Obesity and Weight Management Flashcards

Question

What are orexigens?

Answer 1

Appetite stimulants - increase intake

Answer 2

Neuropeptide Y (NPY) Agouti-related protein (AgRP) Orexin A and Orexin B Melanin-Concentrating Hormone (MCH)

Answer 3

Appetite suppressants - reduce intake

Answer 4

Proopiomelanocortin (POMC) Cocaine amphetamine regulating transcript (CART) Alpha melanocyte stimulating hormone (alpha-MSH) Brain derived neurotrophic factor Serotonin

Answer 5

Growth Hormone Release Inducing Peptide AKA "the hunger hormone" Orexigenic Signal to release ghrelin is an empty stomach Levels increase and peak prior to eating, levels decrease when nutrients are ingested

Answer 6

Fasting, weight loss, stress and sleep deprivation, genetic syndromes

Answer 7

Meals, weight gain (stomach stretching), leptin, sleeve gastrectomy

Answer 8

Produced by l-cells in proximal small bowel (duodenum/Jejunum) Secreted after fat/protein ingestion and stomach distension Short acting peak at 15-30 minutes from meal initiation Stimulates gallbladder contraction, slowing stomach emptying, reducing appetite Receptor in GI tract and brain

Answer 9

Produced by L-cells of the ileum and proximal colon Secretion stimulated by nutrients, neural, and endocrine factors after eating GLP-1 receptors found in heart, kidney, lung, pancreas, CNS, PNS It is an incretin, anorexigenic GLP-1 levels are reduced in obesity, prediabetes, type 2 diabetes

Answer 10

AKA gastric inhibitory peptide Incretin hormone, released by K cells in the duodenum and upper jejunum Released in response to oral glucose load **GIP and GLP-1 together are responsible for up to 70% of the postprandial insulin response** Reduces nausea and stimulates glucagon secretion

Answer 11

Incretin, produced by L-cells in distal small intestines and colon Co-secreted upon eating (made by same precursor as GLP-1) Produced postprandially and actives multiple receptors Exogenous administration can cause weight loss (decreasing appetite and feeding, increasing energy expenditure)

Answer 12

Anorexigenic, produced by L-cells in distal small intestine, colon and rectum Potent appetite suppressant Increases within 1 hour of feeding; delays gastric emptying and intestine transit time

Answer 13

Released in response to calorie load; reduces gastric emptying in gut and reducees hunger expression in hypothalamus Low levels in fasting state Patients with obesity and Prader Willi Syndrome have lower levels of PP

Answer 14

Released in response to eating It is one of the long-term adiposity signaling hormones Centrally reduces appetite in hypothalamus Similar effect to leptin in the CNS but less potent Resistance attenuates weight loss effects centrally In muscles: uptakes glucose (glycogen), uptake amino acids (protein) In liver: stimulates uptake glucose (glycogen), inhibits conversion fat and protein (glucose) In adipose: stimulates fat synthesis

Answer 15

Amino acid hormone co-secreted with insulin by beta cells, makes insulin more effective Secreted in response to meals Regulates glucose and bodyweight by reducing food intake, slowing gastric emptying, suppressing glucagon production in the liver Effects are similar to GLP-1 (milder glucose reduction and weight loss)

Answer 16

Secreted by adipocytes in white adipose tissue; secretion is diurnal Major role in energy balance Circulating levels directly proportional to body fat mass Crosses BBB and binds to the hypothalamic leptin receptors Can activate the sympathetic nervous system Interacts with gonadotropin pulse generators in the hypothalamic pituitary gonadal axes Has regulation of immune function, hematopoiesis and angiogenesis

Answer 17

Improves insulin sensitivity in skeletal muscle, improves insulin sensitivity in liver, reduces vascular inflammation Most abundant hormone secreted by adipocytes Levels inversely related to body fat mass Liver activity: enhances insulin sensitivity, decreases non-esterified fatty acids, increases fatty acid oxidation, reduces liver glucose output Muscle activity: stimulates glucose use and fatty acid oxidation Vascular endothelium activity: inhibits monocyte adhesion, inhibits macrophage

