Obesity Management

Question 1

When does obesity occur?

Answer 1

When there is an increased energy storage resulting from an imbalance between energy intake and energy expenditure over time

Question 2

What is the single largest determinant of energy expenditure?

Answer 2

Metabolic rate

Question 3

What is defined as the REE measure soon after awakening in the morning at least 12 hours after the last meal

Answer 3

Basal metabolic rate (BMR)

Question 4

What is the major factor that affects total energy expenditure?

Answer 4

Physical activity

Question 5

What is a measure of total weight relative to height?

Answer 5

BMI

Question 6

The pattern of obesity is associated with an increased propensity for the development of what 4 things?

Answer 6

1. Hypertension
2. Dyslipidemia
3. Type 2 diabetes
4. Cardiovascular disease

Question 7

What is the high risk waist circumference for men?

Answer 7

> 40 in

Question 8

What is the high risk waist circumference for women?

Answer 8

> 35 in

Question 9

When is it not necessary to measure waist circumference?

Answer 9

BMI >/= 35

Question 10

When are weight loss medications not indicated?

Answer 10

With a BMI <27

Question 11

How many kcal should you decrease by to induce an energy deficit?

Answer 11

500 kcal/day

Question 12

Amount of energy expended daily at rest

Answer 12

BMR

Question 13

What % is added to BMR to estimate caloric requirements to maintain their current weight?

Answer 13

15

Question 14

What is the standard recommendation for physical activity?

Answer 14

30 minutes

Question 15

What drug is approved for short term use?

Answer 15

Phentermine

Question 16

What are 4 contraindications for phentermine?

Answer 16

1. CVD
2. CAD
3. Arrythmias
4. Stroke

Question 17

What are 4 side effects of orlistat?

Answer 17

1. Gas
2. Oily spotting
3. Fecal incontinence, urgency or frequency
4. Oily or fatty stool

Question 18

How can the side effects of orlistat be limited?

Answer 18

By adhering to a low fat diet (avg. 15g of fat per meal)

Question 19

What should patients take 2 hours before or after taking orlistat?

Answer 19

Vitamins D,E,A,K

Question 20

What should you separate orlistat with by at least 4 hours?

Answer 20

Levothyroxine

Question 21

What is there a caution of use of with orlistat?

Answer 21

Warfarin

Question 22

How should you take qsymia?

Answer 22

Once daily in the morning with or without food

Question 23

When should you avoid taking qsymia?

Answer 23

In the evening due to possibility of insomnia

Question 24

What dose do you start a patient on with Qsymia?

Answer 24

3.75 mg/23 mg

Question 25

What are 3 Qsymia ADEs?

Answer 25

1. Insomnia 2. Mood and sleep disorders 3. Suicidal ideation

Question 26

What are 3 contraindications to Qsymia?

Answer 26

1. Pregnancy 2. Glaucoma 3. Hyperthyroidism

Question 27

What drug needs to be in the REMS program?

Answer 27

Qsymia

Question 28

What is special about contrave?

Answer 28

Dose escalation schedule

Question 29

What are 3 contraindications of contrave?

Answer 29

1. Seizure disorders, anorexia/bulimia, abrupt d/c of alcohol 2. Use of other bupropion containing products 3. Chronic opioid use

Question 30

How often do you inject saxenda?

Answer 30

Daily

Question 31

What are contraindications for saxenda?

Answer 31

1. Personal or family history of medullary thyroid cancer or endocrine neoplasia syndrome type 2 2. Pregnancy

Question 32

What is the boxed warning for saxenda?

Answer 32

Risk of thyroid C-cell tumors, including medullary thyroid carcinoma

Question 33

What are 2 other warnings/precautions for saxenda?

Answer 33

1. Acute pancreatitis 2. Acute gallbladder disease

Question 34

How often is wegovy injected?

Answer 34

Weekly

Question 35

True or false: Zepbound and Wegovy have a dose escalation

Answer 35

False (Zepbound only)