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ADA 23 > 8. Obesity and Weight Management 23 > Flashcards

8. Obesity and Weight Management 23 Flashcards

1
Q

According to the article, why should surgery be postponed in individuals with certain conditions?

A

Alcohol or substance use disorders, severe depression, suicidal ideation, or other significant mental health conditions.

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2
Q

What are some potential mental health outcomes associated with obesity?

A

Some potential mental health outcomes associated with obesity include worsening or new-onset depression, anxiety disorders, and suicidal ideation.

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3
Q

What is the potential risk associated with metabolic surgery?

A

People who undergo metabolic surgery may be at increased risk for substance abuse.

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4
Q

What are the components of initial management for PBH?

A

The components of initial management for obesity include education, reduced intake of rapidly digested carbohydrates, adequate intake of protein and healthy fats, and vitamin/nutrient supplements.

-nutrition therapy with a dietitian experienced in PBH
-CGM
MEDS: is primarily aimed at slowing carbohydrate absorption (e.g., acarbose) or reducing glucagon-like peptide 1 and insulin secretion (e.g., diazoxide, octreotide)

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5
Q

When does dumping syndrome typically occur?

A

Dumping syndrome often occurs soon after surgery and improves over time.

عكس PBH

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6
Q

When does the post-bariatric hypoglycemia (PBH) typically present?

A

PBH typically presents more than one year post-surgery.

DX: BY HX AND BGM

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7
Q

AS A RESULT OF PBH When does overstimulation of insulin release and a sharp drop in plasma glucose commonly occur after a high-carbohydrate meal?

A

Most commonly, overstimulation of insulin release and a sharp drop in plasma glucose occur 1-3 hours after a high-carbohydrate meal.

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8
Q

When does overstimulation of insulin release and a sharp drop in plasma glucose occur?

A

Overstimulation of insulin release and a sharp drop in plasma glucose occur most commonly 1–3 h after a high-carbohydrate meal.

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9
Q

HOW PBH HAPPENING?

A

Altered gastric emptying, rapid intestinal glucose absorption, excessive postprandial secretion of glucagon-like peptide 1 and other gastrointestinal peptides.

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10
Q

What is one of the effects of altered gastric emptying in PBH?

A

Rapid intestinal glucose absorption.

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11
Q

Which gastrointestinal procedures can lead to postbariatric hypoglycemia (PBH)?

A

RYGB, VSG, and other gastrointestinal procedures.

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12
Q

When does dumping syndrome usually occur?

A

Dumping syndrome usually occurs shortly (10–30 min) after a meal.

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13
Q

What are some common symptoms of dumping syndrome?

A

Some common symptoms of dumping syndrome include diarrhea, nausea, vomiting, palpitations, and fatigue.

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14
Q

HOW LONG TO CHECK MICRINUTRIENT VITAMIN POST OP BARIATRIC SURGERY?

A

The content recommends routine monitoring of micronutrient and nutritional status and lifelong vitamin/nutritional supplementation.

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15
Q

What are some longer-term risks associated with POST OP BARIATRIC SURGERY?

A

Some longer-term risks of obesity and weight management include vitamin and mineral deficiencies, anemia, osteoporosis, dumping syndrome, and severe hypoglycemia.

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16
Q

What is an important factor in determining mortality, complications, reoperations, and readmissions? IN BARIATRIC SURGERY

A

Proficiency of the operating surgeon and surgical team.

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17
Q

What is the approximate percentage of patients experiencing minor complications and requiring operative reintervention according to the article?

A

Up to 15%

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18
Q

What is the percentage range of major complications occurring in those undergoing metabolic surgery?

A

2-6%

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19
Q

What are the typical perioperative mortality rates?

A

The typical perioperative mortality rates are 0.1–0.5%.

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20
Q

What is the potential role of metabolic surgery in individuals with type 1 diabetes?

