Mech/Path/Manage Obesity

Question 1

BMI heritability Rates

Answer 1

40-70%

Question 2

Number of Monogenic forms obesity; most common

Answer 2

11; Heterozygous mutation alpha melanocortin-4 receptor gene

Question 3

ENERGY-BALANCE DYSREGULATION

Answer 3

• Short-term and long-term energy balance is controlled through a coordinated network of central mechanisms and peripheral signals that arise from the microbiome and cells within adipose tissue, stomach, pancreas, and other organs.
• An increase in central orexigenic signals may account for a subtle and often unappreciated counterregulatory increase in appetite and food intake that limits the degree of predicted weight loss

Question 4

Pathophysiological effects Obesity

Answer 4

• Adipocytes secrete proinflammatory adipokines
• INC in liposomes leading to INC risk of NAFL, steatohepatitis, + cirrhosis
• Accumulation of excess lipid intermediates (ceramides) -> Inflammation
• Impaired insulin signaling f/ free FA, adipokines, + Ceramides

Question 5

Look AHEAD Study

Answer 5

A 5% weight loss improves pancreatic β-cell function and the sensitivity of liver and skeletal muscle to insulin; a larger relative weight loss leads to graded improvements in key adipose-tissue disturbances

Question 6

Bariatric Surgery + WL + Dx

Answer 6

Mean losses of 16 to 32% of baseline weight produced by bariatric surgery in patients with severe obesity may lead to disease remission, including remission of type 2 diabetes in patients who undergo bariatric surgery, particularly Roux-en-Y gastric bypass

Question 7

Pharmacotherapy indications for Obesity

Answer 7

adults who have a BMI of 30 or higher or a BMI of 27 to 29 with at least one weight-related coexisting condition

Question 8

Phentermine

• Mech
• Use

Answer 8

• sympathomimetic amine

- Short-term WL

Question 9

FDA-approved 3 monotherapies for WL

Answer 9

orlistat, lorcaserin, and liraglutide

Question 10

FDA-approved combination therapies for WL

Answer 10

phentermine–topiramate and naltrexone–bupropion

Question 11

Weight Loss medication Risks

Answer 11

• Tachycardia
• attenuate expected blood-pressure reductions
• Weight gain after termination

Question 12

Laparoscopic adjustable gastric banding

Answer 12

• Least invasive + safest Surgical Tx

- involves placing an inflatable silicone band around the gastric fundus to create a small (approximately 30-ml) pouch

Question 13

Roux-en-Y gastric bypass

Answer 13

• restricts food intake by creating in the upper gastric fundus a small (<50-ml) pouch anastomosed to a Roux limb of jejunum

Question 14

vertical-sleeve gastrectomy

Answer 14

removal of approximately 70% of the stomach, with subsequent acceleration of gastric emptying