Drug Topics - November 10, 2008 - (Page 43)

CONTINUING EDUCATION TABLE 3 Medications Associated with Weight Gain Diabetes agents Insulin Meglitinides Sulfonylureas Thiazolidinediones Neurologic agents Anticonvulsants Psychiatric agents SSRIs Antipsychotics MAOIs Phenothiazines Miscellaneous Alpha adrenergic blockers Antihistamines Beta blockers Centrally acting agents Hormomes TCA depot injections MAOI = Monoamine oxidase inhibitors SSRI = selective serotonin reuptake inhibitor TCA = tricyclic antidperessant Adapted from: Malone M, Annals of Pharmacotherapy, 2005 are excellent candidates for weight loss. Work, social engagements, and family environments should be conducive to implementation of weight-loss strategies. For patients not ready to commit to weight loss, the prevention of further weight gain and exploration of barriers or myths can be initiated, in the hope of moving the patient to a state of readiness. One key area to target for patient education is the habit of mindless eating. Mindless eaters tend to fall into these categories: eating too much at meals, grazing throughout the day, overeating at restaurants or special occasions, and eating during work or when driving. An extra 100 calories consumed daily during mindless eating will contribute to a 10-lb weight gain in one year. Pharmacists can use their unique position in the community to educate patients on modifying portion sizes. A variety of tools exist online to which patients can be directed (see Online Resources). The American College of Sports Medicine and the American Heart Association released an update on physical activity guidelines in 2007.10 The basic recommendations for healthy adults under age 65 who aim to maintain health and reduce their risk of chronic disease are: moderate intense aerobic activity 30 minutes a day, ﬁve days a week, or vigorous intense activity 20 minutes a day, three days a week; plus 8 to 10 strength-training exercises, at 8 to 12 repetitions each, twice a week. An initial activity goal for patients wanting to achieve weight loss should be 20 to 40 minutes, 3 to 5 days of the week, and patients may build up to continuous activity. Short bouts of activity have been shown to result in cardiovascular beneﬁt and weight loss. The level of intensity or duration of activity should be increased as the level of ﬁtness improves and weight is reduced, with an optimal goal of 60 minutes of aerobic activity daily and 60 to 90 minutes of aerobic activity for weight maintenance. Some helpful tips pharmacists can share with patients include: setting a schedule, changing activities and intensities, exercising in W W W.D R U GTO P I C S .C O M short bouts, and encouraging family involvement.10-11 Weight maintenance is deﬁned by the NHLBI guidelines as a gain of less than 3 kg over 24 months or a sustained reduction in waist circumference of 4 cm.5 The National Weight Control Registry database includes information from more than 4,000 patients who have kept weight off for at least one year.12 Some common approaches reported are: lifelong modiﬁcation of diet and exercise of 60 to 90 minutes most days of the week, self-monitoring through journaling, behavioral modiﬁcation through support groups, eating breakfast everyday, weighing frequently, and avoiding excessive indulgence in mindless activities such as watching television. The key weight-loss approach is behavioral modiﬁcation.1,5,6 While energy balance through proper diet and exercise are fundamental components in achieving weight loss, behavioral modiﬁcation is also necessary in maintaining healthy weight. A recent systematic review showed that behavioral therapy facilitated weight loss in comparison to placebo (2.5 kg) and facilitated weight loss when added to diet and exercise (5 kg).13 However, changing a patient’s behavioral pattern to decrease calorie consumption and increase energy expenditure may not be an easy task. For patients to achieve sustained behavior modiﬁcation, both self-discipline and social support are important. It is also important to discuss with patients the techniques of self-monitoring, stimulus control, problem-solving, cognitive restructuring, stress management, and social support. These techniques add to the benefits of other forms of weight-loss treatment and should be a part of all weight-loss interventions. Several studies have identiﬁed substantial weight loss in patients who carefully monitor their energy intake.14-15 Patients can be encouraged to use hand-held computer-tracking devices to record food intake at the time of consumption vs. recording intake at the end of the day or week. Stimulus control is necessary to achievement of permanent changes in eating habits. Some ways a patient can take control include using strategies to avoid temptation, such as not going grocery shopping when hungry or reaching for healthy alternatives to high-calorie snacks. It is important to remind patients that building new behavioral strategies and increasing levels of physical activity will take time. Therefore realistic goals are a key component of the achievement of long-lasting lifestyle changes. Patients with a social support system of either family or healthcare providers generally tend to have greater weight loss and less residual weight gain. If and when patients hit a roadblock in achieving their weight-loss goals, clinicians can remind patients that rather than give up, they can use those experiences as stepping stones toward reﬁning their techniques. Complications Sixty-one percent of patients with diabetes are obese.16 In addition, uterine cancer, hypertension, cardiovascular disease N OV. 10, 2008 DRUG TOPICS 43 http://WWW.DRUGTOPICS.COM

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Drug Topics - November 10, 2008 Contents Up Front Up Front in Depth Letters Rx Care Government Community Practice First Responders Clinical Practice Self-Care FDA Safety Page Weighing the Complications of Obesity New Products Viewpoint

Drug Topics - November 10, 2008

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