A

Surgery has been shown to improve the metabolic profiles of people with type 1 diabetes.
larger and longer-term studies are needed

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21
Q

What are some factors associated with higher rates of diabetes remission in presurgical patients?

A

Younger age, shorter duration of diabetes (<8 years), and lesser severity of diabetes (better glycemic control, nonuse of insulin)

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22
Q

For how long do the majority of people who undergo surgery maintain substantial improvement of glycemia?

A

The majority of people who undergo surgery maintain substantial improvement of glycemia for at least 5-15 years.

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23
Q

What is the median disease-free period following RYGB?

A

The median disease-free period following RYGB is 8.3 years.

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24
Q

What percentage of patients who initially achieve remission of diabetes eventually experience recurrence?

A

35-50% of patients who initially achieve remission of diabetes eventually experience recurrence.

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25
Q

In the STAMPEDE trial, what percent of participants treated with RYGB achieved A1C of 6.0% or lower after 5 years?

A

RYGB 29%……
VSG 23%

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26
Q

What was the type of surgery performed on participants in the STAMPEDE trial?

A

Metabolic surgery

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27
Q

What percentage of patients with RYGB experience diabetes remission after 1–5 years?

A

30–63% of patients with RYGB experience diabetes remission after 1–5 years.

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28
Q

What percentage of the stomach is removed in Vertical Sleeve Gastrectomy (VSG)?

A

Approximately 80% of the stomach is removed in VSG.

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29
Q

What is the size of the stomach pouch created in Roux-en-Y Gastric Bypass (RYGB)?

A

The stomach pouch created in RYGB is roughly the size of a walnut.
thereby bypassing the duodenum and jejunum

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30
Q

What is the effect of metabolic surgery on the incidence of microvascular disease?

A

Metabolic surgery reduces the incidence of microvascular disease.

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31
Q

What are some benefits of metabolic surgery?

A

Metabolic surgery reduces the incidence of microvascular disease, improves quality of life, decreases cancer risk, and improves cardiovascular disease risk factors and long-term cardiovascular events.

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32
Q

What does metabolic surgery achieve in regards to glycemic control and cardiovascular risk?

A

Metabolic surgery achieves superior glycemic control and reduction of cardiovascular risk.

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33
Q

Why should people who undergo metabolic surgery be evaluated for ongoing mental health services?

A

People who undergo metabolic surgery should be evaluated for ongoing mental health services to help with the adjustment to medical and psychosocial changes after surgery.

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34
Q

What is the purpose of evaluating people who undergo metabolic surgery for ongoing mental health services?

A

The purpose of evaluating people who undergo metabolic surgery for ongoing mental health services is to assist them with the adjustment to medical and psychosocial changes after surgery.

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35
Q

What is the recommended management for postbariatric hypoglycemia?

A

The recommended management includes education, medical nutrition therapy with a dietitian experienced in postbariatric hypoglycemia, and medication treatment, as needed.

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36
Q

What is the importance of continuous glucose monitoring in postbariatric hypoglycemia management?

A

Continuous glucose monitoring is important to improve safety by alerting individuals to hypoglycemia, especially for those with severe hypoglycemia or hypoglycemia unawareness.

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37
Q

What kind of monitoring should be done for people who undergo metabolic surgery?

A

Routine micronutrient, nutritional, and metabolic status monitoring should be done for people who undergo metabolic surgery.

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38
Q

What should be evaluated in people being considered for metabolic surgery?

A

Comorbid psychological conditions and social and situational circumstances that have the potential to interfere with surgery outcomes should be evaluated.

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39
Q

According to the article, where should metabolic surgery be performed?

A

Metabolic surgery should be performed in high-volume centers with multidisciplinary teams knowledgeable about and experienced in managing obesity, diabetes, and gastrointestinal surgery.

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40
Q

What kind of teams should be knowledgeable and experienced in managing obesity, diabetes, and gastrointestinal surgery?

