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Nutrition > Obesity > Flashcards

Obesity Flashcards

1
Q

Obesity is determined by ___ and _____

A

BMI and waist circumference.

and visual inspection of the patient

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2
Q

Estimated ____ of US adults are considered obese

A

42%

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3
Q

What are some risk factors for obesity?

A

female
Black, Native American, or Mexican American
Lower income
lower education

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4
Q

Which risk factor category is plays the biggest role?

A

socioeconomic status

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5
Q

How is BMI calculated?

A

pt weight/ pt height

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6
Q

BMI may (over/under)estimate weight in pts with high muscle mass

A

overestimate

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7
Q

BMI may (over/under)estimate weight in pts with low muscle mass or abnormal anatomy

A

underestimate

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8
Q

T/F: BMI index differentiates for gender

A

FALSE! no differences for sex

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9
Q

**Underweight BMI is consider ____

A

< 18.5

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10
Q

**normal weight BMI is consider ____

A

18.5-24.9

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11
Q

** overweight BMI is consider ____

A

25-29.9

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12
Q

**obese BMI is consider ____

A

anything greater or equal to 30

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13
Q

What is considered morbid obesity?

A
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14
Q

What types of fat are considered more concerning? Less concerning?

A

visceral is worse than subcutaneous

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15
Q

What types of fat distribution are considered more concerning?

A

Truncoabdominal is more concerning than gluteofemoral distribution

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16
Q

a male waist circumference needs to be ___

A

less than 102cm (40in)

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17
Q

a female waist circumference needs to be ___

A

less than 88cm (35 inches)

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18
Q

male waist/hip ratio needs to be ___

female needs to be ____

A

1

.88

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19
Q

T/F: BMI should be obtained during their annual wellness exam

A

FALSE, needs to be obtained at every visit

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20
Q

Obesity is mulitfactorial, name some of the general factors

A

genetics, behavior, medical factors, psychological factors, and socioeconomics

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21
Q

___ and ____ are the most impactful factors of obesity

A

lifestyle and diet

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22
Q

Genetic contribution to BMI is about ____ in most cases

A

40-70%

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23
Q

Name some drug categories that contribute to obesity

A

Antipsychotics
Mood stabilizers
Antidepressants

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24
Q

Name some factors that can contribute to women gaining weight

men

A

pregnancy
oral contraceptives
menopause
___________

lifestyle
testosterone: declines with age, more fat and less muscle

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25
Q

____ ethnicity has the increased propensity to be obese

A

Hispanic

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26
Q

Blacks patients have an increased obesity in _____, less obesity in ___

A

females

males

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27
Q

_____ of obesity onset in Hispanic and black women as compared to white women

A

younger age

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28
Q

What behavioral factors lead to increase in obesity?

A

prolonged TV watching
sleep deprivation
smoking

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29
Q

sleep deprivation is associated with decreased _____ and increased _____(increased hunger and appetite)

A

leptin (anorexigenic)

ghrelin (orexigenic),

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30
Q

In adopted twin studies BMI of children generally corresponds with _____ parents

A

biological

not adoptive family

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31
Q

What are some metabolic/homeostatic factors that contribute towards obesity

A

adaptation
gut hormones
gut flora

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32
Q

**Name the 6 criteria for metabolic syndrome. Need at least 3 of them

A
  • Central (abdominal) obesity
  • Low HDL
  • Hypertension
  • Hyperglycemia
  • Hypertriglyceridemia
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33
Q

___% of obese patients meet the criteria for metabolic syndrome

A

60%

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34
Q

What are some questions you would want to ask your patient when evaluating for obesity

A

Age at onset of obesity
Recent weight changes
Family history of obesity
History of weight loss attempts
Alcohol or tobacco use
Illicit substances
Obesity-related conditions
Medication list
Anxiety or mood disorders
Binging/purging behavior
Exercise behavior

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35
Q

What are some PE exam findings that are secondary causes of obesity

A

Thyroid goiter
Moon facies/buffalo hump
Hirsutism

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36
Q

A patient with a BMI of 20-25 is considered minimal risk for obesity unless ____ and ____ are present. What is the specific intervention?

A

there is a high waist circumference
or
weight gain or more than 10kg since 18

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37
Q

At pt with a BMI of 25-29.9 is considered minimal risk as long as they do NOT have ___ or _____

A

CVD or no obesity-related cormorbidities

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38
Q

What is the intervention for a pt with low risk of developing obesity?

