Pharmacist's Counseling Guide for Obesity Management

Currently in the United States, the incidence of obesity is increasing at an alarming rate. It is estimated that 61% of adults in this country were either overweight or obese in 1999. More than 300,000 obesity-related deaths occur each year in the United States.¹ Obesity is more common among females than males. Childhood obesity continues to increase as well, with approximately 15% of children between the ages of 6 and 19 considered overweight.²

Assessment

Obesity is typically defined as having an exceedingly high quantity of body fat in relation to lean body mass. Ideal body weight is usually determined by a comparison of a person's height and weight. Determining body mass index (BMI) is the traditional method of determining whether a person is considered obese.

An individual is considered overweight if the BMI is 25 to 29.9 and obese if the BMI is 30 or higher. The BMI, however, does not take into account whether the person's weight is fat accumulation or muscle mass, as in the case of some athletes. Another means of determining obesity is through the use of the waist-to-hip ratio. Waist circumferences in females should not exceed 35 inches, and in males they should not exceed 40 inches.³

Etiology

The most common factors contributing to obesity are consumption of excess calories, lack of physical activity, socioeconomic factors, and poor nutrition. Obesity, however, also may be due to physical conditions, disease, or pharmacologic agents, such as those shown below.

Physical Conditions

The following physical conditions and factors contribute to obesity:

• Genetic predetermination
• Polycystic ovary syndrome
• Sedentary lifestyle
• Hypothyroidism
• Cushing's syndrome
• Nutritional habits
• Prader-Willi syndrome

Pharmacologic Agents

The following pharmacologic agents are known to cause weight gain:

• Steroids?testosterone, progesterone, estrogens, and corticosteroids
• Anticonvulsants?valproic acid, carbamazepine
• Psychotropic drugs?lithium
• Monoamine oxidase inhibitors
• Tricyclic antidepressants

Physiologic Complications Due to Obesity

Persons who are obese are more prone to develop a number of possible health risks, including the following:

• Heart disease
• Stroke
• Hypertension
• Coronary artery disease
• Diabetes
• Osteoarthritis
• Sleep apnea
• Gallstones
• Colon cancer
• Depression
• Infertility
• Gout

Types of Diet Plans

Diet plans range from low-calorie plans to meal-replacement plans to popular fad diets. For diets to be effective, they must be tailored to the profile of the individual. Byron Richard, MS, RD, CDE, coordinator of the Tulane University Hospital Center for Diabetes in New Orleans, La, believes that an emphasis on patient education is imperative for successful weight-management programs. Most diets can have immediate and dramatic positive effects (weight loss) with patient compliance and motivation. The key to seeing lasting results is a multi-step approach that includes both nutritional and behavioral modification toward permanent change. Patients must understand from the beginning that maintaining their healthier weight requires new lifelong habits.

A few of the most popular diets are listed in Table 1. Whereas no studies have proven that any one of these diets is more effective than another, all have exhibited some success within the patient population. Molly Kimball, registered dietitian at Elmwood Fitness Center in New Orleans, has stated that, on the whole, all diets (such as the Atkins and Sugar Busters diets) can offer beneficial results because they regulate the patient's intake of carbohydrates and refined sugars. These diets do have limitations, however, and sometimes they may not be effective, depending on the patient's level of physical activity and medical history. Effective weight management often requires individualized nutrition plans. The true benefits of dieting can be attained only when permanent changes are made in a patient's eating habits and those changes are consistent.

Low-Calorie Diets

Low-calorie diets emphasize portion control. Generally, these diets restrict caloric intake to approximately 1500 calories per day. A reduction in 500 to 1000 calories per day may result in a weight loss of 1 to 2 pounds per week in some cases.

Meal-Replacement Plans

These plans also are an attempt to regulate the number of calories consumed. Patients replace regular meals and snacks with low-calorie drinks or some prepackaged foods.

Lifestyle Change Tips

Tips for successful weight loss include the following:

• Decrease caloric intake
• Increase physical activity by attempting a routine exercise program
• Consult with a dietitian or nutritionist for a personalized nutrition plan
• Change eating behavior and establish a willingness to lose the weight

When Dieting Fails

For severe obesity, there are other treatment options, including the use of pharmacologic agents specifically designed for weight loss. It is important to note that these agents must be used in conjunction with a weight-management program. Currently, 3 agents are approved by the FDA for weight loss (Table 2).

Gastric bypass surgery is another option for severely obese patients with a BMI of 40 or more. Most gastric bypass patients lose 50% of their extra weight. This surgery can be performed via laparoscopic techniques.

The Role of the Pharmacist

Pharmacists can be an essential resource for obese patients attempting to manage their weight. They can monitor patient medication profiles to detect those prescribed agents that may have the potential for weight gain, and they can provide information about proper weight-loss programs. Pharmacists can encourage patients to utilize long-term weight-management goals rather than just some of the quick-fix OTC products. Pharmacists should stress to their patients that even a moderate amount of weight loss, can be beneficial.

Ms. Terrie is a clinical pharmacy writer based in Slidell, La.

For a list of references, send a stamped, self-addressed envelope to: References Department, Attn. A. Stahl, Pharmacy Times, 241 Forsgate Drive, Jamesburg, NJ 08831; or send an e-mail request to: astahl@mwc.com.