Answer 18

Increases ghrelin, increases PYY, reduces insulin, reduces leptin

Answer 19

Large reduction ghrelin, increases GLP-1, increases PYY, decreases insulin, decreases leptin

Answer 20

Variable ghrelin, large increase in GLP-1, increases PYY, increases OXM, reduces Insulin, reduces Leptin

Answer 21

Adipocyte hyperplasia (lots of small adipocytes) Adipocyte hypertrophy (few large adipocytes)

Answer 22

Increase M1 Macrophages increase with obesity and secrete proinflammatory factors (TNF, IL-6, MCP-1) M2 macrophages predominate in lean individuals and secrete anti-inflammatory factors In obesity M1/M2 proportion is polarized towards proinflammatory

Answer 23

Mitochondrial dysfunction and endoplasmic reticulum stress create reactive oxygen species, releasing cytokines, insulin resistance and cellular apoptosis Increases in circulating proinflammatory factors and decreases in anti-inflammatory factors may promote inflammation and liver fat accumulation

Answer 24

Hepatocyte injury and death from intracellular accumulation of fatty acids, cholesterol and other toxic lipids and from ROS Cellular death promotes inflammatory responses Fibrosis develops --> cirrhosis --> end stage liver disease --> increases risk of need for liver transplant and hepatocellular carcinoma

Answer 25

Fasting glucose, A1c, hepatic panel, fibrosis 4 index panel, serum biomarkers, imaging, liver biopsy Liver biopsy is gold standard to assess fat and fibrosis but is not routinely done

Answer 26

Increased visceral and epicardial fat increase the risk of atherosclerotic CV disease --> increased coronary artery calcification Increased fat mass compress veins and impair venous blood return which increases/promotes thrombosis Cardiac remodeling (LVH, atrial enlargement, fat deposition --> fibrosis) Activation of sympathetic nervous system increases BP Activation of the RAAS causing elevated BP Inflammatory effects --> vasoconstriction and arterial stiffness Reduction in HDL, increase in LDL, increase in VLDL, increase in small, dense LDL particles

Answer 27

> 80% of adults with OSA are overweight >>50% of adults with OSA have obesity Is a vicious cycle Alter in the circadian system --> altered feeding, changes to body composition, increased blood sugar, higher blood pressure, higher cholesterol, increased risks of heart disease and stroke

Answer 28

Obesity increases the load and impact on the cartilage of the knee Obesity also causes systemic metabolic factors and adipokines may influence cartilage homeostasis Obesity/overweight also risk factor for hip OA Can be worse for women in perimenopause/menopause/postmenopausal

Answer 29

Declining estrogen = increased leptin, decreased ghrelin and NPY Body composition changes (increased fat mass, increased adiposity, loss free fat mass) Increased risks of CV disease (2-4 x higher rates) Elevated blood pressure, elevated LDL, weight gain, loss lean muscle mass, reduced activity levels, dietary changes, food preference changes Sarcopenic obesity

Answer 30

Long-term stress can result in an increase in hypothalamic corticotropic activity: increases in blood cortisol, can worsen sleep patterns, increase food cravings Increase BP, worsen metabolism, cause dysregulation in the immune responses

Answer 31

Notes: EtOH has a lot of empty sugars, traveliing a lot and thus eating out/fast food a lot?