A

counseling on avoiding wt gain, diet advice, physical activity recommendations

39
Q

Describe the criteria necessary in order to be considered moderate risk of developing obesity? What is the intervention?

A

BMI of 25-29.9 with 1+ CVD risk factors, or BMI of 30-34.9

Specific tools and strategies for dietary changes, increased physical activity from baseline (even if already active), behavioral intervention, pharmacotherapy

40
Q

What is the criteria to be considered high risk of developing obesity? What is the intervention?

A

BMI of 35 and above

specific diet and exercise plans, multicomponent behavioral intervention, pharmacotherapy, bariatric surgery

41
Q

____ is a common behavorial interventional strategy that helps pt lose weight

A

setting realistic goals in terms of how much body weight you want to lose

42
Q

Losing weight with lifestyle changes alone ____
Lifestyle changes and medication _____
Bariatric surgery ____

A

Lifestyle changes alone - 5-7%
Lifestyle changes and medication - 5-12% or more
Bariatric surgery - 15-20% or more

43
Q

_____ has shown to offsetting reduced BEE/BMR that can occur with wt loss and improved functional status (especially in elderly)

A

exercising

44
Q

What type of exercise is recommended?

A

aerobic and resistance for the max benefit

45
Q

What is the normal recommended exercise weekly schedule?

A

30 minutes/5 days a week

46
Q

What do we need to do before a pt becomes active?

A

assess CV health, pulmonary function and msk health

47
Q

General weight loss diet principles, minimizing or eliminating _____

A

caloric beverages

48
Q

With a reduced calorie intake often aim for ______ a day. Consider initial reduction of ____ from baseline

A

1000-1500 kcal/day

10-20% (or ~500 kcal/day)

49
Q

What is the most important consideration when formulating a diet plan for patient

A

patient compliance!!

50
Q

______ treatments are usually preferred prior to starting combination therapy

A

single-agent

51
Q

Orlistat, liraglutide, semaglutide, Qsymia are approved for what ages?

A

12+

52
Q

Most anti-obesity prescription are approved for what BMI?

A

BMI at or above 30
or
may use for BMI at or above 27 with obesity-related comorbidity

53
Q

Anti-obesity rx are usually prescribed for ___ weeks

A

12 weeks

54
Q

_____ sympathomimetic - stimulates NE release

A

Phentermine (Adipex)

55
Q

_____ Schedule IV medication - only approved for short-term use (12 wks)
Previously, the MC prescribed rx for wt loss in the US

A

Phentermine (Adipex)

56
Q

What side effects are the SE of Phentermine (Adipex)?

A

HTN, increased HR, insomnia, agitation, palpitations, constipation, dry mouth

57
Q

What are the CI of Phentermine (Adipex)

A

Cardiovascular disease, hyperthyroidism, agitated state, glaucoma, hx of substance abuse, use within 14 days of MAOi, pregnancy, breastfeeding

58
Q

What are the DDI of Phentermine (Adipex)?

A

psych meds, antihypertensives, antihistamines, insomnia meds

59
Q

________ stimulates NE release/anticonvulsant

A

Phentermine/Topiramate (Qsymia)

60
Q

What schedule and how long should you prescribe Phentermine/Topiramate (Qsymia)?

A

schedule 4: only approved for 12 weeks

61
Q

Name some SE of Phentermine/Topiramate (Qsymia)?

A

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

62
Q

What are the CI of Phentermine/Topiramate (Qsymia)?

A

Hyperthyroidism, glaucoma, hx of substance abuse, use within 14 days of MAOi, pregnancy, breastfeeding

63
Q

_____ inhibits intestinal lipase, blocking fat absorption

A

Orlistat (Alli, Xenical)

64
Q

Is Orlistat (Alli, Xenical) dose dependent?

A

Dose-dependent increase in fecal fat excretion

65
Q

What are the SE of Orlistat (Alli, Xenical)?

A

GI complaints
borborygmi
cramps
flatus
oily spotting
fecal incontinence

66
Q

What are the CI to Orlistat (Alli, Xenical)?

A

pregnancy
cholestasis
hx of calcium oxalate stones
chronic malabsorption syndrome

67
Q

____ agonist of glucagon-like-peptide-1 (GLP-1) receptors

A

liraglutide
semaglutide

68
Q

What is the dosing difference between Liraglutide and Semaglutide

A

Liraglutide: target dose of 3 mg SC daily

**Semaglutide: target dose of 2.4 mg SC weekly or daily oral dose

69
Q

What are the SE of GLP-1 Agonists (liraglutide, semaglutide)?

