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Nutrition > Obesity > Flashcards

Obesity Flashcards

1
Q

How many people in the US are obese?

A

42% of US adults and 19.7% of kids

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2
Q

What are risk factors for obesity?

A

Females
Black, Native Americans, Mexicans
Low income

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3
Q

What is BMI?

A

kg/(m^2)

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4
Q

What are the BMI categories?

A

Underweight <18.5
Normal 18.5-24.9
Overweight 25-29.9
Class 1 Obese 30-34.9
Class 2 Obese 35-39.9
Class 3 Obese >40

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5
Q

What is morbid obesity?

A

More than 100 lbs over ideal body weight or Class 3 or Class 2 with an obesity related condition

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6
Q

Which fat is most concerning?

A

Visceral and truncoabdominal

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7
Q

What waist circumference is dangerous?

A

> 40 inches for male and >35 inches for female

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8
Q

What are the most impactful factors for obesity?

A

Lifestyle and diet

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9
Q

How much do genetics play a role in obesity cases?

A

40-70%

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10
Q

What medications are linked to obesity?

A

Antipsychotics
Mood stabilizers
Antidepressants
Insulins
Oral diabetic medications
Steroids
Beta blockers
Hormonal agents

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11
Q

What are women specific influences on obesity?

A

Pregnancy
Oral Contraception
Menopause

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12
Q

What are men specific influences on obesity?

A

Lifestyle (more sedentary over time)
Testosterone (declines with age and means less muscle and more fat)

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13
Q

How does ethnicity impact obesity?

A

Hispanic = more obese overall
Black = more obese women
younger onset in both

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14
Q

How does socioeconomic status impact obesity?

A

Low literacy/education
Low finances
Environment (food deserts, parks)

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15
Q

How do behaviors influence obesity?

A

Physical activity (especially watching TV)
Sleep deprivation
Smoking Cessation
Diet (high fat and sugar)
Eating habits

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16
Q

What hormones does lack of sleep influence?

A

Decreases leptin and increases ghrelin
Increased hunger and appetite

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17
Q

What is metabolic syndrome?

A

When an obese patient has 3/5 of the following:
- Abdominal obesity
- Low HDL
- HTN
- Hyperglycemia
- Hypertriglyceridemia

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18
Q

When is a BMI for 20-25 a problem?

A

If they have a high waist circumference or if wt gain of >10 kg since age 18

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19
Q

What intervention is indicated for a patient with a BMI of 25-30?

A

Counseling on avoiding weight gain, encourage healthy diet and exercise

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20
Q

What intervention is indicated for a patient with a BMI of 30-35?

A

Specific tools and strategies for dietary changes, increased physical activity, behavioral intervention, pharmacotherapy

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21
Q

What intervention is indicated for a patient with a BMI of 35+?

A

Specific diet and exercise plans, mulicomponent behavioral intervention, pharmacotherapy, bariatric surgery

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22
Q

What type of exercise has the most benefit?

A

Aerobic and resistance

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23
Q

How much should everyone exercise?

A

30 minutes 5x per week

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24
Q

What BMI are most obesity Rx approved for?

A

> 30 or >27 with obesity related comorbidities

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25
Q

How long are obesity Rx used for?

A

Usually 12 weeks or less

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26
Q

What is the MOA of phentermine?

A

stimulates NE release which suppresses appetite and causes early satiety

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27
Q

What are the SE of phentermine?

A

HTN, tachycardia, insomnia, agitation, palpitations, constipation, dry mouth

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28
Q

What are the CI of phentermine?

A

Allergy, CV disease, hyperthyroidism, agitated state, glaucoma, substance use hx, within 2 weeks of an MAOI, pregnancy, breastfeeding

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29
Q

What are the DDI of phentermine?

A

psych meds, antihypertensives, antihistamines, insomnia meds

30
Q

What is the MOA of orlistat?

A

Inhibits intestinal lipase, blocking fat absorption

31
Q

What are the SE of orlistat?

A

borborygmi (loud BS), flatus, oily spotting, fecal incontinence, decreased fat soluble vitamin absorption, liver injury, calcium oxalate stones, AKI

32
Q

What are the CI of orlistat?

A

Allergy, pregnancy, cholestasis/cholelithiasis, h/o calcium oxalate stones, chronic malabsorption syndrome

33
Q

What are the DDI of orlistat?

A

Multivitamins, fat-soluble vitamins, Warfarin, levothyroxine

34
Q

What is lorcaserin?

A

serotonin agonist for serotonin 2C receptor (suppresses appetite)
No longer available due to cancer risk

35
Q

What is the MOA of liraglutide and semaglutide?

A

Agonist of GLP-1 receptors (originally for diabetes)
Increase insulin, decrease glucagon, slow gastric emptying

36
Q

What are the SE of liraglutide and semaglutide?

A

Nausea, Vomiting, Diarrhea, hypoglycemia, anorexia, pancreatitis, gallbladder disease, kidney injury

37
Q

What are the CI for liraglutide and semaglutide?

A

Allergy, pregnancy, personal or fam h/o medullary thyroid cancer or MEN 2A or 2B

38
Q

What are the DDI for liraglutide and semaglutide?

