Obesity

Question 1

Significant co-morbidities associated with obesity:

Answer 1

-obstructive sleep apnea
-hypoventilation syndrome
-non alcoholic fatty liver disease
-gallbladder disease
-gynecologic abnormalities
-osteoarthritis
-gout
-premature death
-phlebitis
-cancer
-severe pancreatitis
-GERD
-stroke
-depression
Cardio/metabolic syndrome

Question 2

BOdy mass index (BMI):

Morbid obesity is :

Answer 2

A measure of body fat based on heigh and weight

-a multi factorial disease of excess fat storage (+40BMI) and associated diseases of other systems

Question 3

NIH body mass index classifications :

Answer 3

🔸25-29.9= overweight
🔸30 or higher = obese
🔸 40 or higher = morbidly obese

Question 4

Chronic disease management:

Answer 4

✅primary prevention: prevent development of overweight and obesity by( education, modifying obesogenic built environment , phys. Activity )
✅secondary prevention : prevent future weight gain and development of complications ( screen BMI, evaluation of complications , treat with lifestyle..)
✅tertiary prevention: treat with weight loss therapy to eliminate weight related conplications ( treat with lifestyle , consider bariatric surgery )

Question 5

Factors predispose to obesity:

Answer 5

Genetic : familial tendency 
Sex : women more 
Activity: lack of physical activity 
Psychogenic : emotional deprivation, depression
Social class: poorer classes 
Alcohol
Smoking 
Prescribed drugs

Question 6

Weight gain : medications

Answer 6

🔸diabetes: insulin, sulfonylureas
🔸depression: tricyclics
🔸seizures: valporic acid, tegretol
🔸hypertension: clonidine, a blockers, b blockers 
🔸hormones : progesterone

Question 7

Hypothalamus:

Answer 7

Control center for hunger and satiety

Question 8

Leptin=

Answer 8

Protein hormone secreted by adipocytes
-levels correlate with lipid content of cells
-acts on hypothalamus to reduce hunger and stimulate energy expenditure
▪️dieting decreases leptin levels and reducing metabolism

Question 9

Ghrelin:

Answer 9

Hormone secreted in the stomach
Acts on the hypothalamus to stimulate apetite
▪️levels in dieters are higher after weight loss

Question 10

Lifestyle modifications:

As a treatment for obesity( BMI>25)

Answer 10

Caloric intake should be reduced by 500 to 1000 per day
Increased physical activity
Behavior modification

Question 11

Pharmacotherapy for weight loss :
For pts with
BMI>27
BMI>30 without co morbidities

Answer 11

5 drugs currently available : 
✅Alli
✅Xenical
✅Adipex 
✅Qsymia
✅Belviq

Question 12

Bariatric and metabolic surgery:
For pts with :
BMI>35 with co morbidities
BMI>40 without co morbidities

Answer 12

✅laparoscopic adjustable gastric banding (place implantable device around upper most part of stomach)
✅sleeve gastrectomy( resect approximately 3/4 of the stomach)
✅gastric bypass surgery (roux en Y ) : bypass a portion if the small intestine and creat and creat a 15-30 cc gastric pouch

Question 13

Bariatric surgery

Benefits Vs. Risks =

Answer 13

🔸Benefits: 
-highest level of excess weight loss 
-co morbidity resolution or reduction
- reduction in mortality 
▪️Risks : 
-general risks of surgery
-bad erosion/ slippage/ leak /malfunction
-esophageal spasm/reflux or esophag. /stomach inflammation
- gastric perforation
-outlet obstruction

Question 14

Nice criteria=

Answer 14

🔸BMI> 40 without co morbidities
🔸BMI>35 with co morbidities
🔸BMI>30 with diabetes 2 diagnosed past 10 yrs and poorly controlled