Obesity algorithm update

Question 1

OMA classification of % body fat *different than American council on exercise classification

Answer 1

women >35

men>30

Question 2

What is the role of SGLT2 inhibitors in treatment of T2DM,obesity and CVD? 3

Answer 2

Lower blood sugar
Reduce progression of kidney disease
Reduce risk of CVD events in patient with obesity

Question 3

Which T2DM drug is best avoided in severe heart disease (cardiomyopathy)

Answer 3

Metformin - risk of lactic acidosis

Question 4

Which should be used for obesity and CVD but no diabetes mellitus or CHF

Answer 4

Liraglutide

Question 5

What our second line drugs recommended for obesity and T2 DM without CVD 4

Answer 5

Contrave
Phentermine\topiramate
Sitagliptin
Alpha glucosidase inhibitor (acarbose)

Question 6

Give examples of third line drugs for treatment of obesity and T2 DM without CVD 2

Answer 6

Orlistat

Phentermine

Question 7

What is the net result of fat weight loss 3

Answer 7

Increased long-term hunger
Reduced metabolic rate
High potential for weight regain

Question 8

Which factors are largely unalterable when it comes to set point 3

Answer 8

Height and gender
Genetic disorders
Neurological disorders

Question 9

What are strategies to alter satiety and hunger hormones after weight loss

Answer 9

Metformin may favorably alter hormones relative to increased body weight
AOMS- increase satiety, reduce intake
Bariatric surgery may alter hormones

Question 10

Which section of the gut absorbs the greatest amount of nutrients

Answer 10

The jejunum, the second longest segment of the SI

Question 11

Which segment of the SI absorbs bile salts, bile acids, vitamin B12, some vitamins and some minerals

Answer 11

The ileum, the longest segment

Question 12

Which 2 hormones increased hunger between meals

Answer 12

ghrelin and neuropeptide Y

Question 13

Which hormones are produced by the pancreas 5

Answer 13

Insulin
Glucagon
Pancreatic polypeptide
Amylin
Somatostatin

Question 14

Which GI ENDOCRINE hormones are produced by the small intestine 5

Answer 14

Cholecystokinin
GIP

Secretin
Motilin
Gastrin

Question 15

Which hormones are produced by the ileum and or large intestine 5

Answer 15

Fibroblast Growth Factor 19
GLP-1
GLP 2
oxyntomodulin
Peptide YY

Question 16

How does obesity increase risk of gallstones?

Answer 16

Obesity increases cholesterol in bile via HMG-CoA reductase

Question 17

How does rapid weight loss contribute to gallstone risk?

Answer 17

Increases liver cholesterol secretion because of increased fat metabolism

Question 18

How does a higher fat diet help to prevent gallstones?

Answer 18

Stimulates gallbladder contractility, flushing out the gall bladder, less time for the bile to sit and form stones

Question 19

Why is uric acid level higher in obesity?

Answer 19

There is decreased clearance from kidney related to high insulin.

Question 20

How does rapid weight loss increase uric acid levels?

Answer 20

Weight loss increases lactic acid ( increased tissue metabolism), which decreases uric acid excretion.

Question 21

What makes visceral adipose more metabolically active than subcutaneous adipose tissue?

Answer 21

VAT has

• higher basal lipolysis than SAT,
• increased sensitivity to catecholamines
• decreased sensitivity to insulin,
• direct access to the liver

Question 22

What does resistin do?

Answer 22

increases
insulin resistance
CVD
NAFLD

IBD
kidney disease

Question 23

Which hormones slow gastric emptying/intestinal motility? the triple threat plus 2

Answer 23

• Glucagon like peptide-1
• Oxyntomodulin
• Peptide YY
• Cholecystokinin
• Amylin