OBESITY

Question 1

Excess abdominal fat, assessed by measurement of waist circumference, is independently associated with a higher risk for metabolic syndrome, diabetes mellitus, and cardiovascular disease

Question 2

For all patients, a fasting lipid profile (total, low-density lipoprotein, and high-density lipoprotein cholesterol and triglyceride levels), chemistry panel, and glycated hemoglobin should be performed, and blood pressure determined.

Question 3

Therapy for obesity always begins with lifestyle management and may include pharmacotherapy or bariatric surgery, depending on BMI risk category. Setting an initial weight-loss goal of 8–10% over 6 months is a realistic target

Question 4

The primary focus of diet therapy is to reduce overall calorie consumption.

Answer 4

AHA/ACC/TOS recommend initiating treatment with a calorie deficit of 500–750 kcal/d compared with the patient’s habitual diet.

Alternatively, a diet of 1200–1500 kcal/d for women and 1500–1800 kcal/d for men (adjusted for the individual’s body weight) can be prescribed. This reduction is consistent with a goal of losing ~1–2 lb/week

Question 5

The 2018 Physical Activity Guidelines for Americans (www.health.gov/paguidelines) recommend that adults should engage in 150 min of moderate-intensity or 75 min a week of vigorous-intensity aerobic physical activity per week, preferably spread throughout the week

Answer 5

A high level of physical activity (>300 min of moderate-intensity activity per week) is often needed to lose weight and sustain weight loss.

Question 6

Adjuvant pharmacologic treatments should be considered for patients with a BMI ≥30 kg/m2 or for patients with a BMI ≥27 kg/m2 who have concomitant obesity-related diseases and for whom dietary and physical activity therapy has not been successful

Question 7

Lorcaserin was approved by the FDA for chronic weight management in 2012 and taken off the market in 2020. Lorcaserin was developed as a selective 5-HT2C receptor agonist with a functional selectivity ~15 times that of 5-HT2A receptors and 100 times that of 5-HT2B receptors.

Answer 7

However, a postmarketing cardiovascular
outcome trial found that more patients taking lorcaserin (7.7%) were diagnosed with cancer compared to those taking a
placebo (7.1%).

Question 8

Naltrexone SR/bupropion SR (NB) is a combination of an opioid
antagonist and a mild reuptake inhibitor of dopamine and norepinephrine,
respectively.

Question 9

Liraglutide, the fourth new medication, is a glucagon-like peptide-1 (GLP-1) analogue with 97% homology to human GLP-1 that was previously approved for the treatment of type 2 diabetes at doses up to 1.8 mg once daily. In addition to its effect as an incretin hormone (glucose-induced insulin secretion), liraglutide inhibits both gastric emptying and glucagon secretion and stimulates GLP-1 receptors
in the arcuate nucleus of the hypothalamus to reduce feeding.

Question 10

Orlistat is a synthetic hydrogenated
derivative of a naturally occurring lipase inhibitor, lipostatin, that is produced by the mold Streptomyces toxytricini. This drug
is a potent, slowly reversible inhibitor of pancreatic, gastric, and carboxylester lipases and phospholipase A2, which are required for
the hydrolysis of dietary fat into fatty acids and monoacylglycerols.

Answer 10

Orlistat acts in the lumen of the stomach and small intestine by forming a covalent bond with the active site of these lipases. Taken at a therapeutic dose of 120 mg tid, orlistat blocks the digestion and absorption of ~30% of dietary fat. After discontinuation of the drug, fecal fat content usually returns to normal within 48–72 h.