Obesity

Question 1

What is the first line treatment for obesity?

Answer 1

Diet and exercise modification

Question 2

What the pharmacological controls for obesity?

Answer 2

Orlistat- lipase inhibitor
Decreases fat absorbed
Liraglutide- stimulates satiety

Question 3

Which classes of medications cause weight gain?

Answer 3

Antipsychotics
Lithium
Anti depressants 
Anti convulsants
Anti diabetics
Serotonin histamine antagonists
Anti histamines
Beta blockers
Steroid hormones

Question 4

How are “overweight” and “obese” classified

Answer 4

By BMI

1. Overweight= BMI 25.0-29.9
2. Obese=BMI 30 + (different classes)

Question 5

What are the medical consequences of obesity?

Answer 5

1. Pulmonary: sleep apnea, hypoventilation
2. Liver: NAFLD, cirrhosis, gall bladder
3. Gynecologic: infertility, polycystic ovarian syndrome
4. Cardio: stroke, HTN, CAD
5. Endo: diabetes, dyslipidemia
6. Cancer

Question 6

What is metabolic syndrome?

Answer 6

1. Cluster of metabolic abnormalities often associated with central obesity
   - hyperlipidemia
   - low HDL, high LDL
   - hyperglycemia
   - hypertension

Question 7

What hormones signal satiety?

Answer 7

1. Leptin- inputs from fat tissue to hypothalamus

Question 8

What hormones signal hunger?

Answer 8

1. Ghrelin- released by stomach to brain

Question 9

What functions does adipose tissue have?

Answer 9

1. Inflammation (adipokines)
2. Energy metabolism
3. Cancer predisposition?
4. Infectious disease?

Question 10

What are the 5 A’s of obesity management?

Answer 10

Ask
Assess
Advise
Agree
Assist

Question 11

What level of obesity needs lifestyle modifications?

Answer 11

1. BMI> 25 +comorbidities needs only lifestyle

2. All others need it but with other add ons

Question 12

What level of obesity needs pharmacotherapy?

Answer 12

1. BMI > 27 + comorbidities

2. Anything heavier as well

Question 13

What level of obesity needs bariatric surgery?

Answer 13

BMI > 35 with comorbidities or BMI > 40

Need documented failure of other programs, psychologically stable, family support, no substance abuse

Question 14

what are the comprehensive lifestyle management guidelines?

Answer 14

1. Nutrition: hypocaloric (-500 to -750), evidence based diet
2. Activity; min. 150 min moderate activity, 200-350 for maintenance
3. Behaviour- food journal etc

Question 15

What types of bariatric surgery exist?

Answer 15

1. Laproscopic gastric band
2. Sleeve gastrectomy
3. Gastric bypass**