A

Other hypoglycemic agents, serotonergic drugs, thiazides

39
Q

What is the MOA for tirzapetide?

A

Agonist of GLP-1 and GIP receptors
inc insulin, dec glucagon, dec gastric emptying
Thought to work better than GLP-1 agonist alone

40
Q

What are the SE of tirzapetide?

A

Nausea, Vomiting, Diarrhea, hypoglycemia, anorexia, pancreatitis, gallbladder disease, kidney injury

41
Q

What are the CI of tirzapetide?

A

Allergy, pregnancy, personal or fam h/o medullary thyroid cancer or MEN 2A or 2B

42
Q

What are the DDI of tirzapetide?

A

Other hypoglycemic agents, serotonergic drugs, thiazides

43
Q

What is the MOA of cellulose and hydrogel?

A

Expand in the GI tract to create a sensation of satiety

44
Q

What are the SE of cellulose and hydrogel?

A

Diarrhea, abdominal distension, abdominal pain, “adverse effects”

45
Q

What are the CI of cellulose and hydrogel?

A

Allergy, pregnancy

46
Q

What are the DDI of cellulose and hydrogel?

A

None

47
Q

What is the MOA of naltrexone/bupropion?

A

Opioid antagonist/norepinephrine and dopamine reuptake inhibitor. Unclear why effective in weightloss

48
Q

What are the SE of naltrexone/bupropion?

A

Nausea, constipation, HA, vomiting, dry mouth, agitated mood, insomnia, HTN, tachycardia, palpitations
Not first line medication

49
Q

What are the CI of naltrexone/bupropion?

A

Allergy, pregnancy, HTN, epilepsy, bulimia, anorexia

50
Q

What are the DDI of naltrexone/bupropion?

A

ETOH, psych meds, opiates, metoprolol

51
Q

What is the MOA of phentermine/topiramate?

A

Stimulates NE release/anticonvulsant. Schedule IV med. Suppresses appetite/early satiety

52
Q

What is the SE of phentermine/topiramate?

A

Dry mouth, constipation, paresthesia, depression, brain fog, HA, altered taste

53
Q

What are the CI of phentermine/topiramate?

A

Allergies, hyperthyroidism, glaucoma, substance use hx, 2 weeks of MAOI, pregnancy

54
Q

What are the DDI of phentermine/topiramate?

A

ETOH, psych meds, antihypertensives, insomnia meds, loop diuretics, metformin

55
Q

What is the MOA of human chorionic gonadotropin?

A

alleged to increase metabolic rate and suppress appetite. Nearly always given with low calorie diet…so that’s probably why

56
Q

Who is a candidate for weight loss surgery?

A

BMI >40
BMI >35 with 1 or more comorbidities
BMI >30 with a severe comorbidity

57
Q

What are obesity related comorbidities?

A

T2DM, HTN, HLD, OSA, NAFLD/NASH, OHS, GERD, asthma, pseudotumor cerebri, severe OA, severe UI, impaired quality of life, unable to get other surgery

58
Q

What is the most common bariatric surgery?

A

Roux-en-Y (47%)

59
Q

What is a roux-en-Y?

A

Small gastric pouch is connected to the small bowel causing both restrictive and malabsorptive weight loss

60
Q

What are complications of a roux-en-y?

A

Healing problems: peritonitis, hernias, stenosis, staple disruption
Long-term: gallstones, neuropathy, GI sx, gastric ulcers

61
Q

What nutritional deficiencies are common s/p Roux-en-Y?

A

iron, B12, folate, calcium, vitamin D

62
Q

What is a sleeve gastrectomy?

A

Greater curvature of the stomach is removed creating a tubular stomach, restrictive weight loss

63
Q

What hormone effect does a sleeve gastrectomy have?

A

Increases GLP-1, decreases ghrelin

64
Q

What are the complications of a sleeve gastrectomy?

A

Healing: Surgical site leak, hernias, staple disruption
Long-term: GERD, neuropathy, N/V

65
Q

What are nutritional deficiencies associated with a sleeve gastrectomy?

A

Iron, B12, Folate, Calcium, Vit D (all same but less than RYGB)

66
Q

What is a laparoscopic adjustable gastric banding?

A

Compartmentalization of the upper portion of the stomach by placement of a restrictive, adjustable prosthetic band

67
Q

What are the complications for a laparoscopic adjustable gastric banding?

A

Band slippage, band erosion, mechanical failure
Long term: esophageal erosion, reoperation, weight regain

68
Q

What is liposuction?

A

Removal of fat tissue via saline injection or aspiration of fat tissue
Cosmetic only, no change in comorbidity development or progression

69
Q

What is aspiration therapy?

A

Percutaneous gastric tube is implanted endoscopically and meals are drained from the stomach

70
Q

What is biliopancreatic division with duodenal switch?

A

Procedure done for BMI >50. Many side effects and technically complex. Gastric size decreased. Small intestine is divided and one tract from stomach to large intestine and other is pancreas to large intestine.

71
Q

What is a intragastric balloon?

A

A saline filled balloon is placed endoscopically in the stomach for 6 months and reduces gastric volume and gives sensation of satiety

Nutrition (5 decks)

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