Answer 32

Vitals: height, weight, BP, BMI, HR, respirations, O2, waist circumference, hip circumference, neck circumference

Answer 33

CBC, CMP, fasting lipids (esp. triglycerides and HDL), A1c, TSH, vitamin D Of note: accurate triglycerieds needs to be from a fasting state

Answer 34

Total body mass (muscle, organs, water, bones, ligaments, tendons) Includes water, mineral, protein and glycogen DXA measures fat, soft tissue and bone FFM = total mass - fat mass

Answer 35

Total body mass (muscles, organs, water, bones, ligaments, tendons), less non essential or storage adipose tissue Includes water, mineral, protein, glycogen, essential fat in organs, CNS and bone marrow Usually only differs from FFM by ~5% Total body mass = fat mass + lean mass + bone mass Lean mass = total mass - fat mass-BMC % body fat = Fat mass/(total body mass-bone mass)

Answer 36

Basal metabolic rate, resting metabolic rate, cellular respiration, direct calorimetry, indirect calorimetry

Answer 37

Energy expended while fasting, rested and supine in thermoneutral environment

Answer 38

Energy expended at rest, doesn’t require overnight supine measurement

Answer 39

Converts biochemical energy like food into heat and cellular energy

Answer 40

Measure heat generated by organism, measures difference in temperature of water entering and leaving the chamber via heat exchanger Value of generated heat can estimate total energy expenditure Enclosed calorimeter

Answer 41

Estimate basal EE and resting EE by measuring O2 consumption VO2 and CO2 production VCO2

Answer 42

Most common: Harris-Benedict, Mifflin St. Jeor

Answer 43

Activity records as data to validated EE tables Calculations based on HR Motion sensors (pedometers) Accelerometers

Answer 44

Eating plans/Nutrition Activity Behavior techniques Other health factors Stress management Sleep

Answer 45

Carbohydrates, lipids, fats

Answer 46

Source of energy and provide cellular structural elements Includes: **starches, sugars, fiber** 4 kcal/gram (except for fiber) **Satiation is dependent on presence of fiber** Glucose stored as glycogen in muscle and liver. If positive caloric balance then glucose converted to fat in the liver and is stored as adipose tissue Dietary reference intake: at least 130 g per day Simple: mono and disaccharides - table sugar, dairy products, malt sugar. Broken down during digestion into glucose, galactose, fructose Complex: poly and oligosaccharides; starches and high fiber foods like whole grains, beans, fruits/vegetables **Whole grain carbs REDUCE CVD risk** 45-65% total daily intake

Answer 47

Is a carbohydrate **Some are fermentable** - low, moderate and high: low (cellulose, hemicelluloses, wheat bra), moderate (beta-glucans, gums, pectin, resistant starch), high (inulin, oligofructose) Soluble, viscous fiber could help reduce blood cholesterol and improve glycemic control **Fiber can also increase satiety and help gut microbiome** 20-35 grams per day

Answer 48

Glucose is a simple sugar found in fruit (glycemic index of 100) Fructose is found in fruit (GI of 25) Sucrose (disaccharide of glucose + fructose derived from sugar cane or beets) has GI of 65 High fructose corn syrup: artificial sweetener, derived from corn starch glucose syrup processed into fructose; is a liquid containing unbound glucose and fructose and has a GI of ~70 Excessive intake of HFCS can lead to obesity, FLD, hypertriglyceridemia and DM Limit added sugars to < 10% total daily intake

Answer 49

Used as energy source for many metabolic processes including immune response, cell membrane, brain, synthesis of bile acid, cholesterol, vitamin D and steroid hormones and for insulation Dietary reference intake: at least 30 g/d Polyunsaturated, monosaturated, transsaturated, saturated Essential fatty acids are Omega 3 and Omega 6 fatty acids Endogenously derived essential fatty acids like EPA, DHA (both omega 3 fatty acids), and Gamma linolenic acid (omega 6 fatty acid) 20-35% total daily calories

Answer 50

**INCREASE CVD risk** Artificially are partially hydrogenated vegetables oils, naturally are conjugated linoleic acid from ruminants and has no detriments to health. Artificials are associated with increased LDL, reduced HDL, increased CV disease, diabetes and cancers. Can find them in microwavable foods, margarine, crackers, fried fast foods, frozen pizza