A

Multidisciplinary teams should be knowledgeable and experienced in managing obesity, diabetes, and gastrointestinal surgery.

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41
Q

Who is metabolic surgery recommended for?

A

Metabolic surgery may be considered as an option to treat type 2 diabetes in adults with BMI 30.0–34.9 kg/m2 (27.5–32.4 kg/m2 in Asian American individuals) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.

42
Q

What are the criteria for recommending metabolic surgery to treat type 2 diabetes?

A

Metabolic surgery should be recommended to treat type 2 diabetes in screened surgical candidates with BMI ≥40 kg/m2 (BMI ≥37.5 kg/m2 in Asian American individuals) and in adults with BMI 35.0–39.9 kg/m2 (32.5–37.4 kg/m2 in Asian American individuals) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.

43
Q

What comorbidity should be improved with nonsurgical methods before considering metabolic surgery to treat type 2 diabetes?

A

Before considering metabolic surgery to treat type 2 diabetes, durable weight loss and improvement in comorbidities, including hyperglycemia, should be achieved with nonsurgical methods.

44
Q

How does the oral hydrogel (Plenity) work?

A

The oral hydrogel (Plenity) expands in the stomach and fills a portion of the stomach volume to decrease food intake during meals.

45
Q

What is the average weight loss for participants using the oral hydrogel (Plenity) compared to a placebo?

A

The average weight loss for participants using the oral hydrogel (Plenity) is 2-3% greater than the placebo.

46
Q

Which subgroup of participants showed improved weight loss outcomes with the oral hydrogel (Plenity)?

A

The subgroup of participants with prediabetes or diabetes at baseline showed improved weight loss outcomes with the oral hydrogel (Plenity).
(8.1% weight loss)

47
Q

What has happened to the popularity of gastric banding devices since 2015?

A

Gastric banding devices have fallen out of favor in recent years.

48
Q

What is the recommendation when early use of a medication for weight loss is ineffective?

A

It is recommended to discontinue the medication and consider other treatment options.

49
Q

How much weight loss is considered ineffective after 3 months’ use of a medication?

A

Typically, less than 5% weight loss is considered ineffective after 3 months’ use of a medication.

50
Q

How is chronic weight loss medication typically defined?

A

Chronic weight loss medication is typically defined as achieving more than 5% weight loss after 3 months.

51
Q

How often should efficacy and safety be assessed for weight loss medication?

A

At least monthly for the first 3 months and at least quarterly thereafter.

52
Q

What is the recommended dosage of Orlistat that can be purchased over the counter?

A

The recommended dosage of Orlistat that can be purchased over the counter is 60 mg three times a day.

53
Q

What is the recommended dosage range for Phentermine?

A

The recommended dosage range for Phentermine is 8-37.5 mg once daily

LESS THAN 12 W

الباقية فوق ١٢ اسبوع

54
Q

Which individuals should not take these medications? OBESITY MEDICATIONS

A

These medications are contraindicated in individuals who are pregnant or actively trying to conceive and not recommended for use in women who are nursing.

55
Q

What are some FDA-approved treatments for obesity?

A

FDA-approved treatments for obesity include orlistat, phentermine/topiramate ER, naltrexone/bupropion ER, liraglutide 3 mg, and semaglutide 2.4 mg.

56
Q

For what conditions is setmelanotide approved for use?

A

Setmelanotide is approved for use in cases of rare genetic mutations resulting in severe hyperphagia and extreme obesity, such as leptin receptor deficiency and proopiomelanocortin deficiency.

57
Q

What is the recommended dosage of liraglutide for the treatment of obesity?

A

The recommended dosage of liraglutide for the treatment of obesity is 3 mg.

58
Q

Which medications are FDA approved for long-term use in adults with BMI ≥27 kg/m2 and one or more obesity-associated comorbid conditions?

A

Five medications are FDA approved for long-term use in adults with BMI ≥27 kg/m2 and one or more obesity-associated comorbid conditions.

