April 7, 2016 - Management Options of Obesity

Question 1

The 5 A’s

Answer 1

Ask

Assess

Advise

Agree

Assist

Question 2

Orlistat

Answer 2

A pancreatic lipase inhibitor

30% less fat is absorbed

Causes lots of GI side effects

Question 3

Liraglutide

Answer 3

A GLP-1 receptor agonist

Stimulates POMC/CART neurons in arcuate nucleus which slows gastric emptying

Question 4

Criteria for Surgery for Obesity

Answer 4

BMI > 35 and a major obesity-related comorbidity

OR

BMI > 40

Question 5

Obesity-Related Comorbidities

Answer 5

Diabetes

HTN

Sleep apnea

Dyslipidemia

Osteoarthritis

GERD

Depression

Cardiovascular disease

PCOS

Question 6

Laparoscopic Adjustable Gastric Band

Answer 6

Involves placement of a band around the upper part of the stomach.

Complications are relatively low but it may slip or erode over time.

Question 7

Sleeve Gastrectomy

Answer 7

Permanent resection of 70-80% of the stomach. This restricts the intake of food and leads to gut hormone changes.

Effective, but irreversible. Also, the risk of complications are higher than that of the gastric band. Big complication is new-onset heartburn.

Question 8

Gastric Bypass

Answer 8

This is the gold standard.

Anatomy and physiologic procedure with a strong physiologic drive.

Highest risk of complications, however has massive reduction rates in comorbidities with a mean weight loss of 100 pounds.

Technically the most challenging procedure though.