Answer 51

Short chain: created and absorbed in intestine as result of fiber fermentation, medium chain - transported into portal vein after digestion and can induce ketosis (MCT oil tx of epilepsy) Long chain: found meats, dairy, tropical oils, hydrogenated vegetable oils like shortening

Answer 52

**REDUCE CVD risk** Simple molecules, plant based oils typically liquid at room temp, they provide essential fats like Omega 6 and Omega 3. Nuts contain both poly and monounsaturated fats

Answer 53

**REDUCE CVD risk** Liquid at room temp, found in plant foods (nuts, avocados, olives, canola oils, vegetable oils)

Answer 54

Contains 4 kcal/gram Amino acids, serve as building blocks Essential AA are those we cannot make and must consume Protein restriction may delay progression to dialysis for CKD patients Protein deficiency: Kwashiorkor Dietary reference intake 0.8-2.0 grams/kg/day (dependent on age, gender, activity, health) Complete proteins have all 9 essential amino acids Incomplete proteins lack 1 or more AA but can be combined to form a complete protein 10-35% of total daily intake

Answer 55

30/30/30 30% carb, 30% fats, 30% protein

Answer 56

Low Calorie: Women 1000-1200 kcal/d, Men 1200-1600 kcal/d

Answer 57

Fat restriction: low fat < 30% fat calories OR very low fat: < 10% fat calories to minimum of 30 g/day After 6 months can produce similar weight loss ot low carb diet May reduce fasting glucose, insulin level and modest reduction in BP Modest decrease in LDL and HDL Risk of deficiency if consuming <30 g/d or 270 kcal

Answer 58

Carb restriction: low glycemic OR low carb:< 130 g/d or < 26% calories OR very low carb: < 50 g/d Modest weight loss for first 6 months, after that weight loss is similar to other calorie restricted diets Reduces fasting glucose, insulin and triglycerides Increases HDL and may lower LDL Modest reduction in BP Metabolic changes with or without weight loss Epilepsy patient’s using the very low carb/ketogenic diet can reduce seizures Low carb may improve DM complications like neuropathy May induce gout flares, could result in malaise, could be challenging in patients with protein restriction (CKD), monitor for low blood sugar and BP and adjust meds as needed

Answer 59

< 800 kcal/d **CLINICAL SUPERVISION SHORT DURATION** Meal replacements May need supplementation due to micronutrient deficiencies Produces rapid weight loss **Beneficial for pre surgical preparation** Reduces fasting glucose, insulin and triglycerides, increases HDL, decreases LDL, reduces BP Adverse effects - fatigue, nausea, constipation, diarrhea, hair loss, brittle nails, cold intolerance, dysmenorrhea, slight increased risk of gallstones, kidney stones and gout flares **Increased risk of cardiac dysrhythmias and muscle cramping** if micronutrient deficiencies Weight regain will occur if not taught how to maintain when transitioning back to different diet

Answer 60

Olive oil as main source of fat Vegetables 3-9 servings Whole fruit 0.5-2 servings Whole grains/legumes 1-13 servings per day Moderate intake of red wine Moderate consumption of seafood, fermented dairy products, poultry, nuts, seeds, eggs Limit red meat, meat products, ultra processed carbs Saturated fats minimal

Answer 61

Dietary approaches to stop hypertension Primarily to treat HTN/High BP Vegetables, fruits, whole grains, fat free or low fat dairy, fish, poultry, lean meats, nuts, seeds, legumes, fiber, calcium, potassium, magnesium Limit sodium 1500-2300 mg/d Limit total fat ~27% total calories per day Limit saturated fat < 6% total daily calories Limit cholesterol < 150 mg per day for 2100 calorie eating plan (adjust accordingly) Avoid red and processed meats, sugar sweetened beverages, and foods with ADDED sugars

