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nutrition > obesity and management pt 2 > Flashcards

obesity and management pt 2 Flashcards

1
Q

what are common behavioral strategies for obesity interventions

A
  1. setting realistic goals
    - benefits with as little as 5% loss
    - 5-7% with lifestyle changes
    - 5-10% or more with lifestyle and meds
    - 15-20% or more with bariatric surgery
  2. self-monitoring
  3. stimulus control
  4. slowing eating style
  5. nutritional education
  6. meal planning
  7. stress reduction and problem solving
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2
Q

benefits of losing weight with exercise alone

A
  1. slowing/preventing further weight gain
  2. reducing weight regain after successful weight loss
  3. attenuating diet-induced loss of muscle mass
  4. improved physical functioning
  5. offsetting reduced BEE/BMR that can occur with wt loss
  6. improved functional status - esp elderly
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3
Q

what type of exercise do we need?

A

both aerobic and resistance (mainly aerobic)

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4
Q

how often do we need to exercise?

A

150 min week
30 m/d

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5
Q

general diet principles

A
  1. minimizing or eliminating caloric beverages
  2. portion size control
  3. self monitoring
  4. viewing diet changes as long-term/lifelong
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6
Q

what is the ultimate goal of diet

A

reduce calorie intake
aiming for 1000-1500 kcal/day diet
- ensure adequate nutrition
- consider food volume/calorie density

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7
Q

what is the most important consideration for diet guidelines

A

patient compliance

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8
Q

what are the general guidelines for anti-obesity Rx?

A
  1. age - most for adults
  2. weight status - most for BMI >30, some >27 with obesity-related comorbidity
  3. duration of therapy - some only for short-term
  4. cost of rx
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9
Q

what is the anti-obesity Rx approved for ages 12+

A

orlistat (xenical)

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10
Q

when do you assess the efficacy for anti-obesity Rx?

A

12 week mark

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11
Q

what is the anti-obesity Rx that is sympathomimetic - stimulating NE release

A

phentermine (adipex)

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12
Q

what is the most common wt loss rx

A

phentermine

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13
Q

SE of phentermine (adipex)

A

HTN, ↑ HR, insomnia, agitation, palpitations, constipation, dry mouth

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14
Q

CI for phentermine (adipex)

A
  1. CV disease
  2. hyperthyroidism
  3. agitated state
  4. glaucoma
  5. substance use hx
  6. use within 14 days of an MAOI
  7. pregnancy/breastfeeding
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15
Q

DDI of phentermine (adipex)

A

Psych meds
antihypertensives
antihistamines
insomnia meds

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16
Q

Rx that inhibits intestinal lipase, blocking fat absorption, increasing fecal fat excretion

A

Orlistat (Alli, Xenical)

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17
Q

SE of Orlistat (Alli, Xenical)

A
  1. GI
    - borborygmi
    - cramps
    - flatus
    - oily spotting
    - fecal incontinence
  2. Decreased absorption of fat-soluble vitamins
    (Rare - liver injury, calcium oxalate stones, acute kidney injury)
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18
Q

CI for Orlistat (Alli, Xenical)

A
  1. pregnancy
  2. cholestasis/cholelithiasis
  3. hx of calcium oxalate stones
  4. chronic malabsorption syndrome
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19
Q

DDI of orlistat (alli, xenical)

A
  1. Multivitamins
  2. fat-soluble vitamins
  3. warfarin
  4. levothyroxine
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20
Q

Rx that acts as serotonin agonist for serotonin 2C receptor
Worked by suppressing appetite

A

Lorcaserin (Belviq)

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21
Q

SE of Lorcaserin (Belviq)

A

generally mild - headache, dizziness, nausea, URI

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22
Q

what rx is not on the market anymore and why?

