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PHAR 359 > Obesity > Flashcards

Obesity Flashcards

1
Q

What BMI is considered underweight?

A

<18.5

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2
Q

What BMI is considered healthy range

A

18.5 to <25

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3
Q

What BMI is considered overweight?

A

25 to <30

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4
Q

What BMI is class 1 obesity?

A

30-34.9

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5
Q

What BMI is class 2 obesity?

A

35-39.9

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6
Q

What BMI is class 3 obesity?

A

40+

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7
Q

Waist circumference is strongly associated with CV and all-cause mortality, particularly when adjusting for BMI. What values are considered very high risk for men and women?

A

WC 40.2+ inches (102cm) for men
34.6+ inches (88cm) for women

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8
Q

True or False? BMI is an accurate tool for identifying adiposity-related complications

A

False - it’s not really

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9
Q

Why are we concerned about obesity?

A

Excess adipose tissue is associated with increased morbidity and mortality

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10
Q

Obesity increases the risk of the following cancers: (5)

A
  1. Colon (both sexes)
  2. Kidney (both sexes)
  3. Esophagus (both sexes)
  4. Endometrium (women)
  5. Postmenopausal breast (women)
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11
Q

What are some potential risk factors for obesity? (10)

A
  1. Lower socioeconomic status
  2. Genetic predisposition
  3. Highly processed diet
  4. Physical inactivity
  5. Disordered/insufficient sleep
  6. Stress
  7. Depression, some eating disorders, other mental health conditions
  8. Medications
  9. Childhood obesity
  10. Gut microbiota?
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12
Q

What 2 classes of diabetes meds produce weight loss?

A
  1. SGLT2I’s
  2. GLP1RA’s
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13
Q

What 3 classes of diabetes meds are weight neutral?

A
  1. DPP-4 inhibitors
  2. Acarbose
  3. Metformin
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14
Q

What 4 classes of diabetes meds cause weight gain?

A
  1. Insulin
  2. Sulfonylureas
  3. Meglitinides
  4. TZDs
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15
Q

Obesity has not received official recognition as a chronic disease by the federal/provincial governments. Why?

A

This would be extremely expensive for the government to cover

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16
Q

What are some examples of weight bias/stigma? (2)

A
  1. People who are overweight face judgement
    - From individual people/HCPs
    - From society
  2. People who have overweight or obesity may take all the negative noise and turn it inwards on themselves (internalized weight bias)
    - Important to evaluate mental health
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17
Q

How is the hypothalamus associated with eating?

A

The hypothalamus: helps regulate energy intake and expenditure
- When activated, stimulates hunger sensation and food-seeking behaviour

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18
Q

How is the mesolimbic area associated with eating?

A

The mesolimbic (hedonic area): provides the emotional, pleasurable, rewarding aspects of eating
- Smells, sights, and emotions signal a desire to eat

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19
Q

How is the cognitive lobe associated with eating?

A

The cognitive lobe (executive functioning): helps one control adverse situations (such as overeating at night)
- May be impaired in those with obesity

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20
Q

What are 3 forms of obesity management?

A
  1. Lifestyle (dietary, physical activity, CBT)
  2. Pharmacotherapy
  3. Bariatric surgery
    (Combination of these 3 should be used for ideal outcome)
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21
Q

Most people return to baseline weight within 1-2 years after calorie restriction. Why?

A

Not due to willpower, but rather strong biological mechanisms that protect the body against weight loss

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22
Q

What to consider when it comes to nutritional interventions? (3)

A
  1. There are various diets that can be tried, but they should be patient-specific
    - Refer to dietician when available!
  2. Focus on changes that will improve health, not just weight changes
  3. Consider what is acceptable and affordable for the patient
23
Q

What to know about physical activity and weight loss? (4)

A
  1. Regular physical activity can improve cardiometabolic risk factors and QOL, mood, body image – benefits are partly independent of weight loss
  2. Aerobic Exercise:
    - Goal of 30-60min of moderate to vigorous aerobic activity on most days (≥ 150min/week)
  3. Resistance training:
    - May promote weight maintenance
    - Increase muscle mass
  4. Decrease sedentary time
24
Q

True or False? The more weight a person can lose, the more health benefits they can expect to see

25
Q

Weight loss drugs face some challenges, such as? (4)

A
  1. Perception of obesity not being a disease
  2. Perception these drugs are not effective
  3. Skepticism
  4. Cost
26
Q

What are 4 big options for obesity drugs?

A
  1. Orlistat
  2. Liraglutide
  3. Naltrexone/bupropion
  4. Semaglutide
27
Q

What is the MOA of orlistat? (4)

A
  1. Reversible lipase inhibitor in the GI tract
  2. Lipases hydrolyze dietary fats, converting them to monoglycerides and triglycerides
  3. Inhibits dietary fat absorption by approximately 30%
  4. As a result, increased fecal fat excretion
28
Q

Describe how orlistat is taken (4)

A
  1. Dose: 120 mg oral capsule TID
  2. Take with, or up to 1 hour after, each meal
  3. Skip a meal (or meal has no fat), skip a dose
  4. Follow a mildly hypocaloric diet with ≤30% calories from fat
29
Q

What are the adverse effects of orlistat? (4)

A

Orlistat is not absorbed significantly; most AE’s are GI
1. Flatulence (sometimes with discharge)
2. Loose, oily stools
3. Fecal urgency / incontinence
4. Abdominal discomfort

30
Q

What are the contraindications of orlistat? (2)

A
  1. Malabsorption syndromes
  2. Cholestasis
31
Q

What are 2 precautions for orlistat use?

