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Obesity Flashcards

1
Q

Is obesity considered a chronic medical disease?

A

Yes

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2
Q

What BMI defines obesity

A

> 30

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3
Q

BMI - Class 1 Obesity

A

30 - 34.9

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4
Q

BMI - Class 2 Obesity

A

35 - 39.9

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5
Q

BMI - Class 3 Obesity

A

> 40

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6
Q

BMI - underweight

A

<18.5

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7
Q

BMI - healthy range

A

18.5 to <25

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8
Q

BMI - overweight

A

25 to <30

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9
Q

What are some limitations of BMI?

A
  • does not represent body composition
  • does not consider waist size
  • was not intended for individual assessment
  • inaccuracies in certain populations: older adults, those who are ill, pregnancy, ethnicities, growing children/adolescents
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10
Q

Low risk waist circumference (men and women)

A

Men: <37 inches
Women: < 31.5 inches

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11
Q

High risk waist circumference (men and women)

A

Men: >37 inches
Women >31.5 inches

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12
Q

Very High Risk Waist Circumference (Men and Women)

A

Men: >40.2 inches
Women: > 34.6 inches

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13
Q

What is waist circumference strongly associated with?

A

CV and all cause mortality

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14
Q

What is preclinical obesity?

A

a condition of excess adiposity without current organ dysfunction or limitations in daily activities but with increased future health risk

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15
Q

What is clinical obesity?

A

associated with organ dysfunction or limitations

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16
Q

Why are we concerned about obesity?

A

excess adipose tissue is associated with increased morbidity and mortality

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17
Q

What are some complications of obesity?

A

Type 2 Diabetes, Gallbladder disease, non-alcoholic fatty liver disease, gout

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18
Q

What cancers does obesity increase the risk of?

A

colon, kidney, esophagus (both sexes)

endometrium, postmenopausal breast (women only)

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19
Q

What are some risk factors for obesity?

A

lower socioeconomic status, genetic predisposition, highly processed diet, physical inactivity, disordered/insufficient sleep, stress, depression, some eating disorders, other mental health conditions, medications, childhood obesity, ?gut microbiota

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20
Q

What are diabetes medications that produce weight loss?

A

SGLT2is and GLP1RAs

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21
Q

What are diabetes medications that are weight neutral?

A

DPP4i, acarbose, metformin (but maybe weight loss)

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22
Q

What diabetes medications produce weight gain?

A

insulin, sulfonylureas, meglitinides, TZDs

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23
Q

What are the 3 realms of obesity management?

