Obesity Flashcards
Obesity is determined by ___ and _____
BMI and waist circumference.
and visual inspection of the patient
Estimated ____ of US adults are considered obese
42%
What are some risk factors for obesity?
female
Black, Native American, or Mexican American
Lower income
lower education
Which risk factor category is plays the biggest role?
socioeconomic status
How is BMI calculated?
pt weight/ pt height
BMI may (over/under)estimate weight in pts with high muscle mass
overestimate
BMI may (over/under)estimate weight in pts with low muscle mass or abnormal anatomy
underestimate
T/F: BMI index differentiates for gender
FALSE! no differences for sex
**Underweight BMI is consider ____
< 18.5
**normal weight BMI is consider ____
18.5-24.9
** overweight BMI is consider ____
25-29.9
**obese BMI is consider ____
anything greater or equal to 30
What is considered morbid obesity?
What types of fat are considered more concerning? Less concerning?
visceral is worse than subcutaneous
What types of fat distribution are considered more concerning?
Truncoabdominal is more concerning than gluteofemoral distribution
a male waist circumference needs to be ___
less than 102cm (40in)
a female waist circumference needs to be ___
less than 88cm (35 inches)
male waist/hip ratio needs to be ___
female needs to be ____
1
.88
T/F: BMI should be obtained during their annual wellness exam
FALSE, needs to be obtained at every visit
Obesity is mulitfactorial, name some of the general factors
genetics, behavior, medical factors, psychological factors, and socioeconomics
___ and ____ are the most impactful factors of obesity
lifestyle and diet
Genetic contribution to BMI is about ____ in most cases
40-70%
Name some drug categories that contribute to obesity
Antipsychotics
Mood stabilizers
Antidepressants
Name some factors that can contribute to women gaining weight
men
pregnancy
oral contraceptives
menopause
___________
lifestyle
testosterone: declines with age, more fat and less muscle
____ ethnicity has the increased propensity to be obese
Hispanic
Blacks patients have an increased obesity in _____, less obesity in ___
females
males
_____ of obesity onset in Hispanic and black women as compared to white women
younger age
What behavioral factors lead to increase in obesity?
prolonged TV watching
sleep deprivation
smoking
sleep deprivation is associated with decreased _____ and increased _____(increased hunger and appetite)
leptin (anorexigenic)
ghrelin (orexigenic),
In adopted twin studies BMI of children generally corresponds with _____ parents
biological
not adoptive family
What are some metabolic/homeostatic factors that contribute towards obesity
adaptation
gut hormones
gut flora
**Name the 6 criteria for metabolic syndrome. Need at least 3 of them
- Central (abdominal) obesity
- Low HDL
- Hypertension
- Hyperglycemia
- Hypertriglyceridemia
___% of obese patients meet the criteria for metabolic syndrome
60%
What are some questions you would want to ask your patient when evaluating for obesity
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
What are some PE exam findings that are secondary causes of obesity
Thyroid goiter
Moon facies/buffalo hump
Hirsutism
A patient with a BMI of 20-25 is considered minimal risk for obesity unless ____ and ____ are present. What is the specific intervention?
there is a high waist circumference
or
weight gain or more than 10kg since 18
At pt with a BMI of 25-29.9 is considered minimal risk as long as they do NOT have ___ or _____
CVD or no obesity-related cormorbidities
What is the intervention for a pt with low risk of developing obesity?
counseling on avoiding wt gain, diet advice, physical activity recommendations
Describe the criteria necessary in order to be considered moderate risk of developing obesity? What is the intervention?
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
What is the criteria to be considered high risk of developing obesity? What is the intervention?
BMI of 35 and above
specific diet and exercise plans, multicomponent behavioral intervention, pharmacotherapy, bariatric surgery
____ is a common behavorial interventional strategy that helps pt lose weight
setting realistic goals in terms of how much body weight you want to lose
Losing weight with lifestyle changes alone ____
Lifestyle changes and medication _____
Bariatric surgery ____
Lifestyle changes alone - 5-7%
Lifestyle changes and medication - 5-12% or more
Bariatric surgery - 15-20% or more
_____ has shown to offsetting reduced BEE/BMR that can occur with wt loss and improved functional status (especially in elderly)
exercising
What type of exercise is recommended?
aerobic and resistance for the max benefit
What is the normal recommended exercise weekly schedule?
30 minutes/5 days a week
What do we need to do before a pt becomes active?
assess CV health, pulmonary function and msk health
General weight loss diet principles, minimizing or eliminating _____
caloric beverages
With a reduced calorie intake often aim for ______ a day. Consider initial reduction of ____ from baseline
1000-1500 kcal/day
10-20% (or ~500 kcal/day)
What is the most important consideration when formulating a diet plan for patient
patient compliance!!
______ treatments are usually preferred prior to starting combination therapy
single-agent
Orlistat, liraglutide, semaglutide, Qsymia are approved for what ages?
12+
Most anti-obesity prescription are approved for what BMI?
BMI at or above 30
or
may use for BMI at or above 27 with obesity-related comorbidity
Anti-obesity rx are usually prescribed for ___ weeks
12 weeks
_____ sympathomimetic - stimulates NE release
Phentermine (Adipex)
_____ Schedule IV medication - only approved for short-term use (12 wks)
Previously, the MC prescribed rx for wt loss in the US
Phentermine (Adipex)
What side effects are the SE of Phentermine (Adipex)?
