Obesity

Question 1

OBESITY: the scope of the problem

Answer 1

• obesity is a chronic disease

- GLOBAL EPIDEMIC

Question 2

Etiologies of Obesity

Answer 2

Genetic factors
Environmental 
Physical Activity 
Secondary Causes: 
-Cushings, Insulinoma, hypothyroidism, hypothalamic, damage resulting in hyperphagia, growth hormone deficiency

Question 3

What are the comorbidities associated w/ being overweight & obese

Answer 3

• T2DM
• HTN
• Dyslipidemia
• Heart Disease: CHD, Heart failure,Atrial fibrillation
• Stroke
• Osteoarthritis
• Sleep apnea
• Cancer

Question 4

Treatment of Obesity

Answer 4

-diet: decrease food intake, increase energy expenditure, behavior modification (food diary)

Exercise

Medication: BMI >30
-Lorcarserin (Belvaq): selective antagonist of seritonin, decrease appetite, may be habit forming, use no > 60mo

• Orlistat (Alli,Xenical): lipase inhibitor, inhibits absorption of dietary fats, may use this long term
• Phentermine (Adipex-P): anorectic agent, amphetamine like, use no longer than 3mo.

Surgery:
-Lap-band: restrictive process, limits amount of food

-Sleeve Gastrectomy: reduces stomach capacity

• Roux-en-Y Gastric Bypass: restrictive AND malabsorptive
• duodenum is bypassed: you dont absorb vitamins, calories, etc. Reattach duodenum to jejunum for pancreatic and gallbladder enzymes
• all three surgeries done laproscopically

Question 5

Types of diets to treat obesity

Answer 5

Balanced-low calorie/portion controlled

low fat

low carb

Mediterranean diet

Question 6

Indications for surgery

Answer 6

• motivated

- BMI>40 or BMI