Obesity

 


Obesity is a disease process which has reached epidemic proportions in the United States and impacts millions of adults around the world.  The causes of obesity are complex and include an interplay between genetics, environment, psychologic factors and chronic diseases.  As such, we must look at obesity as a chronic disease and consider management with a variety of modalities including lifestyle, medications and possible surgical approaches based upon the patient’s health needs and goals. 
The use of medications in the management of obesity has continued to grow and develop.  We commonly see patients utilize lipase inhibitors, glucagon-like peptide-1 receptor agonists and other combination medications to manage their obesity and in an attempt to lower weight and improve health under the supervision of their healthcare provider.
1. For this assignment, create a table that summarizes the following anti-obesity medications that you can save and utilize later in practice:
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o Orlistat
o Semaglutide
o Phentermine/Topiramate
o Naltrexone/Bupropion

2. For each of the medications provided above include a summary of the following information in your table:
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o Mechanism of Action
o Indications for use
o Contraindications for use
o Potential Side Effects
o Expected weight loss
o Estimated cost of medication
o A minimum of two supporting references
Requirements
• Prepare and submit a table in MS Word or PDF format for this assignment.
• Utilize a minimum of two references to support the information summarized in your table.
• Include a cover page consistent with APA format and a reference page with full citations for each source.
• Address all the prompts for each of the four medications listed above.
• Please review the rubric to ensure that your assignment meets the criteria.

 

Medication (Brand Names)Mechanism of Action (MOA)Indications for UseContraindicationsPotential Side EffectsExpected Weight Loss (% of initial body weight)Estimated Cost (Monthly, Uninsured/List)
Orlistat (Xenical, Alli)Lipase Inhibitor. Selectively inhibits pancreatic and gastric lipases, blocking the hydrolysis of triglycerides and thus preventing the absorption of about 30% of dietary fat.BMI $\ge 30\text{ kg/m}^2$ OR BMI $\ge 27\text{ kg/m}^2$ with at least one weight-related comorbidity (e.g., hypertension, dyslipidemia).Chronic malabsorption syndrome, cholestasis, pregnancy.Gastrointestinal: Oily spotting, flatulence with discharge, fecal urgency, steatorrhea.5% to 10% (Compared to placebo over 1 year) (Apovian et al., 2021)$150 - $300
Semaglutide (Wegovy, Ozempic)Glucagon-like Peptide-1 (GLP-1) Receptor Agonist. Mimics the natural GLP-1 hormone, slowing gastric emptying, increasing insulin secretion, and reducing appetite/satiety centers in the brain.BMI $\ge 30\text{ kg/m}^2$ OR BMI $\ge 27\text{ kg/m}^2$ with at least one weight-related comorbidity (e.g., hypertension, T2DM).Personal or family history of Medullary Thyroid Carcinoma (MTC), Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), history of severe hypersensitivity.Gastrointestinal: Nausea (most common), vomiting, diarrhea, constipation. Risk of pancreatitis.15% to 17% (Seen in clinical trials over 68 weeks with the highest dose of Wegovy) (Wilding et al., 2021)$1,300 - $1,700
Phentermine/Topiramate ER (Qsymia)Combination Agent. Phentermine is a sympathomimetic amine (stimulant) that suppresses appetite. Topiramate is an anticonvulsant that enhances satiety and reduces food cravings.BMI $\ge 30\text{ kg/m}^2$ OR BMI $\ge 27\text{ kg/m}^2$ with at least one weight-related comorbidity.Glaucoma, hyperthyroidism, MAOI use (within 14 days), pregnancy (Category X—teratogenic risk).Central Nervous System: Paresthesia ("pins and needles"), insomnia, dizziness, dry mouth, cognitive impairment ("fogginess"), increased heart rate/blood pressure.10% to 11% (Compared to placebo over 1 year with higher doses) (Apovian et al., 2021)$200 - $300 (Generic available)
Naltrexone/Bupropion ER (Contrave)Combination Agent. Bupropion (atypical antidepressant) targets appetite centers in the hypothalamus. Naltrexone (opioid antagonist) blocks the negative feedback loop in the brain's reward pathways, reducing cravings and promoting satiety.BMI $\ge 30\text{ kg/m}^2$ OR BMI $\ge 27\text{ kg/m}^2$ with at least one weight-related comorbidity.Uncontrolled hypertension, seizure disorder, use of other bupropion products, chronic opioid use, abrupt discontinuation of alcohol or sedatives.Gastrointestinal: Nausea (most common), constipation, headache, dizziness, dry mouth. Increased risk of suicidal thoughts.5% to 9% (Compared to placebo over 1 year) (Apovian et al., 2021)$200 - $350 (Generic available)

 

Supporting References

 

Apovian, C. M., Aronne, L. J., Burns, C., & Kim, E. L. (2021). Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 106(11), e3451–e3477. doi:10.1210/clinem/dgab482

Wilding, J. P. H., Batterham, R. L., Calanna, B., van Gaal, M. A., et al. (2021). Once-Weekly Semaglutide in Adults with Overweight or Obesity. The New England Journal of Medicine, 384(11), 989-1002. doi:10.1056/NEJMoa2032183

Sample Answer

 

 

 

 

 

Summary of Key Anti-Obesity Medications

 

This table summarizes four major anti-obesity medications, detailing their mechanism of action, indications, contraindications, side effects, and expected efficacy based on current evidence.