Obesity Flashcards
What are the metabolic effects of obesity?
- prediabetes, type II diabetes, dyslipidemia
- hypertension, CAD, stroke, CHD, AF, venous stasis, VTE
- cancer
- GERD, erosie gastritis, cholelithiasis, nonalcoholic FLD
- women -> PCOS, infertility, pregnancy complications
- men -> BPH, erectile dysfunction
- migraine
- skin & soft tissue infections
What are the mechanical effects?
- obstructive sleep apnea
- restrictive lung disease
- osteoarthritis
- low back pain
What are the psychosocial effects?
- depression
- anxiety
What is the treatment approach for obesity?
- diet control -> calorie restriction gradually (500-1000kcal deficit -> 0.5-1kg/week) (>800kcal/day)
- exercise -> 200min/week of moderate intensity aerobic exercise
- pharmacological
- bariatric procedures
Why is it difficult to maintain weightloss?
ADHERENCE
- motivation to adhere diminishes overtime
HYPOTHALAMIC INJURY
- biological adaptations to promote weight gain after weight loss
- decline in energy expenditure (adaptive thermogenesis) & an increase in hunger
could exercise alone lead to weight loss?
no
only 0.1kg/week
Which drug is an intestinal lipase inhibitor?
Orilstat
- contraindicated in pregnancy
side effects
- cramps
- flatulence
- fecal incontinence
- oily spotting
- absorption of fat-soluble vitamins is reduced
which obesity medication is a stimulant/anti-seizure drug?
Phentermine-topiramate -> satiety
- contraindicated in pregnancy & hyperthyroidism
side effects
- dry mouth
- taste disturbance
- constipation
- depression
- anxiety
- elevated heart rate
- insomnia if high dose
- ABUSE POTENTIAL
which obesity medication is an opioid antagonist/norepi & dopamine reuptake inhibitor drug?
Bupropion-naltrexone -> satiety
- contraindicated in uncontrolled HTN, seizure, pregnancy & breast feeding
side effects
- nausea
- constipation
- headache
- vomiting
- dizziness
- insomnia
- dry mouth
which obesity medication is a glucagon-like peptide 1 receptor agonist?
Liraglutide & Semaglutide
- contraindicated in pregnancy, family history of medullary thyroid cancer or multiple endocrine neoplasia 2A or 2B
for Semaglutide -> monitor patients with diabetic retinopathy for eye complications
side effects
- nausea, vomiting, diarrhea, constipation
- injection site reactions
- increased lipase
- increased heart rate
What is the goal of pharmacotherapy for obesity?
- 5% of total body weight loss at 3 months
- treat complications of obesity
What is the management approach for a low risk obesity patient?
BMI 25 to 29.9kg/m2
- if no risk factors for cardiovascular disease or other comorbidities just counsel on dietary habits & physical activity
What is the management approach for a moderate risk obesity patient?
BMI 25 - 29.9 kg/m2 with 1 or more risk factors for CVD
OR
BMI 30 - 34.9 kg/m2
- counseled about weight loss interventions -> diet, physical activity, behavioral modification, pharmacological therapy
What is the management approach for a high risk obesity patient?
BMI 35 - 40 kg/m2 & above
- most aggressive treatment -> lifestyle modifications, pharma therapy, bariatric surgery
What are the indications for bariatric surgery?
- BMI of 40 or more
- BMI of 35 - 39.9 with a serious comorbidity
