
cause of death after smoking
• Anorexia nervosa (10% mortality)
-Below 85% ideal body weight
• Bulimia (unknown mortality)
-Binge eating, normal weight
3. IDEAL BODY WEIGHT
• Men- 106 plus 6
-for a man 5’ 7”
-106 plus 7 times 6 = 148 lbs
Women- 105 plus 5
-for a woman 5’ 3”
-105 plus 3 times 5 = 120 lbs
4. BODY MASS INDEX
• Weight in kilograms divided by
height in meters squared
-For a man 5’ 7” and 148 lbs
-67 inches = 1.7 meters
-148 lbs = 67.3 kilograms
• 67.3 kg divided by 1.7 M squared=
23.3
5. BMI RANGES
• Underweight- Below 18.5
• Normal- 18.5 to 24.9
• Overweight- 25 to 29.9
• Obesity I 30 to 34.9
• Obesity II 35 to 39.9
• Extreme 40 or more
7. WEIGHT LOSS STRATEGY
• Take in fewer calories per day
than are burned i.e. diet and
exercise
• Reduce energy intake by 300 to
500 kcal/day
• Adhere to diet (it doesn’t matter
which one)
• Keep track of calories
8. MAJOR DIETS
• ATKINS- low carb
• Ornish- fat restricted
• Weight Watchers- portion and
calorie restricted
• Zone- low glycemic index
• One year weight loss 4.6 to 7.3 lbs
irrespective of diet (adherence is
what matters)
9. EXERCISE
• FEDERAL GUIDELINES:
-To lose weight: 60 min/ day
-To maintain weight loss: 90
min/day
Foregoing guidelines appear highly
unrealistic for someone working full
time.
10. WEIGHT LOSS DRUGS
• APPROVED FOR LONG TERM USE:
-Silbutramine (Meridia) in
combination with a reduced-
calorie diet, for 16 yrs and
older
-Orlistat (Xenical, Alli)
11. SILBUTRAMINE
• AN APPETITE SUPPRESSANT
-Blocks serotonin and
norepinephrine reuptake
-Has antidepressant actions
-10 to 15 mg /day
-10 to 15 lbs over 12 months
-Early responders do best (4 lbs
over 4 weeks)
-Headache, dry mouth, constipation,
insomnia, nervousness
12. ORLISTAT
• REDUCES ABSORPTION OF FAT
-Inhibits gastric and pancreatic
lipases that break down triglycerides
-Fat absorption is reduced 30%
-Reduces LDL cholesterol
-Increases HDL
-Reduces blood glucose
-Lowers blood pressure
13. OTHER WEIGHT LOSS MEDS
• APPETITE SUPPRESSANTS
-Wellbutrin
-Prozac
-Topamax
• SUGAR SUBSTITUTES
-Sweet ‘N Low (saccharin)
-Splenda (sucralose)
-Neotame
14. LEPTIN SIGNALLING
• 1994 – Jeffrey Friedman MD, Rockefeller
University, discovers leptin
• LEPTIN (a hormone) is produced by adipose
cells
• Leptin signals the hypothalamus that no
more food is needed to meet metabolic
needs
• Obese patients appear to have Leptin
insensitivity
• They continue to eat more than their
metabolism requires
• The excess calories increase the size of
adipose cells
15. REFERENCES
• Kupfer DJ et al, DSM-5, American
Psychiatric Association, 2013.
• Lehne RA, Pharmacology for
Nursing Care, Seventh Edition,
Saunders Elsevier, St Louis,
Missouri, 2010.
