Obesity (Lauren) 🏋🏻♀️⛹️♂️🥦🥬🍏 Flashcards
What is the #1 cause of preventable disease and disability?
Obesity
What BMI range is “Overweight”
25-29.9
What BMI range is Class I Obesity?
30-34.9
What BMI range is Class II Obesity?
35-39.9
What BMI range is Class III (Severe) Obesity?
40+
What is the best estimate to determine if someone is underweight, healthy weight, overweight, or obese?
BMI
For what population is BMI not an accurate correlation with total body fat?
Body builders
You need to measure waist circumference in patients whose BMI is between ____ and ____
25-35
What was it circumference is considered increased risk for women?
> 35”
> 31.5” for Asian women
What waist circumference is increased risk for men?
> 40
> 35.4 for Asian men
What does a waist circumference that is too big put you at risk for?
It indicates abdominal obesity which increases cardiometabolic risk: CAD, DM, HTN, HLD, nonalcoholic fatty liver
Is obesity a disease?
YES~~~~~~****~~**~~~
What is the #1 cause of obesity?
Energy (Calorie) Balance
What are some other causes of obesity other than eating too much?
Medications- steroids, lithium, insulin
Neurohormonal
Environment/Community- unsafe neighborhood, no sidewalks, parks
Other diseases- PCOS, Cushings, hypothyroid
How do you create a negative energy balance?
Increase activity, and eat fewer calories
A 500-1000 calorie/day deficit will lead to a weight loss of _______ per week
1-2 lbs
What are some tools that may be helpful for your patients in their weight loss journey?
Food diary
Apps**
Online tools
What things do you need to assess when evaluating an obese patient?
History and exam
Fasting glucose and/or HgA1C
TSH
Liver enzymes
Fasting lipids
Sleep apnea? Recent smoking cessation? CV risk factors? Osteoarthritis?
Why was the 2005 food pyramid better than the old one?
More individualized
Limit oils, saturated fats, trans fats, and sodium
Choose foods low in added sugar
Includes exercise
What do we use now instead of the food pyramid?
MyPlate
What are the 10 tips from myplate.gov to eat healthier?
- Balance calories
- Enjoy food, but eat less
- AVOID OVERSIZED PORTIONS****
- Know which foods to eat more of
- Make half your plate fruit/veggies
- Switch to skim or 1% milk 🥛
- Half of your grains should be whole grain
- Know which foods to eat less
- Reduce sodium
- Drink water instead of sugary drinks**
What are the 2 diets that seem to work really well for weight loss and protection against diabetes and CAD?
DASH diet
Mediterranean diet
What is the Mediterranean diet?
Primarily plant based
Fish, poultry OK. Limit red meat.
Main source of fat should be from olive oil
🥑🍅🌽🍆🥔🥕🍗🥙🐟🐔
____________ may be an even stronger predictor of mortality than established risk factors like smoking, HTN, and DM
Sedentary Lifestyle***
🛋🛌
Inactivity is a (modifiable/unmodifiable) risk factor
Modifiable lol
Should you prescribe an exercise regimen to all patients?
Yes
What are the benefits of physical activity?
Reduced cancer
Brain health-less risk of dementia, better sleep, reduced anxiety/depression, improved cognition
Reduced risk of falls
Improved quality of life
Cardiopulmonary fitness
Muscle strength
Reduced BP
Who needs to be screened for obesity
ALL ADULTS*****
If a patient has a BMI of 30 or higher, what do you need to do?
Refer them to an intensive, multicomponent behavioral intervention*****
What will an Intensive, multicomponenet behavioral intervention do for patients with BMIs of 30+?
Help patients make long term changes
Help control environmental stimuli that trigger eating
How many sessions of intensive, multicomponenet behavioral intervention do patients with BMI of 30+ need?
12-26 sessions/ year**
2x/month for 3 or more months
Who is the most trusted source of nutrition information?
Primary care providers
What is the best way to bring up obesity and fitness when talking to patients?
The 5 A’s!!!
