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Nutrition Sum 2023 > Lecture 4 > Flashcards

Lecture 4 Flashcards

1
Q

What are some common behavioral strategies to losing weight?

A

Setting realistic goals(% of body weight)
Self-monitoring
Stimulus control
Slowing eating style
Nutritional education
Meal planning
Stress reduction and problem solving

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2
Q

How much weight do you lose based on the types of changes?

A

5-7% from lifestyle changes
5-10% from lifestyle and meds
15-20% with bariatric surgery

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3
Q

How does exercise benefit other than losing weight?

A

Slow/prevent further weight gain
Reducing weight regain after successful weight loss
Doesn’t lose as much muscle mass from low diet
Improved physical functioning
Offsetting reduced BEE/BMR that occur with wt loss
Improved functional status

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4
Q

What types or exercises and how often do we need?

A

aerobic and resistance training
balance/flexibility for elderly
30mins/day 5x/week (may need to build up)

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5
Q

What do we check before a pt becomes active?

A

CV
Pulmonary
MSK

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6
Q

What are some principles for dieting?

A

Min/eliminate caloric beverages
Portion size control
Self-monitoring
View changes as long-term/lifelong

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7
Q

Whats the ultimate goal for dieting?

A

Reduce caloric intake

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8
Q

What do we need to consider when asking patients to diet?

A

Patient compliance

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9
Q

What diet has a more rapid initial weight loss?

A

Low-carb

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10
Q

What are the guidelines before prescribing a medication of weight loss?

A

Age restriction
Weight status
Duration of therapy
Cost of prescriptions

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11
Q

What anti-obesity Rx is approved for ages 12+?

A

orlistat(Xenical)

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12
Q

What BMI are usually most anti-obesity drugs approved for?

A

BMI of ≥ 30
BMI of ≥ 27 with obesity-related comorbidity

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13
Q

Phentermine (adieux)
MOA
SE
CI
DDI

A

MOA: Stimulate NE release
SE: Dry mouth, constipation, paresthesia
CI: substance use hx, hyperthyroidism, pregnancy
DDI: ETOH, anti-HTN, metformin, loop diuretics, insomnia rx, psych rx

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14
Q

Orlistat(Alli, Xenical)
MOA
SE
CI
DDI

A

MOA: dose dependent increase in fecal fat excretion. inhibits intestinal lipase (block fat absorption)
SE: GI: borborygmi(sound), flatus(sound), decrease fat-sol vit absorption, liver injury, stones
CI: pregnancy, stones, cholestatis
DDI: multivitamins, fat-soluble vitamins, warfarin, levothyroxine

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15
Q

Lorcaserin(Belviq) not in market
MOA
SE

A

MOA: serotonin agonist for serotonin 2C receptor(suppress appetite)
SE: HA, dizziness, nausea, URI
Colorectal, pancreatic, and lung cancer in trials

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16
Q

Liraglutide/Semaglutide (Saxenda/Wegovy)
MOA
SE
CI
DDI

A

MOA: agonist of GLP-1 receptors
SE: N/V/D
CI: pregnancy, family hx of medially thyroid cancer or MEN 2A/2B
DDI: Other hypoglycemic agents, serotonergic drugs, thiazides

17
Q

Tirzapetide(mounjaro)
MOA
SE
CI
DDI

A

MOA: Agonist of GLP-1 and GIP receptors
SE: N/V/D
CI: pregnancy, family hx of medially thyroid cancer or MEN 2A/2B
DDI: Other hypoglycemic agents, serotonergic drugs, thiazides

18
Q

Cellulose/Hydrogel(Plenity)
MOA
SE
CI
DDI

A

MOA: Expands GI tract to create sense of satiety
SE: Diarrhea, abdominal distention, pain
CI: pregnancy
DDI: none

19
Q

Naltrexone SE/Bupropion SR (Contrave)
Not recommended first line
MOA
SE
CI
DDI

A

MOA: opioid antagonist/norepinephrine and dopamine reuptake inhibitor
SE: Nausea, constipation, HA
CI: pregnancy, HTN, anorexia
DDI: ETOH, psych meds, opiates, metoprolol, several others

20
Q

Phentermine/Topiramate(Qsymia)
MOA
SE
CI
DDI

A

MOA: stimulates NE release
SE: dry mouth, constipation, paresthesia
CI: substance use history, hyperthyroidism, glaucoma
DDI: ETOH, psych rx, anti-HTN rx, insomnia rx, loop diuretics, metformin

21
Q

Human Chorionic Gonadotropin (HCG)
MOA

A

MOA: alleged to increase metabolic rate and suppress appetite

however… you need to eat a very low cal diet

22
Q

What are the OTC weight loss supplements that are not really reliable?

A

Green tea
Gardenia Cambodia (this a fruit)
Linoleum acid
Chitosan
Guar gum
Calcium

GGGLCC

23
Q

Who’s eligible for bariatric surgery?

A

BMI ≥ 40
BMI ≥ 35 with 1+ obesity-related comorbidity
BMI ≥ 30 with severe/progressive comorbidity(sometimes)

and dumb insurance

24
Q

What are CI to bariatric surgery?

A

Not obese - to tx of HLD, DM, or to reduce CV risk w/o obesity
Inability to comply with nutritional requirements
Age - not usually done in pts < 18 or > 65
Cardiac disease (cannot undergo anesthesia)
Coagulopathy
ETOH or drug use
Psych - uncontrolled/untreated depression, psychosis, eating disorders (especially bulimia)
NACCEP

25
Q

Sleeve Gastrectomy
Where?
Weight loss?
Complications?

A

Location: greater sleeve of stomach
Loss: 60% of weight
Complications: Surgical site leak. hernias, staple disruption
Long-term: GERD
Nutritional: Iron, vit B12, folate, calcium, Vit D

26
Q

How does bariatric surgery work?

A

Restriction of food
Malabsorption
Sometimes neurohormonal effect

27
Q

What are CI to bariatric surgery?

A

Not obese - to tx of HLD, DM, or to reduce CV risk w/o obesity
Inability to comply with nutritional requirements
Age - not usually done in pts < 18 or > 65
Severe cardiac disease (cannot undergo anesthesia)
Severe coagulopathy
Current ETOH or drug use
Psych - uncontrolled/untreated depression, psychosis, eating disorders (especially bulimia)

28
Q

Roux-en-Y gastric bypass
Where?
Weight loss?
Complications?

A

Location: gastric pouch anastomosed to the small bowel
Weight loss: 70%
Complications: peritonitis due to anastomotic leak; abdominal wall hernias; stenosis; staple disruption
Gallstones, neuropathy, ulcers
Iron, vit 12, folate, calcium, vit D

29
Q

Laparoscopic adjustable gastric banding
Where?
Weight loss?
Complications?

A

Location: Adjustable prosthetic band on upper portion of stomach
Weight loss: 50%
Complications: band slippage, band erosion, mechanical failure
esophageal erosion, reoperation, weight regain

30
Q

What is liposuction?

A

Sucking out that fat
w/ saline injection or aspiration of fat tissue
Cosmetic only

31
Q

What is aspiration therapy?

A

Percutaneous gastrostomy tube is implanted endoscopically
where after meals you can drain food out

Basically, opening the door to let food out

32
Q

What is Biliopancreatic Diversion with Duodenal Switch (BPD/DS)?

A

Mainly for BMI 50+
Lots of complications
Changes size of stomach and length of SI

33
Q

What is a Intragastric Balloon ?

A

Saline-filled balloon placed endoscopically for max 6 month period
Reduce gastric volume and promotes satiety

Nutrition Sum 2023 (10 decks)

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