Intervention

Question 1

Transtheoretical Model or Stages of Change

Answer 1

Pre-contemplation – patient is not willing to change, appears to be resistant and unmotivated

Contemplation – patient is ambivalent or uncertain as to whether they want to make a behavior change

Preparation – patient is now thinking about a behavior change and actually planning first steps

Action – patient now is motivated to change and receptive to conversations related to potential behavior change interventions and ready to go

Maintenance – patient continues with behavior changes and practices healthy strategies to continue to maintain success

Question 2

What are elements to a comprehensive lifestyle interventions?

Answer 2

• Diet - Low-calorie diet (1200-1500 kcal/d for women; 1500-1800 kcal/d for men) using dietary approaches based on patient preference & health aspects.
• Increased physical activity - >150 min/wk of aerobic activity to 300 min/wk for additional benefits. Additional benefits with muscle-strengthening activities for 2 or more days/wk.
• Frequency and duration of treatment - ≥14 in-person counseling sessions (individual or group) in the first 6 months with a trained interventionist. Continued contact with the trained interventionist for weight maintenance, along with feedback and support.
• Behavioral strategies - Monitoring of food intake and physical activities using paper diaries or apps. Daily to weekly monitoring of weight and strategies such as goal setting, problem solving, stimulus control.
• Technology to support programs - Telehealth options such as social media platforms and other enhanced digital intervention options can be an alternative to in-person counseling using web-based platforms.

Question 3

What are the approved weight loss medications?

Answer 3

Orlistat (Xenical™, Alli™)

Phentermine/Topiramate ER (Qsymia®)

Naltrexone ER/Buproprion ER (Contrave®)

Liraglutide (Saxenda®)

Semaglutide (Wegovy™)

Question 4

What is the criteria for weight loss medication?

Answer 4

BMI > 30 kg/m2
OR
BMI ≥ 27 kg/m2 with significant comorbidity.

Question 5

What is the protocol for Naltrexone ER/Buproprion ER and Lorcaserin?

Answer 5

If the patient has not lost at least 5% of their baseline body weight after 12 weeks on a maintenance dose, discontinue the medication.

Question 6

What is the protocol for Phentermine/Topiramate ER?

Answer 6

If patient has lost >5% body weight after 12 weeks on recommended dose of 7.5mg/42mg, continue dose.

If patient has NOT lost >5% body weight after 12 weeks on recommended dose of 7.5mg/42mg, increase to max dose for another 12 weeks.

If patient has not lost at least 3% of body weight after 12 additional weeks on maximum dose, discontinue medication.

Question 7

What is the protocol for Liraglutide 3mg?

Answer 7

If the patient has not lost at least 4% of body weight after 16 weeks, discontinue medication.

Question 8

Due to it’s potential cancer risk, what weight loss drug was withdrawn?

Answer 8

Lorcaserin (Belviq®)

Question 9

Who is suited for bariatric surgery?

Answer 9

Laparoscopic Adjustable Gastric Banding
Lower BMI; no metabolic disease

Sleeve Gastrectomy
Metabolic disease present

Roux-en-Y Gastric Bypass
Higher BMI, GERD, Type 2 DM

Biliopancreatic Diversion with Duodenal Switch
Higher BMI, Type 2 DM

Loop Duodenal Switch
Higher BMI, Type 2 DM

Question 10

What are other FDA-approved Bariatric Technologies?

Answer 10

Aspiration Therapy via Modified Percutaneous Endoscopic
Gastrostomy (PEG), Electrical Vagal Blocking System, Intragastric Balloons, and Endoscopic Plication Devices.

Question 11

Which of the following stages of readiness to change is most important in implementing an intervention?

Answer 11

Action