non -pharm grab bag of Obesity treatment strategies

Question 1

What are important treatments for Sarcopenia and Frailty? 3

Answer 1

Adequate protein (1-1.5 g/kg/day)
Vitamin supplementation
Resistance exercise

Question 2

What is the calculation for determining what you will weight when you achieve your desired body fat percentage?

Answer 2

Desired body weight = Lean body weight/(1-desired body fat percentage)
IE/woman 120 pounds, going from 25% to 20% body fat? How much weight will she need to lose? 120x .75=90 lbs, 90/ (1-0.20)=113 lbs

Question 3

Risks of excessive weight loss - many, 9

Answer 3

Social isolation
Eating disorder
Weight regain/cycling
Sarcopenia/frailty
Osteopenia/osteoporosis
Malnutrition
Gout
Gallstones
Dehydration

Question 4

What percentage weight loss in first month is a predictor for long term WL success?

Answer 4

2.5%

Question 5

Ideas for what to do if patients have not achieved >2.5% loss in first month

Answer 5

Review meds
Increase activity
Work up for medical conditions that may promote obesity
Address sleep, stressors
Screen for eating disorders/depression
Increase frequency of appointments

Question 6

How much does each 5kg/m2 rise in BMI above 25 raise mortality?

Answer 6

30%

Question 7

What is a good weight loss goal for patient with pre-diabetes?

Answer 7

10%

Question 8

What are HTN and CVD risks 7

*BMI is NOT an independant risk factor, though increased WC and MetSy are

Answer 8

obesity
age
ethnicity/race
sedentary
increased Etoh
high sodium diet
family history

Question 9

Neck measurements putting you at risk of OSA

Answer 9

> 16 women, >17 men

Question 10

Obesity is implicated in what percent of all cancer related mortality?
Obesity 2nd most common cause of cancer
proportion excess cancer attributable to obesity is 5%in men, 10% women

Answer 10

15-20%

Question 11

Weight gain after these 4 cancer Diagnoses leads to poor outcomes

Answer 11

Breast
prostate
colorectal
childhood leukemias

Question 12

What are some challenges of obesity with cancer diagnosis?

Answer 12

Chemo and premature meno. can trigger weight gain, esp. sarcopenic obesity
People with Ob. are more likely to delay care or participate in screening
Ob. can influence accuracy of cancer diagnostics
Ob. poses technical challenges for RadTx and surgery
Ob. is linked with higher risk of VTE when getting chemo

Question 13

Which lab measurements re: hypogonadism are more common in men with MetS and high WC?

Answer 13

Decreased SHBG, free T and total T

*obesity may cause suppression of hepatic SHBG synthesis by elevated concentrations of insulin

Question 14

TKR complications in obesity

Answer 14

infection-prosthetic and superficial
decreased wound healing
increased DVT
decreased survival

Question 15

Drugs to avoid when starting keto or VLDC 5

think diabetes, kidney stones, HTN

Answer 15

insulin
sulfonylureas
diuretics
SGLT2 inhibitors
orlistat

topiramate