59
Q

What are some examples of obesity-associated comorbid conditions?

A

Some examples of obesity-associated comorbid conditions include type 2 diabetes, hypertension, and dyslipidemia.

60
Q

For how long is phentermine and other older adrenergic agents indicated for treatment?

A

Phentermine and other older adrenergic agents are indicated for short-term (≤12 weeks) treatment.

61
Q

What is the benefit of FDA-approved obesity medications?

A

They have been shown to improve glycemia in people with type 2 diabetes and delay progression to type 2 diabetes in at-risk individuals.

62
Q

What is the impact of FDA-approved obesity medications on glycemia?

A

They have been shown to improve glycemia in people with type 2 diabetes.

63
Q

What are some medications often associated with weight gain?

A

Insulin secretagogues, thiazolidinediones, and insulin are often associated with weight gain.

64
Q

Which class of medications is known to be associated with weight gain?

A

Antipsychotics, some antidepressants, glucocorticoids, injectable progestins, some anticonvulsants, and possibly sedating antihistamines and anticholinergics are medications associated with weight gain.

65
Q

Name two specific antipsychotics associated with weight gain.

A

Clozapine and olanzapine are two antipsychotics associated with weight gain.

66
Q

What is the effect of dipeptidyl peptidase 4 inhibitors on weight?

A

Dipeptidyl peptidase 4 inhibitors are weight neutral.

67
Q

What are some agents associated with weight loss?

A

Metformin, α-glucosidase inhibitors, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, dual glucagon-like peptide 1/glucose-dependent insulinotropic polypeptide receptor agonist (tirzepatide), and amylin mimetics.

68
Q

What did a meta-analysis of 227 randomized controlled trials of glucose-lowering treatments in type 2 diabetes find?

A

The meta-analysis found that A1C changes were not associated with baseline BMI.

69
Q

Who can benefit from the same types of treatments for diabetes as normal-weight individuals?

A

People with obesity can benefit from the same types of treatments for diabetes as normal-weight individuals.

70
Q

What is the definition of effective obesity pharmacotherapy?

A

Obesity pharmacotherapy is considered effective if there is a weight loss of at least 5% after 3 months of use.

71
Q

What should be considered if there is insufficient early response or significant safety issues with obesity pharmacotherapy?

A

Discontinuation of the medication should be considered and alternative medications or treatment approaches should be evaluated.

72
Q

What is the likelihood of further weight loss with continued use of effective obesity pharmacotherapy?

A

Further weight loss is likely with continued use of effective obesity pharmacotherapy.

73
Q

What is obesity pharmacotherapy effective as?

A

Obesity pharmacotherapy is effective as an adjunct to nutrition, physical activity, and behavioral counseling for selected people with type 2 diabetes and BMI ≥27 kg/m2.

74
Q

What should be minimized whenever possible for comorbid conditions associated with weight gain?

A

Medications

75
Q

When selecting glucose-lowering medications for people with type 2 diabetes and overweight or obesity, what factor should be considered?

A

The medication’s effect on weight should be considered.

76
Q

What population should consider the effect of glucose-lowering medications on weight when choosing treatment options?

A

People with type 2 diabetes and overweight or obesity should consider the effect of glucose-lowering medications on weight.

77
Q

What do large systematic reviews show about most trials evaluating nutrition supplements for weight loss?

A

Most trials evaluating nutrition supplements for weight loss are of low quality and at high risk for bias.

78
Q

What type of supplementation may be indicated in cases of documented deficiency?

A

Vitamin/mineral supplementation (e.g., iron, vitamin B12, vitamin D) may be indicated in cases of documented deficiency.

79
Q

What benefits were associated with the use of a partial meal replacement plan in the Look AHEAD trial?

A

The use of a partial meal replacement plan in the Look AHEAD trial was associated with improvements in nutrition quality and weight loss.