Answer 62

Low fat meal plan recommended by National Cholesterol Education program, Adult Treatment Panel Utilized in lipid clinical trials Includes physical activity and smoking cessation Total fat: 25-35% daily calories Limit sat fat < 7% Limit cholesterol < 200 mg/d Avoid trans fatty acids

Answer 63

Very low fat restriction, foods eaten in natural form Vegetables, fruits, legumes, whole grains Small meals eaten frequently Limit dietary fat < 10% total daily calories Dietary cholesterol < 10 mg per day Limit sugar, sodium, alcohol Avoid animal products and caffeine Avoid trans fatty acid, refined carbs, and oils

Answer 64

Foods that come mostly from plants AVOID ultra processed foods, fried foods, and refined carbs - negates the benefits of vegetarian diets Monitor for deficiencies like Vitamin B12

Answer 65

Vegan: ONLY plant based foods, no animal proteins or by products Lacto vegetarian: plants + some or all dairy products Lacto-ovo vegetarian: plant, Dairy and eggs Semi or partial vegetarian: plant, may include some chicken/fish, dairy, eggs, NO red meat Pescatarian: plant + seafood Flexitarian: mostly plant based, occasional fish, meat, animal products

Answer 66

Based on diet presumed to have excited during the Paleolithic period EXCLUDES grains, dairy, ultra processed foods Fresh vegetables, fruits, root vegetables Grass fed lean red meats, fish and seafood, eggs, nuts/seeds Naturally produced oils (olive, walnut, flaxseed, macadamia, avocado, coconut) AVOID: cereal grains, legumes (includes peanuts), dairy, potatoes, ultra processed foods, refined sugars, refined oils, and salt

Answer 67

Car-restriction promoting utilization of fat for energy, generates ketosis Encourage balance of saturated, monounsat and polyunsaturated fats Need vitamin and fiber supplementation Avoid ultra processed, refined, high glycemic index, trans fatty acid foods Generally limit cereals, breads, grains, dairy ( except cheese), starchy vegetables, most fruits Benefits: weight loss, reduce hunger, lower postprandial glucose and insulin, may improve glucose metabolism (insulin sensitivity, reduced fasting glucose and insulin), reduce diastolic BP, reduce TG and increase HDL, ketonemia can treat seizures, adjunct to certain kinds of cancer therapy Risks: may increase LDL (can avoid by eating polyunsat versus sat fats), no improvement in insulin sensitivity if no weight loss, transient fatigue, mild decrease in cognition (upon start of diet), physical performance changes

Answer 68

Induction phase: <= 20 g carbs per day non starchy vegetables, leafy greens and adequate protein to reduce insulin and generate ketosis Ongoing weight loss phase: wider variety vegetables, seeds, nuts and low glycemic whole fruits like strawberries and blueberries Pre Maintenance Phase: once goal weight achieved, allow carb intake to slowly increase while monitoring weight Maintenance phase: 60-90 g of carbs per day if weight and health maintained; may include legumes, whole grains and whole fruits

Answer 69

Reduced decision fatigue, quickly reversible, may fit better in day to day schedule, may reduce caloric intake, may improve metabolic parameters and reduce body weight

Answer 70

Does not necessarily emphasize “healthy” meal quality, may not want to use in patients with eating disorder history, increases risk of hypoglycemia, no great evidence of sustainability, long-term evidence of benefits/safety/efficacy from animal studies, Prolonged fasting may promote gout, urate nephrolithiasis, postural hypotension and dysrhythmias

Answer 71

150-300 minutes + moderate-intensity activity OR 75-150 min+ vigorous intensity activity per week Muscle strengthening activities 2+ days per week Moderate intensity: brisk walk, raking yard, etc Vigorous intensity: running, weight lifting, fitness class Moderate or vigorous: swimming, bicycling For clinically significant weight loss and maintenance activity should be 250 min or greater per week Resistance training can improve the proportion of fat to fat free mass loss Without weight loss it still improves health risk

