Obesity

Question 1

What are three false statements regarding weight loss

Answer 1

Lose weight fast (in most cases, you shouldn't lose weight fast)
It's simple (it's not simple for most people)
Science based (it's not science based)

Question 2

What BMI indicates overweight?

Answer 2

25-30

Question 3

What BMI indicates obese?

Answer 3

Over 30

Question 4

What are complications of obesity?

Answer 4

Fatigue
Depression
Clots (stroke, MI, VTE)
Increased blood pressure
Increased lipids
Diabetes
OA
Sleep apnea
GERD
Gout
Various cancers
Liver, skin, gall bladder disease
Pancreatitis
Cataracts
Death

Question 5

What is the association between BMI and mortality?

Answer 5

Normal to overweight BMI carry the lowest risk of mortality, with around 25 appearing the lowest (around 27.5 in elderly). Mortality increases when BMI is below “low-normal” and obese, more at the extremes

Question 6

How much weight should be loss?

Answer 6

A decrease in 5-10% of initial body weight can lead to substantial improvement in insulin sensitivity, glycemic control, hypertension, dyslipidemia and obstructive sleep apnea and in physical function in obese patients with OA

Question 7

What are the 5 “A”s of weight loss assessment?

Answer 7

ASK for permission to discuss weight and explore readiness
ASSESS obesity related risks and “root causes” of obesity
ADVISE on health risk and treatment options
AGREE on health outcomes and behavioural goals
ASSIST in accessing appropriate resources and providers

Question 8

What are guiding principles of weight loss?

Answer 8

Obesity is a chronic and often progressive condition
Obesity management is not about simply reducing numbers on the scale
Early intervention means addressing root causes and removing roadblocks
A patient’s “best” weight may never be an “idea” weight
Success is different for every individual

Question 9

What are some drugs that can cause weight gain?

Answer 9

Atypical antipsychotics (30% weight gain in over 7% of patients)
Antidepressants (15-20% weight gain in over 7% of patients)
Insulin, sulphonylureas
Others: valproic acid (30-60%), lithium (25-60%)

Question 10

What are some myths regarding weight loss pills?

Answer 10

Weight loss pills are an easy way to lose weight (weight loss pills result in minimal weight loss and their side effects make life difficult)
Weight loss pills lead to better health outcomes (weight loss pills do not lead to better overall health)

Question 11

What are some weight loss pills available?

Answer 11

Merida (Sibutramine HCl Monohydrate; it was withdrawn due to increased CV events and stroke)
Xenical (Orlistat)
PGX (no significant effects on body weight)

Question 12

What are the problems with orlistat?

Answer 12

Diarrhea, oily spotting, flatulence

160$/month

Question 13

What are some new prescription products across the border?

Answer 13

Phentermine and topiramate (Qsymia)
Bupropion and naltrexone (Contrave)
Lorcaserin (Belviq)

Question 14

What are the side effects topiramate?

Answer 14

Paresthesias
Dry mouth, taste perversion
Fatigue
Difficulty concentrating
May be a good option when indicated for other reasons (e.g., migraine prevention) and weight loss is desired

Question 15

What are the side effects of liraglutide?

Answer 15

Nausea
Vomiting
Diarrhea
Secondary adverse effects

Question 16

Patients trying to lose weight, should they take oral analgesics?

Answer 16

If an analgesic can improve pain such that exercise capacity is increased, then yet

Question 17

How can weight loss affect OA?

Answer 17

Obesity is the strongest modifiable risk factor in OA both in incidence and progression of the disease. Being only 10 lbs overweight and increase the force by 30-60 lbs with each with each step.
Weight loss is shown to reduce pain, stiffness and decrease the risk of disability. Mechanism: suggests both biomechanical and inflammatory benefits. Not only to prevent surgical intervention