Pharmacology · chapter 32 · Weight Management Drugs
Introduction to Weight Management
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.
Key points
Two ways fat tissue grows
Hyperplasia of adipose tissue is an increase in the number of fat cells in the body. Hypertrophy is an increase in the size of fat cells.
Factors besides diet
In addition to diet, there are other factors that can increase the likelihood of a person developing obesity, including genetics, lack of sleep, decreased or restricted physical activity, certain medications, and stress.
Harms of weight discrimination
Weight discrimination often leads to adverse health consequences such as binge eating, psychological and physiological stress, weight gain, and avoidance of participating in healthy behaviors and provider follow-up (Lee et al., 2021).
Use person-first language
Using person-first terms such as “person with obesity” instead of “obese person” is recommended for health care professionals. The first term identifies the client as having a condition rather than defining the person as obese.
Most and least stigmatizing words
The terms “morbidly obese,” “fat,” and “obese” have been found to be the most stigmatizing, whereas “weight problem,” “unhealthy weight,” and “high BMI” have been found to be the most motivating and least offensive language options for discussing weight with clients (American College of Obstetricians and Gynecologists, 2019).
Lifestyle before drugs or surgery
Nonpharmacological modalities such as meal planning and increased physical activity are encouraged before moving on to weight-loss drugs and bariatric procedures or surgeries.
WHO cut-offs for overweight and obesity
For adults, the World Health Organization (WHO) defines overweight as a BMI greater than or equal to 25 and obesity as a BMI greater than or equal to 30 (WHO, 2021).
BMI in athletes
These parameters may not apply to athletes, body builders, or people who exercise a lot because a BMI may be higher in athletes due to their increased muscle mass.
BMI is not the only measure
Furthermore, the American Medical Association indicates that BMI should not be used as a sole determinant of health and risk.
Obesity and type 2 diabetes
Obesity raises the incidence of developing type 2 diabetes 7–12 times that of a person of a healthy weight (Cleveland Clinic, 2022).
Refer to a dietitian
As metabolic syndrome may be prevented with client education on nutrition and meal planning, it is recommended that providers consider referring clients to a registered dietician for individual meal planning education.
Strain on the respiratory system
Excess body fat also puts additional strain on the respiratory system, contributing to obesity hypoventilation syndrome, sleep apnea, and asthma.
Sleep and weight
Poor sleep is associated with glucose intolerance and insulin resistance. Additionally, sleep deprivation affects metabolic rates, hormones that regulate metabolism, and even eating habits (Papatriantafyllou et al., 2022).
When weight-loss drugs are considered
If a reduction in caloric intake and increasing physical activity is ineffective after 12 months, drugs such as anorexiants, lipase inhibitors, and herbal supplements may be used to aid in weight loss.
Terms to know
- food desert
- People struggling with finances or living in a food desert (an area where people have extremely limited access to healthy, affordable food) often buy low-cost, high-sugar, high-sodium, and high-fat foods that are cheaper than healthy food choices.
- Obesity stigma
- Obesity stigma is characterized by prejudice, stereotyping, and discriminating bias and actions toward people with obesity, often fueled by inaccurate ideas about the causes of obesity (Westbury et al., 2013).
- Metabolism
- Metabolism is the body’s process of converting calories into energy for optimal functioning.
- metabolic syndrome
- These risk factors are often grouped together in a condition called metabolic syndrome, which is a collection of risk factors, including overweight and obesity, that drastically increases the chance of a person developing hypertension, diabetes, heart disease, and stroke.
- BMR
- The foundational physiological factor in weight management is the BMR, which is the amount of energy required to sustain the essential body functions of life.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
The graded version needs JavaScript. Every question is below anyway, with the answer and why.
Every question here, with the answer
A nurse is documenting the assessment of a client with a BMI of 36. Which phrase follows recommended practice?
- Morbidly obese client
- Obese person
- Noncompliant fat client
- Person with obesity
Answer: Person with obesity
Person-first terms such as person with obesity identify a condition rather than defining the person. Morbidly obese, obese and fat are the most stigmatizing terms, and labelling clients noncompliant furthers weight stigma.
A client's BMI is 27. How does the nurse classify this using the WHO definitions?
- Class III obesity
- Healthy weight
- Overweight
- Obesity
Answer: Overweight
WHO defines overweight as a BMI of 25 or more and obesity as 30 or more, so 27 is overweight. Healthy weight ends below 25, and Class III obesity is 40 or more.
A client with obesity asks for a weight-loss pill at the first visit. According to the section, what should come first?
- Meal planning and increased physical activity
- A lipase inhibitor
- Bariatric surgery
- An anorexiant drug
Answer: Meal planning and increased physical activity
Nonpharmacological measures such as meal planning and increased physical activity are encouraged before weight-loss drugs or bariatric procedures. Drugs may be added if these are ineffective after 12 months.
When discussing weight with a client, which terms are the least offensive and most motivating? Select all that apply.
- Morbidly obese
- Fat
- Weight problem
- Unhealthy weight
- High BMI
Answer: Weight problem, Unhealthy weight, High BMI
Weight problem, unhealthy weight and high BMI were found to be the most motivating and least offensive options. Fat and morbidly obese are among the most stigmatizing terms.
The nurse is teaching a client about health problems linked to obesity. Which conditions should be included? Select all that apply.
- Osteoarthritis
- Nonalcoholic fatty liver disease
- Hypothyroidism caused by BMI alone
- Type 2 diabetes
- Sleep apnea
Answer: Osteoarthritis, Nonalcoholic fatty liver disease, Type 2 diabetes, Sleep apnea
The section links obesity to type 2 diabetes, sleep apnea and obesity hypoventilation syndrome, osteoarthritis and low back pain, and fatty liver disease. It does not say BMI alone causes hypothyroidism.
A muscular athlete has a BMI of 29 and asks if this means they are overweight. What is the nurse's best response?
- BMI does not apply to adults.
- You need to start a weight-loss drug.
- BMI may be higher in athletes because of muscle mass, and it should not be the only measure of health.
- Yes, BMI is the single best measure of health.
Answer: BMI may be higher in athletes because of muscle mass, and it should not be the only measure of health.
BMI parameters may not apply to athletes because increased muscle mass raises BMI, and BMI should not be the sole determinant of health and risk. It is not a reason by itself to start drugs.
Where every quote comes from
Section 32.1 Introduction to Weight Management of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.