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Junior - endo II > 7 - Obesity > Flashcards

7 - Obesity Flashcards

1
Q

How many US people are obese?

A
  1. 8% adults

18. 5% kids

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2
Q

How many US adults are overweight?

A

69%

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3
Q

How to calculate BMI?

A

True: Weight in kg/height = kg/m2

Approximate: weight/height x 704
= lbs/in2 x 704

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4
Q

Why do we use BMI calculations?

A

They are easy for researchers to use them b/c you dont need much info to look for correlation with disease processes

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5
Q

Why is BMI ultimately useless?

A

It misclassify’s 25% of people (athletes, old, frail)

Doesnt look at location of body fat

Cant tell fat from lean body mass

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6
Q

Does fat location matter?

A

Yes

Upper body obesity is worse than lower body

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7
Q

Types of abdominal fat?

A

Visceral fat: w/in abdominal cavity

Subcutaneous fat: outside the cavity

Visceral fat is much worse

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8
Q

Health consequences of obesity? (List)

A

Increased risk for:

  • HTN
  • DM2
  • hyperlipidemia
  • metabolic syndrome
  • CAD
  • DJD Degenerative joint disease
  • psychological disability
  • depression
  • thromboembolic disorders
  • gallbladder disease
  • surgical and OB risks
  • sleep apnea
  • cancer (colon, ovary, breast)
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9
Q

What % of body fat is too low?

A

Females require 13-17%
- amenorrhea, osteoporosis
Males require 3%
- chronic fatigue, illness

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10
Q

What is one major problem with the calorie counting method from a patient perspective?

A

Obese patients underestimate their caloric intake by 30-40%

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11
Q

What role do genes play in obesity?

A

Partially responsible for weight (40-70%)

Adoptees weight mirrors biological parents

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12
Q

What is prader-willi syndrome?

A

Most common genetic cause of marked obesity

Diagnosis made by genetic testing

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13
Q

What symptoms are associated with prader-willi syndrome?

A 
Infantile hypotonia
Feeding difficulties  early
>2yrs - hyperphagia and wt gain
Developmental delay
Hypogonadism
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14
Q

Prader-willi syndrome symptoms later in life?

A

Short stature
Sleep disturbance (OSA)
Morbid obesity

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15
Q

What should be in the Hx for an obesity workup ?

A 
Fam hx
Age of onset (obesity)
Occupational hx
Wt loss attempts
Behavioral (eating/exercising)
Tobacco/ETHO
Psychosocial factors (depression/eating disorders/abuse)
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16
Q

Obesity workup PE?

A

BMI
Degree and distribution of body fat
Nutritional status
Signs of secondary causes

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17
Q

What % of obese pts are obese because of a secondary cause?

A

< 1%

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18
Q

What are 2 secondary causes of obesity?

A

Hypothyroidism

Cushing syndrome

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19
Q

How do we screen for metabolic syndrome?

A 
BP (HTN)
Waist circumference (>40 men // >35 women)
Fasting glucose (> 100)
HDL (<40 men // <50 women)
Trigs (>150)
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20
Q

How effective are conventional diet techniques?

A

20% will loose 20lbs and maintain x 2 yrs
5% will loose 40lbs
Average 7% of baseline

21
Q

What aspects of provider patient interaction are crucial to wt loss?

A

Close provider-patient contact is more important than what program is used

Active tx programs are only successful for motivated pts (you can lead a horse to water..)

22
Q

What is the key element to MAJ Trimbles simplified approach to obesity tx?

A

Behavior modification is key

Diet + exercise = greatest
Diet = moderate
Exercise = small
No tx = nothing (hmmm)

23
Q

What are some key elements of behavior modification?

A 
Long term changes
Planning and record keeping
Eating cues (remember were dealing with addiction)
Achievable goals
Refer to dietician
Exercise program 
Pt accountability (addiction)
Follow up goals

SSRI’s???

24
Q

What element does exercise target?

A

Increasing BEE: basal energy expenditure

25
Q

Definition of very low calory diet?

A

800-1000 kcal/day

Usually x 4-6 months

Average max wt loss - 15%

26
Q

Who is a candidate for obesity medications?

