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Clinician’s Corner: The Pharmacy and Weight Gain

Health benefits occur with just a 5% weight loss; however most patients need to lose a greater percentage. A 5-7% weight loss provides beneficial effects for reduction of heart disease, cholesterol, blood pressure, and diabetes mellitus. More than a 30% weight loss goal usually requires bariatric surgery. A 15% weight loss is considered to be a success.

In one large study patients who lost 5-7% of their body mass showed reduced use of blood pressure medications, statins, and insulin; reduction in urinary incontinence, sleep apnea, and depression; and improvements in quality of life, physical functioning, sexual functioning, and mobility.

Before we blame the fork and spoon, let’s look at some other potential causes of weight gain in the pharmacy.

It’s my meds causing weight gain!

  • Valproic acid: Depakene/Depakote
  • Mirtazapine (Remeron)
  • Paroxetine (Paxil)
  • Amitriptyline (Elavil)
  • Prednisone
  • Insulin and sulfonylureas
  • Depo-Medroxyprogesterone
  • All first generation antipsychotics (Thorazine, Stelazine, Haldol, etc)

Here is a breakdown of the second-generation antipsychotics:

HIGHEST WEIGHT GAIN

  • Clozapine (Clozaril®)
  • Olanzapine (Zypexa®)

LOWEST WEIGHT GAIN

  • Ziprasidone (Geodon®)
  • Aripiprazole (Abilify®)
  • Lurasidone (Latuda®)
  • Paliperidone (Invega®)

It’s my thyroid causing weight gain!

“ITS MY THYROID”  if this is suspected…have the patients physician order a blood test!

  • Most of the extra weight gained in hypothyroid individuals is due to excess accumulation of salt and water.
  • In general, average about 7lb of body weight may be attributable to the thyroid, depending on severity.
  • If weight gain is the only symptom of low thyroid that is present, it is less likely that the weight gain is solely due to the thyroid.

The golden rule is there are roughly 3,500 calories in a pound of fat.  Think of the waist line as an individual checking account. Deposits are in the form of calories consumed and withdrawals in the form of exercise and decreased caloric intake.  If less is added, and more is withdrawn, weight loss occurs.

  • Lower calorie intake by 500 kcal per day (3x 12 oz soda) lose one pound per week.
  • Deduct 500 calories per day by exercise, lose 2 pounds per week.
  • Don’t replace “fat calories” with carbs. Balance is the key to any diet plan.

More weight loss tips for your T2DM patients

  • Adopt a healthy lifestyle
  • Follow “My-Plate” -remember it is a 9-inch plate! (go ahead—measure your dinner plate!)
  • Focus on fruits and vegetables, lean meat, low fat dairy, and whole grains
  • All foods can fit, portion control is key
  • Don’t skip meals
  • Avoiding eating-out—save calories and money too!
  • Rethink-your drink- avoid any drink that has calories. Nothing hydrates better than water.
  • Move more!!
  • Schedule an appointment with your dietician.

Caution: Restaurants ahead!

  • From 2015 to 2016, for the first time in history, Americans spent more money at bars and restaurants ($54.857 billion) than they did on groceries ($52.503 billion).
  • It has been estimated that Americans eat 1/3 of their calories away from home. Huge portions of tasty, mouthwatering foods, full of calories and salt make it impossible for weight loss if patients frequent restaurants more than just on special occasions.