Jessica P.
Age 31
Height 5'6"
Weight 180 lbs
Lipid Profile:
HDL 40 mg/dL
LDL 165 mg/dL
TG 175 mg/dL
TC 240 mg/dL
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Dyslipidemia and Overweight, BMI 29
Profile and History:
Jessica P. is a 31-year-old homemaker with four children.
- During the complete physical that you performed at her first appointment, she said she has been overweight since having had her first child and does not like the way she feels or looks.
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Diagnosis and Identification:
- She is 5'6" and weighs 180 lbs. Her BMI is 29 and she appears to carry her excess weight around her waist.
- When the blood work came back, your concerns about her weight and its potential impact on her health were confirmed. Her HDL was 40 mg/dL, while her LDL was 165 mg/dL. Her total cholesterol was 240 mg/dL and her triglycerides were 175 mg/dL.
- Despite this lipid profile, lipid-lowering drugs are not prescribed initially. Instead, recommend weight loss and a low-fat diet with increased exercise to improve her dyslipidemia profile and reduce her cardiovascular risk.
More on identifying patients at risk
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Counseling:
- During the office consultation, Jessica shares your concern and seems motivated to give your plan a try. She tells you, though, that she has tried many diets during her adult years and that she can't seem to stick with them. She thinks it's because she doesn't really see any weight loss in the first few months.
- She also has some concerns about how much she can increase her exercise. The kids keep her very busy, but she finds herself spending more and more time driving them from activity to activity.
- You counsel her that as opposed to diet alone, using XENICAL may help her lose more weight which could also help improve her lipid profile.
More on counseling your patient
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Treatment:
- Treatment goals for Jessica include weight loss, improved lipid profile and reduced cardiovascular risk.
- An 1800-calorie diet containing no more than 30% of calories from fat.
- A prescription for XENICAL to be taken up to 3 times a day with meals containing fat.
- A recommendation of walking the track at the center where her children take after-school classes is a simple and practical approach to increasing her activity.
- You ask her to return every month to be weighed and to have a lipid profile repeated the day before she comes in for her 3 month visit.
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Follow-Up:
Jessica returned to your office and had another blood lipid profile done after 3 months on the plan. She lost 10 pounds and her BMI was down to 27. She tells you that the visits helped her make sure she was sticking to her plan. When you tell her what her LDL cholesterol level is, which was reduced to 155 mL/dL, she can see the good effects of her efforts.
More on follow-up care
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Outcomes:
Population with Abnormal (Untreated) Risk Factors at Randomization
Weight Loss with XENICAL Plus Diet: Improved Lipid Levels
- The changes from randomization following 1-year treatment in the population with abnormal lipid levels (LDL >130 mg/dL, LDL/HDL >3.5, HDL <35 mg/dL) were greater for patients on XENICAL plus diet compared to patients on placebo plus diet with respect to LDL cholesterol (-7.83% vs. +1.14%) and the LDL/HDL ratio (-0.64 vs. 0.46). HDL cholesterol increased in the placebo group by 20.1% and in the XENICAL group by 18.8%.
Population as a Whole
XENICAL Plus Diet: Successful Weight Loss
In clinical trials involving 1064 patients, 69% on XENICAL plus diet lost 3% or more of initial body weight within 3 months, with a mean loss of 13 lbs.18
In clinical trials, the overall mean weight loss from randomization to the end of 1 year in the intent-to-treat population was 13.4 lbs in patients treated with XENICAL plus diet versus 5.8 lbs in placebo-treated patients.
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The long-term effects of XENICAL on morbidity and mortality associated with obesity have not been established.
The patient depicted here is fictitious and is intended to illustrate an obesity-related comorbidity for which a treatment regimen including XENICAL plus a reduced-calorie diet is appropriate.
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