Answer 72

Motivational interviewing Having empathy Going through the 5 A’s Address body image Why do we eat like we do?: physiologic, stress, emotions, timing, environment, information gap, reward Why DON’T we engage in routine activity?: physical symptoms, lack of time, not interested, support, inadequate education, financial, accessibility Elements for success: doable, evidenced base, measurable, accountability, ownership, frequent encounters (medical professionals), education, setting goals, non scale goals, self monitoring, stimulus control, addressing body image, creating plan to change cognitive patterns, rewards, stress mgmt, health care team, group support, weight loss programs, use of technology and social media and telemedicine Stress management Improving sleep Mindful eating

Answer 73

Beta blockers, calcium channel blockers, insulin, sulfonylureas, steroids, progestion contraceptives, gabapentin, valproate, some antipsychotics, lithium, some SSRIs and SNRIs, many others...

Answer 74

Phentermine/topiramate, liraglutide, semaglutide, naltrexone/bupropion, tirzepatide, orlistat

Answer 75

Lomaira/Adipex Reduces appetite CI: uncontrolled HTN, uncontrolled anxiety, CV history, hyperthyroidism, there is risk mania, pregnancy Monitor: BP, pulse, EKG (person dependent) AEs: constipation, dry mouth, headache, insomnia, anxiety, jitteriness, palpitations, elevated HR and BP Caution > 65 years old FDA approved, approved for pediatrics

Answer 76

Topamax Disinterest in food, reduces cravings, less food thoughts Think about using in patients with migraines, insomnia, pain CI: hx of calcium kidney stone, glaucoma, cognitive impairment, risk of birth defects (teratogenic) Monitor: BMP, mental status AEs: drowsiness, paresthesia, memory issues, word finding difficulty, taste changes Caution in elderly, CKD, uncontrolled depression Rare risk of metabolic acidosis **NOT FDA approved**

Answer 77

Qsymia CI: same as individual medications Monitoring: same as individual medications AEs: same as individual medications FDA approved, approved for pediatrics

Answer 78

Vyvanse Causes appetite suppression CI: uncontrolled HTN, anxiety, CV history, risk mania Monitor: BP, pulse, EKG AEs: constipation, dry mouth, headache, insomnia, anxiety, jitteriness, palpitations, dizziness, nausea, vomiting, increased HR, anorexia Caution> 65 years old Use for moderate to severe binge eating disorder and ADHD Approved for pediatrics

Answer 79

Revia Works in mesolimbic reward pathway to decrease cravings Dose around time of largest cravings CI: if taking opioids, upcoming surgery, severe hepatic injury Monitor: LFTs AEs: nausea, dizziness, headaches, anxiety, insomnia is limited **NOT FDA approved**

Answer 80

Contrave Naltrexone mechanism + bupropion mechanism which stimulates POMC reducing hunger. CI: concurrent use MAOI, opioids or CYP2B6 inducers, hx of seizures, active bulimia/anorexia, uncontrolled HTN/anxiety Monitor: BP, HR, LFTs, mental status Hepatic and renal dosing AEs: headache, insomnia, nausea, constipation, vomiting, dizziness, dry mouth, tremor

Answer 81

Xenical or Alli Mechanism: GI lipase inhibitor that impairs digestion of dietary fat AEs: oily stools, oily flatus worse after fatty meals. Can promote kidney and gallstones and malabsorption of fat soluble vitamins CI: chronic malabsorption syndrome and cholestasis Drug interactions: cyclosporine, oral contraception, anti seizure medications, thyroid hormone, warfarin Not often used d/t AEs FDA approved, approved for Peds