80
Q

What is the recommended energy deficit for significant weight loss?

A

The recommended energy deficit for significant weight loss is 500-750 kcal/day.

81
Q

What percentage of the intensive lifestyle intervention participants lost and maintained at least 5% of their initial body weight? LOOK A HEAD TRIAL

A

Approximately 50% of the intensive lifestyle intervention participants lost and maintained at least 5% of their initial body weight.

82
Q

Did the Look AHEAD trial show that intensive lifestyle intervention reduced cardiovascular events?

A

No, the Look AHEAD trial did not show that the intensive lifestyle intervention reduced cardiovascular events.

83
Q

What was the population of the participants in the Look AHEAD trial?

A

The participants in the Look AHEAD trial were adults with type 2 diabetes and overweight or obesity.

84
Q

Is there clear evidence that nutrition supplements are effective for weight loss?

A

No, there is no clear evidence that nutrition supplements are effective for weight loss.

85
Q

What is the calorie range for short-term nutrition intervention using structured, very-low-calorie meals?

A

The calorie range for short-term nutrition intervention using structured, very-low-calorie meals is 800-1,000 kcal/day.

86
Q

What should weight maintenance programs provide at minimum? AFTER REACHING THE TARGET

A

Weight maintenance programs should, at minimum, provide monthly contact and support, recommend ongoing monitoring of body weight (weekly or more frequently) and other self-monitoring strategies, and encourage regular physical activity (200–300 min/week).

87
Q

How long should weight maintenance programs be recommended for?

A

Weight maintenance programs should be recommended for long-term (≥1 year) duration.

88
Q

How many counseling sessions should be included in the interventions?

A

≥16 sessions in 6 months.

89
Q

What areas should the interventions focus on?

A

Nutrition changes, physical activity, and behavioral strategies.

90
Q

What are the recommended interventions for most people with type 2 diabetes and overweight or obesity?

A

Nutrition, physical activity, and behavioral therapy to achieve and maintain ≥5% weight loss.

91
Q

What are the potential benefits of additional weight loss in the management of diabetes and cardiovascular risk?

A

Further improvements in the management of diabetes and cardiovascular risk.

92
Q

What is the range of weight loss considered as small and beneficial for individuals with diabetes and overweight or obesity?

A

Approximately 3-7% of baseline weight.
Glycemia and other intermediate cardiovascular risk factors.

93
Q

What are the potential benefits of larger, sustained weight losses (>10%) for individuals with diabetes and overweight or obesity?

A

They may confer greater benefits, including disease-modifying effects and possible remission of type 2 diabetes, and may improve long-term cardiovascular outcomes and mortality.

94
Q

In what situations may weight need to be monitored and evaluated more frequently?

A

Weight may need to be monitored and evaluated more frequently based on clinical considerations such as the presence of comorbid heart failure or significant unexplained weight gain or loss.

95
Q

When should inpatient evaluation be considered for significant weight gain or loss?

A

Inpatient evaluation should be considered if deterioration of medical status is associated with significant weight gain or loss, especially focused on associations between medication use, food intake, and glycemic status.

96
Q

What factors should be considered when evaluating weight gain or loss in a clinical setting?

A

Factors such as medication use, food intake, and glycemic status should be considered when evaluating weight gain or loss in a clinical setting.

97
Q

What is the purpose of measuring height and weight and calculating BMI?

A

The purpose is to assess the body mass index (BMI) and track weight trajectory for treatment considerations.

98
Q

How frequently should height and weight be measured and BMI calculated?

A

Height and weight should be measured and BMI calculated at annual visits or more frequently.

99
Q

What does weight loss substantially reduce?

A

weight loss substantially reduces A1C and fasting glucose

100
Q

What has weight loss been shown to promote through at least 2 years?

A

weight loss has been shown to promote sustained diabetes remission through at least 2 years

ADA 23 (9 decks)

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