A

N/V/D
hypoglycemia
anorexia

70
Q

What are the CI for (liraglutide, semaglutide) and Tirzapetide (Mounjaro, Zepbound).?

A

pregnancy
personal or family hx of medullary thyroid cancer or MEN2A or 2B

71
Q

_____ agonist of GLP-1 and GIP receptors

A

Tirzapetide (Mounjaro, Zepbound).

72
Q

____ : expands in the GI tract to create a sensation of satiety and is considered a medical device

A

Cellulose and Hydrogel (Plenity)

73
Q

What are the SE of Cellulose and Hydrogel (Plenity)?

A

Diarrhea, abdominal distension, pain

do not give in pregnancy

74
Q

____ opioid antagonist/norepinephrine and dopamine reuptake inhibitor

A

Naltrexone SR/Bupropion SR (Contrave)

75
Q

What are the SE of Naltrexone SR/Bupropion SR (Contrave)?

A

Nausea, constipation, HA, vomiting, dry mouth

(not recommended as first line medication)

76
Q

What are the CI for Naltrexone SR/Bupropion SR (Contrave)?

A

pregnancy, uncontrolled HTN, epilepsy, bulimia or anorexia

77
Q

____ alleged to increase metabolic rate and suppress appetite

A

Human Chorionic Gonadotropin (HCG)

78
Q

____ is nearly always given along with very low-cal diet (200-800 kcal/day) but is not recommended by any evidence based organization for weight loss

A

Human Chorionic Gonadotropin (HCG)

79
Q

Who is a surgical candidate for bariatric surgery?

A

BMI greater than and equal to 35
BMI greater than 30 with 1 obesity related comorbidity

80
Q

Name some obesity related comorbities.

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

81
Q

What are some CI to bariatric surgery?

A

Not obese - to tx of HLD, DM, or to reduce CV risk w/o obesity

Inability to comply with nutritional requirements

Age - less commonly done in pts < 18 or > 65

Severe cardiac disease (cannot undergo anesthesia)

Severe coagulopathy

Current ETOH or drug use

Psych - uncontrolled/untreated depression, psychosis, eating disorders (especially bulimia)

82
Q

_____ monoclonal antibody that inhibits activin type II receptors, promotes weight loss and lean muscle growth (phase 2)

A

Bimagrumab (BYM338):

83
Q

Roux-en-Y Gastric Bypass (RYGB) what is the premise of the surgery? Is it restrictive or malabsorptive

A

A small (30 mL) gastric pouch is anastomosed to the small bowel

both restrictive and malabsorptive

84
Q

What are some complications of Roux-en-Y Gastric Bypass (RYGB)?

A

peritonitis due to anastomotic leak; abdominal wall hernias; stenosis; staple disruption, gallstones; neuropathy; GI symptoms, including ulcers, iron, vitamin B12, folate, calcium, vitamin D

85
Q

_____ of excess weight is lost after a Roux-en-Y Gastric Bypass (RYGB) and up to ____ of patients include complication

A

70% of excess weight

40% of patients experience complications

86
Q

_____ removal of greater curvature of the stomach, leading to a tubular stomach

A

Sleeve Gastrectomy (SG)

87
Q

Is Roux-en-Y Gastric Bypass (RYGB) or Sleeve Gastrectomy (SG) considered more invasive? Which one has more side effects?

A

Roux-en-Y Gastric Bypass (RYGB) is more drastic and has more SE

88
Q

Sleeve Gastrectomy (SG) complications that are more than RYGB include: ____ and ______

A

surgical site leak and long term GERD

89
Q

Which vitamin has less complications in SG than RYGB?

A

Vitamin D

90
Q

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

A

Laparoscopic Adjustable Gastric Banding (LAGB)

91
Q

_____ has the highest rate of revision and weight gain

A

Laparoscopic Adjustable Gastric Banding (LAGB)

92
Q

_____ mainly done for severely obese individuals (BMI of 50+)

A

Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

has lots of complications

93
Q

Describe what is happening in the Intragastric Balloon?

A

Saline-filled balloon placed endoscopically for max 6 month period
Promotes a feeling of satiety and reduces gastric volume

94
Q

Describe what is happening in aspiration therapy

A

Percutaneous gastrostomy tube is implanted endoscopically
20-30 min after meals, patients can open the tube and drain part of the food that has just been ingested into the toilet

Nutrition (11 decks)

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