Obesity Flashcards
What BMI is considered overweight?
> 25
What is the BMD formula?
= kg/m squared
What is healthy range of BMI?
18.5-25
Limitations of BMI?
doesn’t account for muscle mass, waist size, age, child growing, race, ill, pregnant
What is a very high risk waist size for men and women?
Men= >102 cm
women= 88 cm
What is preclinical obesity?
excess adipose tissue without limitations or organ dysfunction
Complications of obesity?
DM, gallbladder disease, NFLD
gout
Risk factors for obesity?
Low money
genetic
bad diet, stress, depression, meds
Why doesn’t Sask consider obesity a chronic disease?
do not want to pay for the medications
Is dietary restrictions for obesity a good option?
good to try but alone doesn’t seem to last (only 1-2 years
Why does diet restriction sometimes not help for obese patients?
body has strong mechanisms to prevent weight loss
Should diet be focused on weight loss?
NO- be healthier
What is the goal for exercise?
> 150 min a week
Are NHP good for weight loss?
FUH NO
What are the reasons many weight loss drugs were removed from he marker?
heart and stroke issues
suicide, cancer
ALL are CNS stimulants= addiction
How does orlistat work?
pancreatic lipase inhibitor= stop break down of fat= can’t absorb it
True or false orlistat decreases appetite?
FALSE
How does liraglutide work?
GLP-1 analog= low hunger, more satiety
How does naltrexone/buproprion work?
increase satiety and lower cravings and hunger
How does semaglutide work?
Another GLP= less appetite, less cravings and hunger and energy intake
Is orlistat a reversible or irreversible inhibitor?
reversible
Main s/e with orlistat?
fatty stools, farts, incontinence, ab issues
When do you take orlistat?
ONLY with meal that has fat or up to 1 hr after each meal
Who can’t use orlistat?
cholestasis, malabsorption syndromes
DI with orlistat?
space multivitamin due to decreased absorb
may make warfarin stronger due to less vitamin K
If someone can’t afford naltrexone and bupropion can they just take one of them?
Need both
How does Bupropion work?
decreased resorb of DA and NE
How do we evaluate efficacy of weight loss meds?
if >5% weight loss at 12 weeks
Administration instructions for nal/bup?
no with fat meal(increases absorb, do not split tablets
S/e of bup/nal
NVDC, seizures, depression
Who can’t use bup/nal?
opioid userws, seizures, anorexia
What CYP does bup use and inhibit?
uses 2B6 and inhibits 2D6
What are incretins?
GIP and GLP
Where do you inject liraglutide?
ab, thigh or upper arm
Dose for liraglutide?
start at 0.6 DAILY then go up to 3
S/e of liraglutide?
N,V,D pancreatitis
CI of liraglutide?
thyroid cancer
How long does nausea last for semaglutide?
36 hours after
Target dose of semaglutide?
2.4mg
Does semaglutide have other benefits?
yes- decrease in MACE and CKD
What is the black box s/e for GLP?
suicide risk
What injection is daily?
liraglutide
Most effective weight loss agent?
semaglutide
How many times a day for bup/nal?
BID
Least effective weight loss agent?
Bup/nal
What happens after stopping weight loss agents?
weight returns
How does tirzepatide work?
GIP and GLP for weight loss
Who is tirzepatide only indicated in?
t2DM
What is an issue with tirzepatide?
longer trial due to titration being so slow
Differences between GIP and GLP?
GIP= LESS nausea
GLP= increases satiety and nausea
Is there any coverage for tirzepatide?
NO
What is coming soon to semaglutide?
generic
When to consider bariatric surgery?
BMI>35
How much weight loss can bariatric surgery give?
25-45%
Why is bariatric surgery good vs bad?
good= best evidence of improve QoL, loss, and resolution of obesity related dz such as T2DM
Bad= lots of complications
What are the three types of bariatric surgeries?
gastric bypass
sleeve gastrectomy
gastric banding
How much weight loss MAY decrease CV events?
5-10%%
What is the only covered thing for obesity?
bariatric surgery BUUUUT wait times long