Ask/Address
Advise
Assess***
Assist
Arrange
How do you Ask/Address weight, nutrition, and exercise?
“Do you exercise?”
Address BMI and waist circumference
How do you “Advise” a patient ?
Provide clear, strong, advice.
“Because of your diabetes, it is important to exercise.” Personalize the case to individual patient
How do you “Assess” a patient?
ASSESS READINESS TO CHANGE***
“Is losing weight something you want in the future?”
Assess motivation, past experiences
How do you “Assist” a patient?
Provide brief counseling or self-help material
“How much do you want to lose? Is family supportive?” Provide referrals and resources.
How do you “Arrange” a patient?
Arrange follow up
“I will refer you to a nutritionist” “Call me in 2 weeks and f/u in 4 weeks”
What is the rate-limiting step in talking to patients about weight?
assessing readiness to make lifestyle changes to achieve weight loss***
They MUST be ready before you continue w/ weight los conversation
What are the goals of obesity intervention?
Prevent, treat, or reverse the complications of obesity
All patients with BMI of _______ are candidates for weight loss interventions
25+
What puts a patient in “Low Risk” Obesity?
BMI 25-29.9 and no CV risk factors/other comorbidities
What is the obesity treatment for people with “Low Risk” obesity
Diet and exercise counseling to prevent weight gain
What puts a patient in the “Moderate Risk” for obesity?
BMI 25-29.9 + CV risk factor
OR
BMI 30-34.9
What is the treatment for patients with “Moderate Risk” obesity?
Intensive multicomponenet behavioral modification
Drug therapy if BMI is 27+
What puts a patient in the “High Risk” obesity category?
BMI 35-40
**
What puts a patient in the “Very High Risk” obesity category?
BMI >40
(BMI like a credit score)
**
What is the treatment for patients in the “High risk” and “Very High Risk” obesity categories?
Intensive multicomponenet behavioral modification
Consideration of drug therapy and bariatric surgery 🔪💊
At what BMI do patients become candidates for drug therapy?
30
OR
Over 27 with comorbidities
**
Is the goal of obesity treatment weight loss?
No, it is to prevent, treat, or reverse the complication of obesity and improve quality of life
____are the most common clinicians to prescribe medications for obesity
Primary Care Providers
Only 1.3% of obese patients receive weight loss medications, and of those, 85% received _______
Phentermine (rather than the newer meds)
Drug therapy (does/does not) cure obesity
Does not lol
What is ALWAYS the 1st line treatment for obesity?
Comprehensive lifestyle program**
If they lost less than 5% of their weight in 3-6 months, thennnnn we can discuss drug therapy
What is the MOA of Olistat (Alli/Xenical)?
Alters fat digestion by inhibiting pancreatic lipase= you poop out fat instead of absorb it
What are the side effects of Orlistat (Alli/Xenical)
Decreased absorption of fat soluble vitamins
Anal leakage and sharting 💨💩
**
What other thing must patients take when they are on Orlistat (Alli/Xenical)?
Multivitamin****
What is the MOA of Liraglutide (Victoza)?
GLP-1 receptor agonist
How is Liraglutide (Victoza) administered?
Daily SQ injection
What are the side effects of Liraglutide (Victoza)?
Nausea/vomiting
Which obesity drug is great for patients with Type 2 DM?
Liraglutide (Victoza)
What is the MOA of Lorcaserin (Belviq)?
Serotonin agonist that decreases appetite
What patients can NOT take phentermine or Phentermine/topiramate (Qsymia)?
HTN
CAD
Hyperthyroidism
***!!!
What is the MOA of phentermine?
Its a sympathomimetic that reduces appetite
How long can patients be on Phentermine
12 weeks ONLY**
**SHORT TERM*****
What is the most widely prescribed weight loss drug?
Phentermine
Which weight loss drug has potential for abuse?
Phentermine
If your patent is on ______ or ______, you need to monitor for neuropsychiatric side effects
Lorcaserin (Belviq)
Phentermine/topiramate (Qsymia)
If your patient has been on weight loss drugs, and they have not obtained ________% weight loss after _______ months, you need to discontinue the drug
4-5%
3 months
What do you need to monitor for if you put a diabetic patient on a weight loss drug?
