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OBESITY Tips - The Three Canadian Approaches


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SNAP SAMP: (Answers below)

  1. Name five diseases co-morbid to Obesity … other than stroke, hypertension, and cardiovascular disease (at The Review Course you'll learn how to not get tricked by this question! See the tips below)

  2. What is the formula to calculate Body Mass Index?

  3. List TWO pharmacotherapies approved in Canada for Weight Management

  4. In Canada, when can pharmacotherapy be initiated as an adjunct to behavioural interventions for Weight Management?

In Canada, there are currently three approaches to the treatment and management of weight:

  1. Non-pharmaceutical

  2. Pharmaceutical

  3. Surgical

a) Non-Pharmaceutical/Behavioural Interventions:

  • Motivational interviewing and counselling

  • Referrals to available allied health care providers. Without reading on, can you list 3 people you could refer your patient to?

  • (These could include Dietician, Kinesiologist, Physiotherapist, Nurse Educator, Psychologist etc).

  • Supervised exercise programs

  • Commercial weight loss programs

  • Food diaries/journals

  • Mindfulness counselling

All of these should be implemented with close follow-up and frequent check-ins.

b) Pharmaceutical Treatments: Of note, the CTFPHC offers a weak recommendation that practitioners NOT routinely offer pharmacological interventions (orlistat or metformin) aimed at weight loss.

Liraglutide

  • A GLP-1 analogue that is injected once weekly, and works to lower appetite at the level of the hypothalamus, reduce glucagon secretion and stimulate insulin secretion. In combination, these effects lead to a reduction of blood glucose and loss in body weight.

  • If BMI >27 kg/m2, the daily recommended dose is 3.0 mg/day, with a starting dose of 0.6mg/week.

  • Common side effects include lowered appetite and GI symptoms such as nausea, vomiting, diarrhea or constipation.

Orlistat

  • A pancreatic lipase inhibitor that works to decrease GI absorption of fats, which are then excreted through the GI system. This leads to reduced caloric energy intake and in turn weight loss.

  • Recommended dose is 120mg PO TID with meals. If a meal contains no fat, then the dose can be omitted.

  • Common side effects include GI symptoms, and thus is contraindicated in patients with chronic malabsorption syndromes.

c) Surgical Treatments:

In general, providers can consider a referral to a bariatric clinic if BMI >40 kg/m2 or BMI >35 kg/m2 + co-morbid condition. Examples of surgical options:

  • Adjustable gastric Bands

  • Vertical Sleeve Gastrectomy

  • Gastric Bypass / Roux – En – Y

  • Bilipancreative Diversion

SNAP SAMP ANSWERS:

  1. There are numerous conditions and diseases that can be significantly impacted by the presence of Obesity. A few examples are Hypertension, Type 2 Diabetes, Cardiovascular Disease, Stroke, Arthritis, Polycystic Ovarian Syndrome, Sleep Apnea, Post-Operative Complications, Depression, Chronic Pain. EXAM TIP: You DID write “Type 2 diabetes” and not “Diabetes” … right? These details are VITAL – so get in the habit now of being specific in your answers!

  2. Body Mass Index (BMI) = Weight (kg) / Height (M) 2

  3. The two pharmacotherapies approved in Canada for Weight Management are Liraglutide and Orlistat.

  4. In Canada, pharmaceutical agents can be initiated as an adjunct to behavioural interventions for Weight Management in adult patients:

  5. When BMI >30 kg/m2

  6. When BMI >27 in the the presence of weight-related comorbidity, who have failed a previous management intervention.


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