Answer 82

Ex: GLP/GIP (semaglutide/Wegovy; liraglutide/Saxenda) CI: personal or FH medullary thyroid carcinoma, MEN2, idiopathic/chronic pancreatitis or pancreatitis from GLP 1 agonist. Exenatide if GFR< 30 ml/min Monitor: A1c, blood sugars as needed, BMP AEs: nausea, diarrhea, constipation, headache, heartburn, gallstones, pancreatitis, gastroparesis, fatigue Tirzepatide/Zepbound: weekly 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg FDA approved, semaglutide and liraglutide approved for pediatrics

Answer 83

Biodegradable oral non-systemic superabsorbent hydrogel Promotes fullness CI: pregnancy, hx of reaction to cellulose, citric acid, sodium stearyl fumarate, gelatin, titanium oxide AEs: abdominal pain, constipation, flatulence, infrequent bowel movements, abdominal distension, diarrhea, nausea FDA approved

Answer 84

Imcivree Melanocortin-4 receptor agonist: use in those with Bardet-Biedl syndrome (clinically diagnosed), POMC, PCSK1, LEPR deficiency (must be confirmed by genetic testing) Discontinue if after 12-15 weeks of tx there is not at least 5% loss of baseline bodyweight AEs: injection site reaction, skin hyperpigmentation, nausea, headache, diarrhea, abdominal pain, back pain, fatigue, vomiting, depression, URI, spontaneous erections FDA Approved

Answer 85

Myalept Leptin Analog Adjunction to diet to treat complications of leptin deficiency Not indicated for patients with NASH or HIV related lipodystrophy CI: hypersensitivity, general obesity not associated with congenital leptin deficiency AEs: headache, hypoglycemia, decreased weight, abdominal pain

Answer 86

VSG (Vertical Sleeve Gastrectomy) RYGB (Roux-en-Y gastric bypass) LAGB (Laparoscopic Adjustable Gastric Banding) Balloons 4,358 (1.6%) Revision

Answer 87

BMI >= 40 Those who are not responding to non surgical weight loss management AND BMI >=35 regardless of comorbidities BMI 30-34.9 and metabolic disease BMI >=27.5 in Asian populations Appropriate pediatric patients

Answer 88

Severe heart failure, unstable CAD, end-stage lung disease, Active cancer treatments, portal hypertension, decompensated liver cirrhosis, drug and alcohol dependency

Answer 89

Most common surgery **Can worsen GERD and Barretts** Favorable changes in gut hormones for hunger, satiety, blood sugar control Common deficiencies: Vitamin B1, B9, B12, D, Iron

Answer 90

Favorable changes in gut hormones and neuroendocrine signaling Bypasses part of the small intestine which limits absorption **Resolves GERD** Good for those at higher BMI, GERD, and Type 2 diabetes Common Deficiencies: Vitamin B1, B9, B12, D, calcium, Iron

Answer 91

Least invasive, removable (not permanent) Metabolic benefits are dependent on amount of weight loss Ideal for those with low BMI and no metabolic conditions Lowest rate of complications Common Deficiencies: Vitamin B1, D

Answer 92

Intragastric balloons, electrical vagal blocking system, endoscopic sleeve gastroplasty (ESG; doesn't affect ghrelin secretion)

Answer 93

3-5 small meals per day Decrease in # of meals as portion size increases Chew thoroughly Avoid consuming liquids during meals Protein at least 60 g/d (1.2-1.5 g/kg/d of lean mass) Avoid excessive calorie intake High quality multivitamins - chewable or liquid

Answer 94

Complication of RNY because it bypasses the pyloric emptying mechanism; common Facial flushing, lightheadedness, fatigue, reactive hypoglycemia, postprandial diarrhea Tx: avoid high glycemic index foods, avoid drinking fluid with meals

Answer 95

Yes AAP Recommendations: SHOULD offer adolescents 12 years and older obesity weight loss pharmacotherapy, according to medication indications, risks, and benefits, as an adjunct to health behavior and lifestyle management Some options: liraglutide, semaglutide, topiramae, vyvanse