Hypoglycemia
If your patient is on a weight loss drug, how often do you need to monitor their weight, BP, HR, and side effects?
Weekly for 4 weeks, the monthly for the next 3-4 months
What are some OTC wight loss drugs that are not recommended?
Garcinia/Hydroxycitric
Human chorionic gonadotropin (hCG)
Why is Garcinia/Hydroxycitric not recommended?
Hepatitis, mania, rhabdomyolysis, serotonin syndrome
Does hCG work for weight loss?
No, it is not more effective than placebo.
How many calories/day can you eat if you’re taking hCG for weight loss
500
What are the BMI cutoffs for considering bariatric surgery?
BMI 40+
BMI 35-39.9 with a serious comorbidity
BMI 30-34.9 + metabolic syndrome or type 2 DM thats hard to control
Loss of ____% of body weight prior to surgery leads to greater weight loss after bariatric surgery
8
Proper bariatric care includes ___________
Lifelong surveillance
What are the contraindications to bariatric surgery?
Eating disorder
Untreated mental illness
Drug/EtOH abuse
Coagulopathy
Severe cardiac disease
Inability to comply with lifelong dietary requirements
How does bariatric surgery cause weight loss?
Limits caloric intake by reducing stomach capacity
Malabsorption
Some decrease appetite and improve metabolism by changing release of various hormones
What are the 3 kinds of bariatric surgery you need to know?
Sleeve gastrectomy
Roux-en-Y Gastric Bypass
Adjustable gastric band/“Lap band” NOT RECOMMENDED
What is a sleeve gastrectomy?
Majority of the greater curvature of the stomach is removed. The new tubular stomach has a small capacity and is resistant to stretching since the fundus is absent, and has fewer ghrelin-producing cells
What happens in a Roux-en-Y gastric bypass?
A small stomach pouch is created and then directly connected to the small intestine. The pouch can only hold 1 oz of food, causing a feeling of fullness after a very small amount of food. Over time, the pouch will stretch to hold about one cup. The body absorbs fewer calories since food bypasses the majority of the stomach and duodenum. Leads to decreased appetite and improved metabolism by changing the release of various hormones.
Are we all created equal
No lol
Everyone needs a different “exercise prescription”
What should you ask your patient when you decide to talk to them about their physical activity?
- How many days/week do you engage in moderate physical activity like a brisk walk?
- On the days you exercise, how many minutes do you spend?
If your patient says they are not exercising, what should you say?
“Today i noticed your BP/cholesterol is slightly elevated. Let’s discuss a possible solution…”
What are the guidelines for physical activity?
****
Adults should perform at least 150-300 min/week of moderate intensity OR 75-150 min/week of vigorous aerobic physical activity (or comparable combo of the two)
PLUS muscle strengthening 2 or more days/week
****
What does FITT mean when it comes to writing an exercise prescription
F- frequency. Aim for 5+ days/week
I- intensity. Aim for moderate-vigorous depending on health/goals
T- time. Aim for 30 min or more BUT we no longer recommend a MINIMUM length of sessions
T- type: walking is a great start for a previously sedentary patient. Must be enjoyable, sustainable, and involve major muscle groups
According to the 2018 Physical Acitvity Guidelines for Americans, what is the minimum length of each exercise session
THERE ISN’T A MINIMUM BECAUSE EVERY MINUTE COUNTS!!! ⏰
What is a method for being aware of level of exertion?
“Talk Test”
Moderate- can talk but not sing
Vigorous- can not say not more than a few words w/o pausing to breath
What is a great initial activity for a previously sedentary patient?
Walking
What do you need to warn your patient about when they’re starting exercise?
Discuss exercise precautions- encourage them to listen to their body and educate about medical danger signs.
Make sure they increase intensity gradually, and always warm up/cool down.
Is physical activity a vital sign?
YES YOU SHOULD ALWAYS ASK ABOUT TI