A

Lorcaserin (Belviq)
Increased occurrence of colorectal, pancreatic, and lung cancers in clinical trials

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23
Q

what RX acts as an agonist of glucagon-like-peptide-1 (GLP-1) receptors

A

Liraglutide (Saxenda)/Semaglutide (Wegovy)

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24
Q

what is the dosing for Liraglutide (Saxenda)/Semaglutide (Wegovy)

A

Injected in abdomen, thigh, or upper arm
- Liraglutide: target dose of 3 mg SC daily
- Semaglutide: target dose of 2.4 mg SC weekly

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25
SE of Liraglutide (Saxenda)/Semaglutide (Wegovy)
1. **N/V** 2. Diarrhea 3. hypoglycemia 4. anorexia Rarer - pancreatitis, gallbladder disease, kidney injury
26
CI of Liraglutide (Saxenda)/Semaglutide (Wegovy)
1. Allergy to med 2. pregnancy 3. personal or family hx of medullary thyroid cancer or MEN 2A or 2B
27
DDI of Liraglutide (Saxenda)/Semaglutide (Wegovy)
Other hypoglycemic agents, serotonergic drugs, thiazides
28
what RX acts as an agonist of GLP-1 and GIP receptors
Tirzapetide (Mounjaro)
29
what RX: Originally developed for diabetes mellitus ↑ insulin release, ↓ glucagon release, slows gastric emptying Thought to have greater effects than GLP-1 agonists alone
Tirzapetide (Mounjaro)
30
dosing for tirzapetide (mounjaro)
Dose: Injected in abdomen, thigh, or upper arm IM
31
SE of Tirzapetide (Mounjaro)
1. **N/V** 2. diarrhea 3. hypoglycemia 4. anorexia Rarer - pancreatitis, gallbladder disease, kidney injury Associated with thyroid tumors in animal studies, but not human
32
CI for Tirzapetide (Mounjaro)
Allergy to med, pregnancy, personal or family hx of medullary thyroid cancer or MEN 2A or 2B
33
DDI of Tirzapetide (Mounjaro)
Other hypoglycemic agents, serotonergic drugs, thiazides
34
what rx expands in the GI tract to create a sensation of satiety Considered “medical devices” - not systemically absorbed
Cellulose and Hydrogel (Plenity) *No restriction on duration of use*
35
SE of Cellulose and Hydrogel (Plenity)
diarrhea, abdominal distension, pain, “adverse effects”
36
Caution in patients with ___ when taking Cellulose and Hydrogel (Plenity)
impaired GI motility
37
what RX is an opioid antagonist/norepinephrine and dopamine reuptake inhibitor with possible effects on hypothalamus and mesolimbic reward system
Naltrexone SR/Bupropion SR (Contrave)
38
SE of Naltrexone SR/Bupropion SR (Contrave)
1. **Nausea** 2. **constipation** 3. **HA** 4. Stimulant-like effect - agitated mood, insomnia, HTN, tachycardia, palpitations *Not recommended as first-line medication*
39
what RX has concern over potential for worsened mood, suicidality
Naltrexone SR/Bupropion SR (Contrave)
40
CI of Naltrexone SR/Bupropion SR (Contrave)
1. pregnancy 2. uncontrolled HTN 3. epilepsy 4. bulimia/anorexia 5. Meds - use within 14 days of an MAOI - current use of opioids or bupropion
41
DDI of Naltrexone SR/Bupropion SR (Contrave)
ETOH, psych meds, opiates, metoprolol
42
what rx stimulates NE release/anticonvulsant Works by suppressing appetite/ causing early satiety
Phentermine/Topiramate (Qsymia)
43
if there is no weight loss after 12 wks with Phentermine/Topiramate (Qsymia), what happens next?
may titrate to max dose of 15 mg/92 mg
44
SE of Phentermine/Topiramate (Qsymia)
1. **dry mouth** 2. **constipation** 3. **paresthesia** 4. depression 5. “brain fog” 6. HA 7. altered taste 8. Stimulant effects - tachycardia, anxiety, insomnia (Rare reports of suicidal ideation)
45
CI of Phentermine/Topiramate (Qsymia)
1. hyperthyroidism 2. glaucoma 3. **substance use hx** 4. use within 14 days of an MAOI 5. pregnancy
46
DDI of Phentermine/Topiramate (Qsymia)
1. ETOH 2. psych rx 3. anti-HTN rx 4. insomnia rx 5. loop diuretics 6. metformin
47
what RX is alleged to increase metabolic rate and suppress appetite Nearly always given along with very low-cal diet (200-800 kcal/day)
Human Chorionic Gonadotropin (HCG) no good!
48
who is a surgical candidate?
BMI - often used as initial determinant of eligibility 1. BMI ≥ 40 2. BMI ≥ 35 with 1+ obesity-related comorbidity: - T2DM, HTN, HLD, OSA, NAFLD/NASH, OHS, GERD, asthma, pseudotumor cerebri, severe OA, severe UI, impaired quality of life, unable to get other surgery 3. Sometimes - BMI ≥ 30 with severe/progressive comorbidity: - Metabolic syndrome, uncontrollable T2DM