HTN, increased HR, insomnia, agitation, palpitations, constipation, dry mouth
What are the CI of Phentermine (Adipex)
Cardiovascular disease, hyperthyroidism, agitated state, glaucoma, hx of substance abuse, use within 14 days of MAOi, pregnancy, breastfeeding
What are the DDI of Phentermine (Adipex)?
psych meds, antihypertensives, antihistamines, insomnia meds
________ stimulates NE release/anticonvulsant
Phentermine/Topiramate (Qsymia)
What schedule and how long should you prescribe Phentermine/Topiramate (Qsymia)?
schedule 4: only approved for 12 weeks
Name some SE of Phentermine/Topiramate (Qsymia)?
dry mouth, constipation, paresthesia, depression, brain fog, HA, altered taste,
What are the CI of Phentermine/Topiramate (Qsymia)?
Hyperthyroidism, glaucoma, hx of substance abuse, use within 14 days of MAOi, pregnancy, breastfeeding
_____ inhibits intestinal lipase, blocking fat absorption
Orlistat (Alli, Xenical)
Is Orlistat (Alli, Xenical) dose dependent?
Dose-dependent increase in fecal fat excretion
What are the SE of Orlistat (Alli, Xenical)?
GI complaints
borborygmi
cramps
flatus
oily spotting
fecal incontinence
What are the CI to Orlistat (Alli, Xenical)?
pregnancy
cholestasis
hx of calcium oxalate stones
chronic malabsorption syndrome
____ agonist of glucagon-like-peptide-1 (GLP-1) receptors
liraglutide
semaglutide
What is the dosing difference between Liraglutide and Semaglutide
Liraglutide: target dose of 3 mg SC daily
**Semaglutide: target dose of 2.4 mg SC weekly or daily oral dose
What are the SE of GLP-1 Agonists (liraglutide, semaglutide)?
N/V/D
hypoglycemia
anorexia
What are the CI for (liraglutide, semaglutide) and Tirzapetide (Mounjaro, Zepbound).?
pregnancy
personal or family hx of medullary thyroid cancer or MEN2A or 2B
_____ agonist of GLP-1 and GIP receptors
Tirzapetide (Mounjaro, Zepbound).
____ : expands in the GI tract to create a sensation of satiety and is considered a medical device
Cellulose and Hydrogel (Plenity)
What are the SE of Cellulose and Hydrogel (Plenity)?
Diarrhea, abdominal distension, pain
do not give in pregnancy
____ opioid antagonist/norepinephrine and dopamine reuptake inhibitor
Naltrexone SR/Bupropion SR (Contrave)
What are the SE of Naltrexone SR/Bupropion SR (Contrave)?
Nausea, constipation, HA, vomiting, dry mouth
(not recommended as first line medication)
What are the CI for Naltrexone SR/Bupropion SR (Contrave)?
pregnancy, uncontrolled HTN, epilepsy, bulimia or anorexia
____ alleged to increase metabolic rate and suppress appetite
Human Chorionic Gonadotropin (HCG)
____ 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
Human Chorionic Gonadotropin (HCG)
Who is a surgical candidate for bariatric surgery?
BMI greater than and equal to 35
BMI greater than 30 with 1 obesity related comorbidity
Name some obesity related comorbities.
T2DM, HTN, HLD, OSA, NAFLD/NASH, OHS, GERD, asthma, pseudotumor cerebri, severe OA, severe UI, impaired quality of life, unable to get other surgery
What are some CI to bariatric surgery?
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)
_____ monoclonal antibody that inhibits activin type II receptors, promotes weight loss and lean muscle growth (phase 2)
Bimagrumab (BYM338):
Roux-en-Y Gastric Bypass (RYGB) what is the premise of the surgery? Is it restrictive or malabsorptive
A small (30 mL) gastric pouch is anastomosed to the small bowel
both restrictive and malabsorptive
What are some complications of Roux-en-Y Gastric Bypass (RYGB)?
peritonitis due to anastomotic leak; abdominal wall hernias; stenosis; staple disruption, gallstones; neuropathy; GI symptoms, including ulcers, iron, vitamin B12, folate, calcium, vitamin D
_____ of excess weight is lost after a Roux-en-Y Gastric Bypass (RYGB) and up to ____ of patients include complication
70% of excess weight
40% of patients experience complications
_____ removal of greater curvature of the stomach, leading to a tubular stomach
Sleeve Gastrectomy (SG)
Is Roux-en-Y Gastric Bypass (RYGB) or Sleeve Gastrectomy (SG) considered more invasive? Which one has more side effects?
Roux-en-Y Gastric Bypass (RYGB) is more drastic and has more SE
Sleeve Gastrectomy (SG) complications that are more than RYGB include: ____ and ______
surgical site leak and long term GERD
Which vitamin has less complications in SG than RYGB?
Vitamin D
____ Compartmentalization of the upper portion of the stomach by placement of a restrictive, adjustable prosthetic band
Laparoscopic Adjustable Gastric Banding (LAGB)
_____ has the highest rate of revision and weight gain
Laparoscopic Adjustable Gastric Banding (LAGB)
_____ mainly done for severely obese individuals (BMI of 50+)
Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
has lots of complications
Describe what is happening in the Intragastric Balloon?
Saline-filled balloon placed endoscopically for max 6 month period
Promotes a feeling of satiety and reduces gastric volume
Describe what is happening in aspiration therapy
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