A

lifestyle, pharmacotherapy, bariatric surgery

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24
Q

What % weight loss is achieved with behavioural alone

A

1-5%

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25
What % weight loss is achieved with behavioural and pharmacotherapy management?
5-15%
26
What % weight loss is achieved with behavioural and surgery?
20-40%
27
In order to lose weight caloric expenditure must be________
greater than caloric intake
28
Is calorie-restriction sustainable long term?
NO not due to willpower, but rather strong biological mechanisms that protect the body against weight loss
29
What can 0-5% of weight loss achieve (comorbidity terms)?
hypertension hyperglycemia
30
What can 5-10% of weight loss achieve (comorbidity terms)?
prevention of T2D, NAFLD, PCOS, dyslipidemia
31
What can 10-15% of weight loss achieve (comorbidity terms)?
cardiovascular disease, OSAS, urinary stress incontinence, GERD, NASH, knee OA
32
What can >15% of weight loss achieve (comorbidity terms)?
T2D remission, CV mortality, HFpEF
33
MOA of Orlistat
pancreatic lipase inhibitor inhibits breakdown of triglycerides into free fatty acids - essentially increases fecal fat excretion
34
MOA of naltrexone/bupropion
opioid receptor antagonist
35
What effect does Naltrexone/Bupropion have?
increases satiety decreases cravings decreases hunger
36
How does liraglutide work in obesity/effect it has?
increases satiety increases insulin release decreases hunger decreases gastric emptying decreases glucagon with glucose increase
37
How does semaglutide work in obesity/ effect it has?
decrease energy intake decrease frequency of cravings decrease glucose levels and glucagon secretion decrease hunger increase appetite regulation increase insulin release
38
How is Orlistat taken?
120mg oral capsule TID taken with or up to 1 hour after each meal If you skip a meal or a meal has no fat, skip a dose (following a low fat diet will help reduce side effects)
39
Adverse Effects of Orlistat
not absorbed significantly - most AE's are GI - flatulence, abdominal discomfort, fecal urgency/incontinence, loose, oily stools
40
Precautions and Contraindications of Orlistat
Precautions: GI, hepatic disorders Contraindications: malabsorption syndromes, cholestasis
41
Drug Interactions with Orlistat
Separate from multivitamin by at least 2 hours - reduces absorption of fat soluble vitamins (ADEK) Decreased Vit K absorption can increase anticoagulation with warfarin May decrease the absorption of cyclosporine, levothyroxine, anti-epileptic drugs and anti-retrovirals - separate dosing times by 3-4 hours
42
Maintenance Dosing of Naltrexone/Bupropion (Contrave) in Obesity
2 tabs BID
43
Why do we slowly titrate Naltrexone/Bupropion?
decreases seizure risk (which is already rare)
44
Common Adverse Effects of Naltrexone/Bupropion
N/V/D, constipation, headache, dry mouth, dizziness, insomnia
45
Rare Adverse Effects of Naltrexone/Bupropion
seizures, worsening of depression
46
Contraindications of Naltrexone/Bupropion
Opioid use, uncontrolled hypertension, history of or risk factors for seizures, bulimia/anorexia
47
Drug Interactions for Naltrexone/Bupropion
CYP2B6 and CYP2D6 MAOIs - do not use within 14 days
48
Why is a low fat diet recommended with Naltrexone/Bupropion?
high fat meal increases systemic absorption
49
What are incretins and how do they work and give 2 examples?
incretins are hormones secreted from the gut in response to food which then stimulates insulin secretion GLP-1 and GIP
50
What age can liraglutide be used down to?
12
51
Common Adverse Effects of Liraglutide
nausea, vomiting, diarrhea
52
Rare adverse effects of liraglutide
acute pancreatitis, cholelithiasis
53
What are the two indications for liraglutide in obesity? (the two populations we would use in)
Adults: BMI >30 or >27 with at least one weight-related co-morbidity 12-18yo: inadequate response to diet/exercise and body weight >60kg and an initial BMI >30kg/m2
54
Contraindications of Liraglutide and Semaglutide
- personal or family history of medullary thyroid cancer - personal history of MEN2 syndrome - pregnancy, attempting conception, breastfeeding
55
What age group can semaglutide be used down to?
12
56
What is the target dose for semaglutide in obesity?
2.4mg/week (higher than in diabetes)
57
What is the pediatric (12-18yo) indication of semaglutide?
- with an initial BMI at the 95th percentile or greater for age and sex and a body weight above 60kg and an inadequate response to reduced calorie diet and physical activity alone
58
What is the frequency of liraglutide injection?
daily
59
What are some other medications that may cause weight loss as a side effect but do not have an approved indication for obesity?
bupropion, fluoxetine, topiramate, methylphenidate, SGLT2i's, metformin
60
When should we stop pharmacotherapy for obesity?
if >5% weight loss is not achieved after 3 months on full/maximum tolerated dose
61
Is pharmacotherapy for obesity intended to be short term or long term?
long term treatment strategy
62
What is the MOA of tirzepatide?
GLP1 and GIP receptor agonist
63
Frequency of Tirzepatide Injection
once weekly
64
Who is bariatric surgery considered for?
those with a BMI >35
65
What are the 3 types of bariatric surgery?
- gastric bypass - sleeve gastroectomy - gastric banding
66
How to help children maintain a healthy weight
healthy eating (eat together as a family, remove distractions), physical activity
67
What happens when a medication is discontinued when being used for obesity?
weight gain is to be expected
68
What are physical activity recommendations?
goal of 30-60min of moderate to vigorous aerobic activity on most days (>150min/week) resistance training may promote weight maintenance, increase muscle mass
69
What is a potential concern/controversy that is emerging with GLP1 RAs
increased risk of self harm suicide? - Health Canada review found no evidence of increase risk - however, the studies in pts with obesity specifically, had inconsistent results

PEBC Prep (61 decks)

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