Information Gathering 1. Gather essential information about the patient’s symptoms, including: a. description of symptom(s) (i.e., nature, onset, duration, severity, associated symptoms) Patient is concerned about her weight and overall appearance. She has never been obese, but she is slightly overweight and wants to lose approximately 15 pounds over the next month or two. b. description of any factors that seem to precipitate, exacerbate, and/or relieve the patient’s symptom(s) Patient tends to snack on sweets, particularly in the afternoon and when she studies at night. c. description of the patient’s efforts to relieve the symptoms Patient has tried several diets over the past 6 months, but she has not been successful …
[ Continue Reading... ]Category: Obesity
Relevant Evaluation Criteria Scenario/Model Outcome Information Gathering 1. Gather essential information about the patient’s symptoms, including: a. description of symptom(s) (i.e., nature, onset, duration, severity, associated symptoms) Patient has battled overweight and obesity his entire adult life. He has never been severely obese but tends to gain 10 to 15 pounds per decade. His obesity does not affect his ability to perform activities of daily living. b. description of any factors that seem to precipitate, exacerbate, and/or relieve the patient’s symptom(s) Patient is a stress eater: he tends to snack on unhealthy foods at work and late at night. c. description of the patient’s efforts to relieve the symptoms Various diets …
[ Continue Reading... ]Orlistat (Xenical, Roche Laboratories) was approved by the Food and Drug Administration in 1999. It differs from the agents previously discussed as its mechanism of action does not exert effects in the central nervous system. Orlistat exerts its activity in the lumen of the stomach and small intestine by forming a covalent bond with the active serine residue site of gastric and pancreatic lipases. It is a reversible lipase inhibitor that decreases the absorption of dietary fats by approximately 30%. These unabsorbed triglycerides are eliminated, resulting in caloric deficit leading to weight loss. The mechanism of action of orlistat allows it to be considered as a potential weight loss agent for …
[ Continue Reading... ]Sibutramine (Meridia, Knoll Pharmaceuticals), approved by the Food and Drug Administration in 1997, is a newer agent that differs in mechanism of action from the anorexiant agents. The mechanism of action of sibutramine involves inhibiting the reuptake of the neurotransmitters norepinephrine and serotonin to stimulate the satiety center in the brain. Sibutramine does, however, share the recommendations for use with the previously discussed anorexiants. Patients taking sibutramine should be those with body mass index (BMI)>30kg/m and concurrently adhering to a reduced calorie diet and exercise program. Patients with risk factors and a BMI>27kg/m, are also potential candidates for sibutramine therapy. Wirth and Krause conducted a …
[ Continue Reading... ]The anorexiants constitute the mainstay of pharmacologic therapy for obesity. Other terms for these agents include the anorectics or anorexigenics. Appetite suppression is produced by direct stimulant effect on the satiety center of the hypothalamic and limbic regions. Agents within this category demonstrate various neurotransmitter activity. Diethylpropion and phentermine have activity on adrenergic activity, while mazindol demonstrates activity along both adrenergic and dopaminergic pathways. Patients report a decrease in appetite as well as an increase in energy. The pharmacokinetic profiles of these agents are similar as well. The effects of the agents last approximately 4-6 hours, with an average half-life of 6 hours. The exception is mazindol, with effects lasting between …
[ Continue Reading... ]In the United States, the number of people who are overweight and obese is on the rise. In the U.S., 54.9% (97.1 million) of the adult population is overweight (including those who are obese), with 59.4% (50.2 million) of men being overweight and 50.7% (46.9 million) of women being overweight. In obesity, the statistics are grim, with 39.8 million (22.3%) obese individuals. Obesity is also on the rise in adolescent age groups. From 1988-1994, 11% of children (ages 6-11 years) and 11% of adolescents (ages 12-17 years) were overweight. Between 1991 and 1998, obesity increased in every state in the U.S. across ethnicities, genders, age groups, educational levels, and smoking statuses. …
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