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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
How long are obesity Rx used for?
Usually 12 weeks or less
26
What is the MOA of phentermine?
stimulates NE release which suppresses appetite and causes early satiety
27
What are the SE of phentermine?
HTN, tachycardia, insomnia, agitation, palpitations, constipation, dry mouth
28
What are the CI of phentermine?
Allergy, CV disease, hyperthyroidism, agitated state, glaucoma, substance use hx, within 2 weeks of an MAOI, pregnancy, breastfeeding
29
What are the DDI of phentermine?
psych meds, antihypertensives, antihistamines, insomnia meds
30
What is the MOA of orlistat?
Inhibits intestinal lipase, blocking fat absorption
31
What are the SE of orlistat?
borborygmi (loud BS), flatus, oily spotting, fecal incontinence, decreased fat soluble vitamin absorption, liver injury, calcium oxalate stones, AKI
32
What are the CI of orlistat?
Allergy, pregnancy, cholestasis/cholelithiasis, h/o calcium oxalate stones, chronic malabsorption syndrome
33
What are the DDI of orlistat?
Multivitamins, fat-soluble vitamins, Warfarin, levothyroxine
34
What is lorcaserin?
serotonin agonist for serotonin 2C receptor (suppresses appetite) No longer available due to cancer risk
35
What is the MOA of liraglutide and semaglutide?
Agonist of GLP-1 receptors (originally for diabetes) Increase insulin, decrease glucagon, slow gastric emptying
36
What are the SE of liraglutide and semaglutide?
Nausea, Vomiting, Diarrhea, hypoglycemia, anorexia, pancreatitis, gallbladder disease, kidney injury
37
What are the CI for liraglutide and semaglutide?
Allergy, pregnancy, personal or fam h/o medullary thyroid cancer or MEN 2A or 2B
38
What are the DDI for liraglutide and semaglutide?
Other hypoglycemic agents, serotonergic drugs, thiazides
39
What is the MOA for tirzapetide?
Agonist of GLP-1 and GIP receptors inc insulin, dec glucagon, dec gastric emptying Thought to work better than GLP-1 agonist alone
40
What are the SE of tirzapetide?
Nausea, Vomiting, Diarrhea, hypoglycemia, anorexia, pancreatitis, gallbladder disease, kidney injury
41
What are the CI of tirzapetide?
Allergy, pregnancy, personal or fam h/o medullary thyroid cancer or MEN 2A or 2B
42
What are the DDI of tirzapetide?
Other hypoglycemic agents, serotonergic drugs, thiazides
43
What is the MOA of cellulose and hydrogel?
Expand in the GI tract to create a sensation of satiety
44
What are the SE of cellulose and hydrogel?
Diarrhea, abdominal distension, abdominal pain, "adverse effects"
45
What are the CI of cellulose and hydrogel?
Allergy, pregnancy
46
What are the DDI of cellulose and hydrogel?
None
47
What is the MOA of naltrexone/bupropion?
Opioid antagonist/norepinephrine and dopamine reuptake inhibitor. Unclear why effective in weightloss
48
What are the SE of naltrexone/bupropion?
Nausea, constipation, HA, vomiting, dry mouth, agitated mood, insomnia, HTN, tachycardia, palpitations Not first line medication
49
What are the CI of naltrexone/bupropion?
Allergy, pregnancy, HTN, epilepsy, bulimia, anorexia
50
What are the DDI of naltrexone/bupropion?
ETOH, psych meds, opiates, metoprolol
51
What is the MOA of phentermine/topiramate?
Stimulates NE release/anticonvulsant. Schedule IV med. Suppresses appetite/early satiety
52
What is the SE of phentermine/topiramate?
Dry mouth, constipation, paresthesia, depression, brain fog, HA, altered taste
53
What are the CI of phentermine/topiramate?
Allergies, hyperthyroidism, glaucoma, substance use hx, 2 weeks of MAOI, pregnancy
54
What are the DDI of phentermine/topiramate?
ETOH, psych meds, antihypertensives, insomnia meds, loop diuretics, metformin
55
What is the MOA of human chorionic gonadotropin?
alleged to increase metabolic rate and suppress appetite. Nearly always given with low calorie diet...so that's probably why
56
Who is a candidate for weight loss surgery?
BMI >40 BMI >35 with 1 or more comorbidities BMI >30 with a severe comorbidity
57
What are obesity related comorbidities?
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
What is the most common bariatric surgery?
Roux-en-Y (47%)
59
What is a roux-en-Y?
Small gastric pouch is connected to the small bowel causing both restrictive and malabsorptive weight loss
60
What are complications of a roux-en-y?
Healing problems: peritonitis, hernias, stenosis, staple disruption Long-term: gallstones, neuropathy, GI sx, gastric ulcers
61
What nutritional deficiencies are common s/p Roux-en-Y?
iron, B12, folate, calcium, vitamin D
62
What is a sleeve gastrectomy?
Greater curvature of the stomach is removed creating a tubular stomach, restrictive weight loss
63
What hormone effect does a sleeve gastrectomy have?
Increases GLP-1, decreases ghrelin
64
What are the complications of a sleeve gastrectomy?
Healing: Surgical site leak, hernias, staple disruption Long-term: GERD, neuropathy, N/V
65
What are nutritional deficiencies associated with a sleeve gastrectomy?
Iron, B12, Folate, Calcium, Vit D (all same but less than RYGB)
66
What is a laparoscopic adjustable gastric banding?
Compartmentalization of the upper portion of the stomach by placement of a restrictive, adjustable prosthetic band
67
What are the complications for a laparoscopic adjustable gastric banding?
Band slippage, band erosion, mechanical failure Long term: esophageal erosion, reoperation, weight regain
68
What is liposuction?
Removal of fat tissue via saline injection or aspiration of fat tissue Cosmetic only, no change in comorbidity development or progression
69
What is aspiration therapy?
Percutaneous gastric tube is implanted endoscopically and meals are drained from the stomach
70
What is biliopancreatic division with duodenal switch?
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
What is a intragastric balloon?
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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