Exam 3: Obesity Flashcards
What is the #1 cause of preventable disease and disability?
Obesity
How is BMI calculated?
Weight (kg)/ Height (m2)
What waist circumference has increased cardiometabolic risk in men?
In women?
Men: >40 inches
Women: >35 inches
In what patients should you measure waist circumference?
Patients with a BMI between 25 and 35
What are some of the health effects of obesity?
-Heart Disease, DM, HTN, CA, HLD, stroke, infertility, liver/gallbladder disease, etc
What are the factors that lead to obesity?
- Behavior/lifestyle
- Medications
- neurohormonal
- Environment
- Other diseases/genetics
What is the initial goal of weight loss? What effect does this have on health?
Initial goal is loss of 5-7% of body weight, which leads to health benefits such as reduced risk of CVD
What two diets are commonly recommended for weight loss and protection against DM and CAD?
Mediterranean diet (#1) and DASH diet
What are the benefits of intermittent fasting?
Promotes weight loss, improved lipids, and reduced BP/fasting BS/HgA1C independent of any change in physical activity
What is the treatment for patients with a BMI >30?
Refer for an intensive, multi component behavior intervention to help make long term changes,
-Comprehensive and high intensity interventions most effective two times a month for >3 years, or 12-26 sessions a year
What are the 5 As when counseling a patient about their weight?
- Ask/address
- advise
- Assess
- Assist
- Arrange
All patients with BMI >** are candidates for weight loss interventions.
25
What patients are at low risk for complications of obesity and what is their treatment?
- BMI of 25-29.9 with no. CVD risk factors or other comorbidities
- Diet and exercise counselling to prevent weight gain
What patients are at moderate risk for obesty complications and what is their treatment?
- BMI of 25-29.9 and >1 CVD risk factor, OR a BMI of 30-34.9
- intensive multi component behavioral modification (diet and exercise to support and maintain weight loss) as well as SOME drug therapy (**only indicated if BMI >27)
What patients are high risk for obesity complications and what is their treatment?
High risk: BMI of 35-40
Very high risk: >40
-Intensive multicomponent behavioral modification and consideration of drug therapy, bariatric surgery
When should drug therapy be considered?
- BMI >30 or >27 with comorbidities
- Unsatisfactory weight loss (<5% in 3-6 months) with a comprehensive lifestyle program
How does Orlistat work?
Side effects?
Alters fat digestion by inhibiting pancreatic lipase
-increased fat in stools and may decreased absorption of fat soluble vitamins
Side effect: Unpleasant GI side effects
How does Liraglutide work ?
Daily SQ injection, GLP1 receptor agonist
-Common choice in Type II DM
How does Lorcaserin work?
-Serotonin agonist, decreases appetite
In what patients should you not use Phentermine/topiramate?
Patients with HTN, CAD, and Hyperthyroid
What is the use of Phentermine?
Sympathomimetic, only FDA approved for short term use
What is the most widely prescribed weight loss drug?
Phentermine
If a patient taking weight loss medications do no have a 4-5% weight loss after 3 months, what should you do?
Discontinue that medication, possible try another medication
When is bariatric surgery considered?
- BMI >40
- BMI 35-39.9 with one or more serious comorbidity
- BMI 30-34.9 and uncontrollable type 2 DM or metabolic syndrome
What leads to great weight loss post op in bariatric surgery?
Loss of 8% of excess body weight prior to surgery
What are the contraindications for bariatric surgery?
Eating disorders, untreated mental illness, drug/ETOH abuse, coagulopathy, and severe cardiac disease
What are the 3 ways that bariatric surgery increases weight loss?
- Restriction
- Malabsorption
- Decrease appetite
What are the 3 surgery types commonly used in for bariatric surgery?
- Sleeve gastrectomy
- Roux-en-Y
- Adjustable gastric band
What are the physical activity guidelines for Americans?
-Adults should perform at least 150-300 min/week of moderate intensity OR 75-150 min/week of vigorous intensity aerobic physical activity
AND
Muscle strengthening >2 days a week
