Obesity

Question 1

What is the fundamental cause of obesity and overweight?

Answer 1

An energy imbalance between calories consumed and calories expended

Question 2

(T/F) - Calories taken in is greater than calories taken out

Answer 2

TRUE

Question 3

What are multifactorial etiologies that could cause or decrease obesity or overweight?

Answer 3

• Genetics
• Environmental factors
• Underlying medical condition or pharmacological agent
• More exercise

Question 4

How many kcal are in 1 lb?

Answer 4

3,500 kcal

Question 5

In one gram, how many kcal are in protein?

Answer 5

4 kcal

Question 6

About how much percent of calories should protein be consumed in one day?

Answer 6

15-20%

Question 7

In one gram, how many kcal are in carbs?

Answer 7

4 kcal

Question 8

About how much percent of calories should carbs be consumed in one day?

Answer 8

50-55%

Question 9

In one gram, how many kcal are in fats?

Answer 9

9 kcal

Question 10

About how much percent of calories should carbs be consumed in one day?

Answer 10

25-30%

Question 11

Calculation question: If an energy balance is 50 kcal/day, what is the resulting weight gain over 1 year?

Answer 11

5 lbs

Question 12

What two methods could be used to diagnose overweight/obesity?

Answer 12

• BMI

- Weight circumference

Question 13

BMI equation

Answer 13

weight (kg) / height (m^2)

Question 14

What is considered overweight BMI?

Answer 14

25-29.9 kg/m^2

Question 15

What is considered class I obesity BMI?

Answer 15

30-35 kg/m^2

Question 16

What is considered class II obesity BMI?

Answer 16

35-40 kg/m^2

Question 17

What is considered class III obesity BMI?

Answer 17

> 40 kg/m^2

Question 18

A waist circumference would be more beneficial in which patients?

Answer 18

BMI 25-34.9 kg/m^2

Question 19

What waist circumference (in inches) in females would be considered a risk of obesity?

Answer 19

Females > 35 inches

Question 20

What waist circumference (in inches) in males would be considered a risk of obesity?

Answer 20

Males > 40 inches

Question 21

What are 7 risk factors for patients who are at risk of being overweight/obese?

Answer 21

Age (until 80 yo)
Lower socioeconomic factors
Female
Immigrants
Family History
Conditions (i.e., thyroid disorders)
Medications

Question 22

What is a realistic amount of weight loss?

Answer 22

5-10% of body weight initially

Question 23

What are 5 non-pharmacological treatments that can be done to minimize obese?

Answer 23

• Identify and manage contributing conditions
• Remove offending drugs (if possible)
• Lifestyle changes
• Fiber
• Activity approaches

Question 24

What are 4 contributing conditions?

Answer 24

• Cushing’s disease
• Hyperthyroidism
• Leptin deficiency
• Binge-eating disorder

Question 25

FYI: What are some classes that are considered offending agents?

Answer 25

``` Antidepressants Antiepileptics Antipsychotics Beta-blockers Chemotherapies Glucocorticoids Hormone replacement Pioglitazones Sulfonylureas Insulin ```

Question 26

FYI: What are some drugs that should be avoided due to being weight offensive?

Answer 26

- Carbamazepine - Gabapentin - Valproic acid - Atenolol - Metoprolol - Propranolol - Progestin injection

Question 27

FYI: What are 5 major mental health therapies that can be offensive to weight?

Answer 27

``` Clozapine Mirtazapine Olanzapine Paroxetine TCAs ```

Question 28

(T/F) - The slower you can digest food, the less you will be in a hunger state

Answer 28

TRUE

Question 29

(T/F) - High consumers of fiber (~35g) have a best chance of decreasing comorbidities, obese, etc. compared to low consumers of fiber (1-25g)

Answer 29

TRUE - more fiber is helpful rather than low fiber

Question 30

Who is applicable in receiving pharmacological treatments for obesity? [3 types of people]

Answer 30

- BMI >/= 30 kg/m^2 - Waist circumference is high - BMI 27-30 kg/m^2 AND 2 risk factors

Question 31

What is the hierarchy of medications to choose for obesity patients?

Answer 31

Semaglutide (Wegovy) > Liraglutide (Saxenda) > Phentermine-containing medication > The others

Question 32

How does phentermine (Adipex-P) work to suppress appetite?

Answer 32

Enhances norepinephrine and dopamine neurotransmission

Question 33

(T/F) - Phentermine is considered a controlled substance

Answer 33

TRUE - scheduled IV

Question 34

Is Adipex-P the most commonly prescribed agent even though it is the 3rd in line agent?

Answer 34

Yes, it's most commonly prescribed

Question 35

What is the duration of using Adipex-P?

Answer 35

Several weeks (short-term)

Question 36

What are some adverse effects associated with phentermine?

Answer 36

Insomnia HTN Palpitations Arrhythmias

Question 37

Phentermine interacts with which drug? What measures should be taken

Answer 37

MAOIs - discontinue MAOIs 14 days before using phentermine

Question 38

What are 5 contraindications with Adipex-P?

Answer 38

- CV disease - Untreated hyperthyroidism - Agitated states - Substance abusers - Glaucoma

Question 39

What time of the day should phentermine be avoided in?

Answer 39

At bedtime

Question 40

Which medications can be used long-term?

Answer 40

Alli (orlistat) [OTC] Xenical (orlistat) Qsymia (phentermine/topiramate) Contrave (bupropion/naltrexone)

Question 41

Alli and Xenical fall in what class?

Answer 41

Protease inhibitors

Question 42

How does Alli and Xenical work to reduce obesity in patients?

Answer 42

Inhibit lipase which induces weight loss by lowering dietary fat absorption and malabsorption of cholesterol