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DEMS > Obesity treatment > Flashcards

Obesity treatment Flashcards

1
Q

How do you produce weight loss

A

reduce food intake to create a negative energy balance. This is hard. Goal is to lose 1-2 lbs qwk

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2
Q

Most important strategy for decreasing dietary intaking

A

monitoring diet- food diary and calorie counting

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3
Q

What is the best diet?

A

The one that the patient can stick with over time

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4
Q

How can weight loss be maintained?

A

regular contact with a trained interventionist greater than one year. Exercise!!!

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5
Q

You should watch less tv

A

You will increase your energy expenditure

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6
Q

Changing social environment can have an impact on weight

A

Study showed this, so….

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7
Q

Sleep is also important for weight loss

A

don’t overeat

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8
Q

What is the importance of exercise

A

Makes improvements in body composition. Increased lean mass. Improved appetite regulation. Must exercise 60 minutes per day to prevent weight regain

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9
Q

Where is hunger controlled?

A

Lateral nucleus of the hypothalamus

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10
Q

Where is satiety controlled?

A

ventromedial nucleus of the hypothalamus

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11
Q

How does leptin work?

A

stimulate energy expenditure and block food intake. Insulin does this as well. Obese prone people have leptin resistance

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12
Q

What are the hunger neurons

A

NPY neurons- release NPY to stimulate food intake and decrease energy expenditure. Also release AgRP to inhibit catabolic pathway. NPY neurons are inhibited by leptin

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13
Q

What is POMC

A

POMC releases MSH to reduce food intake and increase energy expenditure. This is excited by insulin.

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14
Q

What is ghrelin?

A

hunger hormone. Stimulates NPY and inhibit POMC

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15
Q

What are PYY and GLP-1?

A

released by small intestine in response to meal. Satiety hormone. Stimulate POMC and inhibit NPY

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16
Q

What is severe childhood obesity?

A

120 percent of 95th percentile

17
Q

What are some of the avoidable health risks associated with childhood obesity

A

T2DM, HTN, carotid atherosclerosis, arthritis, breast and colon cancer

18
Q

What is overweight range for children

A

85-95% BMI

19
Q

How is obesity defined in children?

A

> 95%

20
Q

Who has the highest prevalence of obesity

A

older children/adolescents
Native american, black, hispanic
lower socioeconomic status

21
Q

How many obese children have sleep apnea?

A

~1/3rd. snoring, bed wetting, morning headaches

22
Q

What is obesity hypoventilation syndrome?

A

Weight on the chest causes restrictive lung disease, leading to hypoventilation and may lead to right heart failure. Set point for CO2 gets higher. Need to use positive pressure- using Oxygen may cause a loss of respiratory drive

23
Q

How much weight do people lose with medication?

A

5-12%, but it only lasts as long as patient takes it. Often not covered by insurance

24
Q

How does phentermine work?

A

Increases NE content in the brain, but it’s not addictive. Cheapest drug. Only FDA approved for 3 months of use. 5-8% weight loss. Side effects- HTN, HA, nervousness

25
Q

Orlistat

A

pancreatic lipase inhibitor- inhibits fat absorption by 30%. Taken 3 times qd. Side FX- oily stools, urgency. Useful with poorly controlled HTN or psych problems. Safest drug!

26
Q

Lorcasarin

A

Serotonin 2C receptor agonist. Least side effects, but high cost.

27
Q

Phentermine/Topiramate

A

Greater efficacy with fewer side fx. Fairly expensive. More side fx than the other drugs- cloudy thinking.
Produces the most weight loss (10-12%), and produces metabolic fx associated with weight loss.

28
Q

Naltrexone/Bupropion

A

Combination pill
Works through POMC
Intermediate in side fx (HTN, lowers seizure threshold, SI) and effectiveness
None of the drugs can be used in pregnancy
Stop if <5% wt loss after 3 months

29
Q

Liraglutide

A

GLP1

30
Q

Surgery

A

Lap band is almost obsolete, Sleeve gastrectomy is almost as effective as gastric bypass, but is much easier to perform.

31
Q

What are the risks of bariatric surgery

A

Death- .7% within 30 days, 2-3% within 2 years
10-15% chance it will not produce weight loss
PE
Anastamotic leaks/sepsis
Vitamin deficiency

Late risks:
B12 deficiency
Anastamotic ulcer or stricture
Birth control efficacy is questionable
Don't get pregnant
32
Q

What are the stages of weight loss

A 
Precontemplative
Contemplative
Planning
Action
Maintenance
Relapse
Identification

DEMS (6 decks)

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