A

Part of a COMPREHENSIVE weight-loss program for:
- BMI >30
- BMI >27 with obesity related risk factors
(HTN, DM2, CVD)

27
Q

When should you consider obesity medication?

A

If there has been little or no progress after AGGRESSIVE attempts to lose excess wt and pt meets BMI requirements

28
Q

Medication types? (List)

A

GI agents (orlistat)
CNS stimulants/anorexants
Antidepressants/opioid antagonist
GLP-1 agonist

29
Q

What is orlistat (xenical, alli)

A

Gi agent

Inhibits intestinal lipase and reduces dietary fat abosrption

30
Q

Side effects of orlistat?

A

oily stools, diarrhea, fecal incontinence, reduced fat soluble vitamins

31
Q

What is lorcaserin (belviq)

A 
CNS stimulant class of drugs
It is a selective seritonin receptor agonist that promotes satiety
- modest wt loss (>5%)
32
Q

SE of lorcaserin?

A

Breast tumors (animals)
Hypoglycemia (DM)
HA

33
Q

What are phentermine (addipex-P) and phentermine/topiramate (qsymia)

A

Increases reuptake of norepi and dopamine to suppress appetite

34
Q

SE of phentermine and phertermine/topiramate

A

Mood changes,
fatigue
insomnia
CVD (elderly)

CE: hyperthyroidism, glaucoma

35
Q

What is a common problem/concern with the CNS stimulant/anorexant drugs?

A

They are schedule IV

Abuse potential

36
Q

What is bupopion and naltrexone (contrave)?

A

Antidepressant/opioid agonist

Regulates activity in dopamine reward system: controls cravings

37
Q

SE of buproprion and naltrexone (contrave)?

A

GI upset

Caution w psych hx

38
Q

What is Liraglutide (saxenda/victoza)?

A

GLP-1 agonist

Increases glucose depletion insulin secreion, decreases inappropriate glucagon, slows gastric emptying

39
Q

SE of lipraglutide?

A

Tachycardia
HA
Hypoglycemia
Nausae

40
Q

When are weight loss drugs generally contraindicated?

A 
Uncontrolled CVD
Pregnancy/lactation
Psych hx
<18 yrs old
MAOIs
41
Q

Who is a candidate for bariatric surgery?

A

BMI>40 or BMI >35 with comorbidities

42
Q

How does the Roux-en-Y gastic bypass (RYGB) work?

A

Combination restrictive and malabsorptive surgery

Distal stomach is resected

Gastric puch is anastomosed to retro-colic roux-en-Y segment of jejunum

The stomach is cut into 2 pieces and the jejunum is sewn to the top part leaving the pt with a 30-50ml stomach capacity

43
Q

What does the roux-en-Y procedure do with the rest of your stomach?

A

It is sewn to the duodenum so that it will continue to secrete stomach juices to aid in digestion

44
Q

What is a vertical banded gastroplasy (VGB)?

A

The “lap band”

A prostetic band (collar) is put on the stomach to effectively restrict the size of gastric outlet

There is a port on the skin that can manipulate the constriction
- think nike pumps

45
Q

What is a sleeve gastrecomy (SG)

A

“Stomach stapling”
Creation of a “sleeve” stomach over a bougie, removing a large portion of the greater curvature

Decreases ghrelin level for up to 1 yr

46
Q

Pro’s of bariatric surgery?

A

Laproscopic
They work: Wt loss 40-75%
Low mortality: 0-2.5%

47
Q

Complications of bariatric surgery?

A 
Up to 40% of pts: 
Peptic ulceration: 1-11%
Outlet stenosis: 3.5-22%
Leakage and sepsis: 0-2.5%
Staple disruption: 1.6-48%
Surgical revision: 17-45%
Wound problems/thromboembolism
Abdominal wall hernias
Gallstones
“Dumping syndrome” 
Pulmonary edema
48
Q

What is dumping syndrome?

A

Rapid gastric emptying

Cramping and diarrhea 10-30 min post eating

49
Q

What is the best side of the house to put the porch on?

A

The outside

Junior - endo II (7 decks)

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