49
Many bariatric surgeons require pts _______ prior to surgery
to participate in a medically guided weight loss program Anywhere from 3-12 months (usually 6 months)
50
All pts undergo ___ looking at psychological status, social support, medical status, expectations for surgery, and anesthesia risk
pre-op assessment
51
CI to bariatric surgery
1. **Not obese** - to tx of HLD, DM, or to reduce CV risk w/o obesity 2. Inability to comply with nutritional requirements 3. **Age** - not usually done in pts < 18 or > 65 4. Severe cardiac disease (cannot undergo anesthesia) 5. Severe coagulopathy 6. Current ETOH or drug use 7. **Psych** - uncontrolled/untreated depression, psychosis, eating disorders (especially **bulimia**)
52
2 ways of how does bariatric surgery work?
1. *Restriction* - limitation of food intake by reducing the stomach’s reservoir capacity via resection - bypass or - creation of a more proximal gastric outlet 2. *malabsorption* - decreases efficacy of nutrient absorption via shortening length of functional small intestine Some surgeries use both restriction and malabsorption Some surgeries may also have a neurohormonal effect
53
One of the most common bariatric surgeries A small gastric pouch is anastomosed to the small bowel BOTH restrictive and malabsorptive loses 70% of excess weight
Roux-en-Y Gastric Bypass (RYGB) Also promotes ↑ hormones like GLP-1, ↓ hormones like ghrelin
54
complications from Roux-en-Y Gastric Bypass (RYGB)
1. healing - peritonitis - anastomotic leak - abdominal wall hernias - stenosis - staple disruption 2. long-term - gallstones - neuropathy - GI symptoms - ulcers 3. nutritional deficiencies - iron, vitamin B12, folate, calcium, vitamin D
55
Removal of greater curvature of the stomach, leading to a tubular stomach Often seen as “not as drastic” by pts, increasing in popularity
Sleeve Gastrectomy (SG) Easier and safer to perform than RYGB
56
Sleeve Gastrectomy (SG) is strictly what type of bariatric surgery?
restrictive Also slows GI motility, ↑ hormones like GLP-1, ↓ hormones like ghrelin
57
complications with Sleeve Gastrectomy (SG)
**less overall than RYGB** 1. healing - **surgical site leak** (more than RYGB) - hernias - staple disruption 2. long-term - **GERD** (more than RYGB) - neuropathy - N/V 3. nutritional - iron, vitamin B12, folate, calcium, vitamin D (*less than RYGB*)
58
Compartmentalization of the upper portion of the stomach by placement of a restrictive, adjustable prosthetic band
Laparoscopic Adjustable Gastric Banding (LAGB) declining popularity
59
which bariatric surgery has high rates of revision and weight regain
Laparoscopic Adjustable Gastric Banding (LAGB)
60
what type of bariatric surgery is Laparoscopic Adjustable Gastric Banding (LAGB)
restrictive
61
Complications with Laparoscopic Adjustable Gastric Banding (LAGB)
**less than RYGB or SG** may include: 1. device - band slippage - band erosion - mechanical failure 2. long-term - esophageal erosion - reoperation - weight regain
62
Removal of fat tissue via saline injection or aspiration of fat tissue No influence on comorbidity development or progression - cosmetic only
lipo
63
Percutaneous gastrostomy tube is implanted endoscopically 20-30 min after meals, patients can open the tube and drain part of the food that has just been ingested into the toilet
Aspiration Therapy
64
Mainly done for severely obese individuals (BMI of 50+) Has high rates of complication
Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
65
what is SADI-S
variant Biliopancreatic Diversion with Duodenal Switch (BPD/DS) procedure using sleeve gastrectomy = lower complications
66
Saline-filled balloon placed endoscopically for max 6 month period Promotes a feeling of satiety and reduces gastric volume
Intragastric Balloon
67
what anti-obesity rx's are only for short-term use?
1. Phentermine (Adipex) 2. Phentermine/Topiramate (Qsymia)
68
which rx must be taken 30 minutes before lunch and dinner
Cellulose and Hydrogel (Plenity)

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