Obesity Treatment: Drugs, Surgical Options, and Popular Diets

Question 1

Not related to this lecture: at 6”2, what should your weight maximally be to avoid weight-related complications?

Answer 1

178 lbs (a BMI of 22.9); a BMI of 23 is where weight-related complications are known to start increasing

Question 2

When counseling a patient on medications to assist in weight loss, you should be sure the patient understands that the drugs must be taken _____________.

Answer 2

chronically; typically, when patients stop taking these medications, their weight returns

Question 3

One common reason people don’t take weight-loss medications is _______________.

Answer 3

that insurance companies won’t pay for them and they’re extremely expensive

Question 4

Which weight-loss drug is chemically related to amphetamine?

Answer 4

phentermine

Question 5

Side effects of phentermine include headache, hypertension, and nervousness. This makes sense, because phentermine is _____________.

Answer 5

a sympathomimetic

Question 6

How does orlistat work?

Answer 6

It inhibits pancreatic lipase, thereby decreasing fat absorption.

Question 7

Side effects of orlistat include ______________.

Answer 7

increasing urgency of stooling and steatorrhea

Question 8

Which weight-loss drug is the safest?

Answer 8

Orlistat (it’s actually available OTC)

Question 9

Why was phen/fen removed from the market?

Answer 9

It (mostly the fen) caused valvular heart disease.

Question 10

____________ works by binding to and activating serotonin 2C receptors.

Answer 10

Lorcaserin

Question 11

The most effective weight-loss medication is ___________.

Answer 11

topiramate/phentermine (can go up to 12%); this combination also raises HDL, lowers BP, and decreases glucose levels

Question 12

Weight-loss drugs also reduce _____________.

Answer 12

A1c (Dr. Bessesen showed the trial for naltrexone/bupropion)

Question 13

The most popular kind of stomach surgery is ____________.

Answer 13

sleeve gastrectomy

Question 14

The most effective stomach surgery is _____________.

Answer 14

gastric bypass

Question 15

Why is gastric surgery effective?

Answer 15

Because they aren’t secreting ghrelin!

Question 16

Long-term studies on gastric-bypass surgery show that ______________.

Answer 16

compared to controls, those who had gastric bypass have fewer cases of diabetes, MI, and cancer

Question 17

What is the mortality of gastric bypass surgery?

Answer 17

0.7%

Question 18

One of the downsides of phentermine is that ____________.

Answer 18

there is no data on long-term safety

Question 19

Women need to have a negative pregnancy test before taking ________.

Answer 19

phentermine/topiramate

Question 20

Which weight-loss drug is the cheapest? Most effective? Safest? Has the fewest side effects?

Answer 20

Cheapest: phentermine
Safest: orlistat
Has the fewest side effects: lorcaserin
Most effective: phentermine/topiramate

Question 21

Avoid phentermine in patients with _________ problems.

Answer 21

psychiatric

Question 22

Paresthesias are a side effect of which weight-loss medication?

Answer 22

Topiramate/phentermine

Question 23

Which drug is considerate to have intermediate effectiveness and safety and is thus a second-line option?

Answer 23

Naltrexone/bupropion

Question 24

________ percent of those who had gastric bypass were able to maintain an A1c less than 6% without medications.

Answer 24

42%