Obesity and Weight Loss Flashcards
What are the #1 and #2 causes of preventable deaths in the US?
- Smoking
2. Obesity
What is the best treatment for obesity?
prevention
What weight gain per year is a red flag?
> 1-2 pounds a year
Why is measuring waist circumference improtant?
waist circumference is a surrogate estimate for visceral fat, which is more metabolically active than other fats meaning it releases FFA and contributes to HLD, atherogenesis, hyperinsulin
In which patients should you consider drug therapy for weight loss?
BMI>30 or BMI>27 with comorbidity (hypertension, diabetes, heart failure, CAD, OSA, arthritis)
What criteria are used to say a weight loss drug is considered effective?
> 4lbs lost at 4 weeks
5% weight loss at 6 months
5% weight loss at 1 year
I think ALL criteria must be met to be successful
What is the name of the only weight loss drug available in the US for long-term use, and which also doesn’t require prescription?
Orlistat
What is the MOA of Orlistat?
Blocks lipase. So it blocks fat absorption in the intestine.
What is the FDA warning for Orlistat?
Rare cases of liver toxicity
What are the most common side effects of Orlistat?
- Abdominal discomfort
2. Increased frequency of defecation
Name 4 noradrenergic sympathomimetic drugs that can be used for short term appetite suppression in the US?
- Diethylpropion
- Benzphetamine
- Phendimetrazine
- Phenteramine
What are side effects of oradrenergic sympathomimetic drugs that can be used for short term appetite suppression?
hypertension
Which two antidepressants can be used for treatment of obesity?
- Fluoxetine
2. Bupropion
What is exenatide (byetta)?
Injectionable drug that mimicks the action of incretin. Used for diabetics and also to treat obesity. Believed to delay gastric emptying.
When should bariatric surgery be considered?
Only if have already tried lifestyle attempts and drug therapy, AND…
BMI>=35 with serious obesity-related comorbidities
OR
BMI>=40
OR
Progressive obesity >11 lbs per year before age 30
What is the hormone pattern in patients with PCOS?
Increased LH/FSH ratio
High testosterone level
Low SHBG level
What is the definition of involuntary weight loss?
loss of >5% total body weight in 6 months, or >10% in 12 months
What is sarcopenia?
age related muscle loss that occurs without other precipitating causes
What is cachexia?
weight loss associated with inflam condition and cytokine production and muscle wasting
reduce mid upper arm circumference is a sign of what?
protein-energy malnutrition
Which drugs are known to cause weight loss in the elderly?
digoxin ace inhibitors NSAIDs SSRIs cholinesterase inhibitors anticholinergic agents theophyllie dopamine agents (L-dopa, metoclopramide)
What does a low albumin and elevated alk phos suggest?
cancer (87% specific, 17% sensitive)
Patients with weight loss and diagnosed with cancer, but have normal CBC and liver tests, should get what next?
upper endoscopy and abdominal CT
Patients with weight loss and diagnosed with cancer, btu have abnormal CBC or liver tests, should get what next?
abdominal ultrasound and abdominal CT
What are the 5 criteria for predicting malignancy as a cause of isolated weight loss?*******
- Age>80 ((+1))
- Serum albumin >3.5 ((-2)) *cancer usually has LOW albumin
- WBC>12,000 ((+1))
- Alk Phos>300 ((+2))
- LDH>500 ((+3))
What screening tests should be done on all patients with BMI>25?
- blood glucose
- serum creatinine
- fasting lipids
Also:
- blood pressure
- TSH
Not cbc or electrolytes!!
what should you do for a patient with recent gastric bypass who is throwing up a lot?
Suspect stomal stenosis, so do an upper endoscopy to prove it and also dilate the stricture.
Second line: barium swallow to diagnose it
In a patient with weight loss, what normal results should be present in order for you to do no intervention and just follow-up in 6 months?
normal labs
normal CXR
normal abdominal US