A
  1. GI disorders
  2. Hepatic disorders
32
Q

What are some drug interactions to be aware of with orlistat? (3)

A
  1. Separate from multivitamin by at least 2 hours
    - Reduces absorption of fat-soluble vitamins (A,D,E,K)
  2. Decreased Vit. K absorption can increase anticoagulation
    with warfarin
  3. May decrease the absorption of cyclosporine, levothyroxine, anti-epileptic drugs and antiretrovirals – separate dosing times by 3-4 hours
33
Q

What is the MOA of naltrexone/bupropion for weight loss? (3)

A
  1. Naltrexone: an opioid receptor antagonist
    - Prevents beta endorphin-mediated pro-opiomelanocortin autoregulation (works in the brain)
  2. Bupropion: inhibits the reuptake of DA and NE
    - Increases DA in the mesolimbic pathway
  3. Help induce satiety and decrease cravings via actions in the brain (i.e. less cravings and less appetite lead to less food intake)
34
Q

What to know about dosing/administration of naltrexone/bupropion? (3)

A
  1. Follow dosing instructions to minimize seizure risk (rare) and AEs
  2. Avoid taking with high fat meals
  3. Tablets should not be split
35
Q

How to evaluate for efficacy of naltrexone/bupropion?

A

At week 12 of full dose, if 5%+ weight loss not achieved, a response is unlikely

36
Q

What are some common AE’s of naltrexone/bupropion? (6)

A
  1. N/V/D
  2. Constipation
  3. Headache
  4. Dry mouth
  5. Dizziness
  6. Insomnia
37
Q

What are some rare AE’s of naltrexone/bupropion? (2)

A
  1. Seizure
  2. Worsening of depression
38
Q

What are some contraindications of naltrexone/bupropion? (4)

A
  1. Opioid use
  2. Uncontrolled HTN
  3. History of or risk factors for seizures
  4. Bulimia/anorexia
39
Q

What are some drug interactions of naltrexone/bupropion? (3)

A
  1. DI = CYP2B6 & 2D6
    - Inhibitor of 2D6
    - Primarily metabolized by 2B6
  2. MAOIs - do not use within 14 days - increased risk of hypertensive reactions
  3. High fat meal increases systemic absorption
40
Q

What are incretins?

A

Incretins are hormones secreted from the gut in response to food which then stimulates insulin secretion

41
Q

What is the MOA of GLP1RAs? (5)

A
  1. Enhance satiety
  2. Decrease appetite
  3. Delay gastric emptying
  4. Decrease glucagon
  5. Increase insulin
42
Q

Liraglutide is actually indicated for weight loss. What are the adult and peds (12-17) criteria?

A
  1. Adults: BMI ≥30 or ≥27 with at least one weight-related co-morbidity
  2. 12-17yo: inadequate response to diet/exercise & body
    weight >60kg & an initial BMI ≥30kg/m2
43
Q

What are some common AE’s of liraglutide? (3)

44
Q

What are some rare AE’s of liraglutide? (2)

A
  1. Acute pancreatitis
  2. Cholelithiasis
    (Monitor BG and signs/symptoms of pancreatitis)
45
Q

What is a contraindication of liraglutide?

A

Personal history of thyroid cancers

46
Q

What is the dosing of liraglutide (weight loss)

A

Start at 0.6mg SQ daily and increase by 0.6mg weekly until 3mg daily

47
Q

How often is semaglutide dosed?

A

Once weekly

48
Q

What semaglutide brand is technically indicated for weight loss (America)?

49
Q

What is the dosing for semaglutide (for weight loss specifically)?

A

Starting dose = 0.25mg/week and gradually increase every 4 weeks. Target dose = 2.4mg/week

50
Q

What are some “other” medications that may cause some weight loss (not approved for weight loss) (6)

A
  1. Bupropion
  2. Fluoxetine
  3. Topiramate
  4. Methylphenidate
  5. SGLT2i’s
  6. Metformin
51
Q

With a person using drugs for weight loss, when should pharmacotherapy be stopped?

A
  1. Intended to be part of a long-term treatment strategy
  2. If 5%+ weight loss not achieved after 3 months on full/maximum tolerated dose - probably not going to see more.
52
Q

What is the MOA of tirzepatide?

A

GIP and GLP-1RA dual agonist

53
Q

What to know about bariatric surgery for obesity?
That is:
Who?
Success?
Weight loss?
Complications?
When we see best outcomes?

A
  1. Consider in those with BMI 35+
  2. Success depends on appropriate patient selection, education, and follow-up
  3. Can lead to sustainable weight loss - 20-45% weight loss
  4. Post-op complications in ~17%; re-operation rate is ~7%
  5. Has the best outcomes on pts with respect to QoL, long-term weight loss, and resolution of obesity-related diseases
54
Q

How to help children maintain a healthy weight? (2)

A
  1. Healthy eating
    - Eat together as a family
    - Remove distractions
  2. Physical activity
    - Recommendation - 60 minutes of physical activity per day
    - Limit sedentary activities

PHAR 359 (26 decks)

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