Overweight and Obesity Flashcards
1
Q
What is obesity?
A
An energy balance disorder where there are more calories in than out
2
Q
What is energy balanced by?
A
Neural and endocrine systems
3
Q
What is the etiology of obesity?
A
genetics, environmental factors, underlying medical condition/pharmacological agent, more excercise
4
Q
What regulates appetite?
A
Hypothalamus (regulates hunger and satiety)
- Also regulates reward, pleasure, memory
5
Q
What has an effect on food intake?
A
NT, receptor, peptide, and hormones
6
Q
What hormones cause increased eating?
A
- Ghrelin
- NPY
- AgRP
- Opioids
- Galanin
- NEa2
- Serotonin 5-HT1A
- Orexin
- MCH
7
Q
What hormones cause decreased eating?
A
- Leptin
- Insulin
- GLP-1
- PYY
- MSH
- NEa1 and b2
- CRH
- CCK
8
Q
What contributes to obesity in the US?
A
- Abundance of food (increased availability, less expensive)
- Sedentary lifestyle
9
Q
AHA and ADA Recommendations for Protein
A
4 kcal/g (15-20% of calories)
10
Q
AHA and ADA Recommendations for Carbohydrates
A
4 kcal/g (50-55% of calories)
11
Q
AHA and ADA Recommendations for Fat
A
9 kcal/g (25-30% of calories)
12
Q
How is obesity diagnosed?
A
- Body mass index (BMI)
- Waist circumference
13
Q
BMI Calculation =
A
= weight (kg)/height (m^2)
14
Q
What is considered an obese BMI?
A
greater than or equal to 30 kg/m^2
15
Q
Class 1 BMI =
A
30-35 kg/m^2
16
Q
Class 2 BMI =
A
35-40 kg/m^2
17
Q
Class 3 BMI =
A
> 40 kg/m^2
18
Q
What is waist circumference?
A
Narrowest circumference between last rib and top of iliac crest
19
Q
Males > 40 in waist circumference are considered _
A
obese
20
Q
Females > 35 in waist circumference are considered _
A
obese
21
Q
What BMI is waist circumference most useful in?
A
BMI 25-34.9 kg/m^2
22
Q
Intrabdominal fat is associated with:
A
HTN, dyslipidemia, T2DM, CV disease
23
Q
Overall mortality and diabetes-related mortality is increased with every _ > _
A
5 kg/m^2 > 25 kg/m^2
24
Q
Complications are increased in obese patients and category 3 patients expect a _ year reduced life expectancy
A
5-9 year
25
Who is at risk of obesity?
1. Age (until age 80)
2. Socioeconomic status (lower status)
3. Women > Men
4. Immigrants
5. Family history
6. Medications
7. Conditions (Thyroid disorders)
26
Prior to treatment, we should...
1. Establish patient and provider weight loss goal (5-10% body weight initially)
2. Weight maintenance (Long term)
27
What is non-pharmacological treatment of obesity?
- Identify and manage contributing conditions
- Remove offending drugs (if possible)
- Lifestyle changes
28
What diet is most useful to patients with obesity?
Mediterranean diet
29
(T/F) Fiber can cause a decrease of 15-30% in mortality of CV death, stroke, T2DM, and Colorectal cancer
True
30
How much activity should a patient get?
30 minutes most days of the week (moderate)
- provides modest weight loss
- improves obesity related comorbidities
- Titrate slowly to avoid injuries
31
What behavioral approaches can be taken to reduce weight?
1. Lifestyle modifications
2. Social support
3. Relapse prevention
4. Motivational interviewing
5. Identifying eating triggers
32
What criteria must a patient meet to be put on pharmacological interventions for obesity?
1. BMI greater than or equal to 30 kg/m^2
2. Waist circumference greater than or equal 40 in (M) and greater than or equal 35 in (F)
3. BMI 27-30 kg/m^2 with 2 risk factors (HTN, dyslipidemia, CHD, T2DM, sleep apnea)
33
MOA of Phentermine (Apipex-P)
Enhances norepinephrine and dopamine neurotransmission to cause appetite suppression
34
What is historically the most commonly prescribed weight loss medication?
Phenteramine
35
Is Phenteramine recommended by the AACE?
No
36
What is Phenteramine structually similar to?
Amphetamine
37
What schedule is Phenteramine?
Schedule IV
38
Adverse effects of Phenteramine
Insomnia, Increased BP, Palpitations, Arrhythmias,
39
Phenteramine Contraindications
CV Disease, Avoid at bedtime, Glaucoma, Agitated states, Substance abusers, Untreated hyperthyroidism
40
Phenteramine Drug Interactions
1. MAOIs - D/C 14 days prior to use of Phenteramine
41
What drugs are Lipase Inhibitors?
Orilistat =
Alli 60 mg ac (OTC)
Xenical 120 mg ac (Rx)
42
Role of Lipase
role in long-chain TG absorption and gastric emptying
43
Lipase Inhibitors MOA
Induces weight loss by lowering dietary fat absorption and malabsorption of cholesterol
44
(T/F) Lipase Inhibitors can be used long term
True
45
What age is Xenical approved for?
>/= 12 y/o
46
Lipase Inhibitors Counseling
1. Take within 1 hour of eating
| 2. Limit dietary intake of fat
47
Lipase Inhibitors AE
1. Soft stools
2. Flatulence with discharge
3. Hepatotoxicity
48
Lipase Inhibitors Drug Interactions
1. Fat soluble vitamines (ADEK)
2. Diarrhea (NTI, OC, Lipohilic drugs)
3. Separate dosing by 2 hours
49
Phentermine/topiramate (Qsymia) MOA
Enhances norepinephrine and dopamine neurotransmission/increases GABA activity (Suppresses appetite)
50
Can Phentermine/topiramate (Qsymia) be used long term?
Yes
51
What schedule is Phentermine/topiramate (Qsymia) ?
Schedule IV
52
When should Phentermine/topiramate (Qsymia) be D/C?
< 5% weight loss at 12 weeks at max dose
OR
< 3% weight loss at 12 weeks or increase dose
53
Can Phentermine/topiramate (Qsymia) be used in pregnancy?
No! Topiramate is a Category X
54
Phentermine/topiramate (Qsymia) AE
1. Dry mouth
2. Constipation
3. Insomnia
4. Dizziness
5. Anxiety
6. Attention disturbance
7. Tachycardia
55
What should Phentermine/topiramate (Qsymia) be avoided with?
MAOI - D/C 14 days prior to use of Phentermine/topiramate (Qsymia)
56
Contraindications of Phentermine/topiramate (Qsymia)
1. Glaucoma
| 2. Untreated hyperthyroidism
57
Bupropion/naltrexone (Contrave) MOA
Norepinephrine-dopamine reuptake inhibitor/opioid receptor antagonist which causes appetite to be suppressed
58
(T/F) Bupropion/naltrexone (Contrave) can be used long term
True
59
When should Bupropion/naltrexone (Contrave) be D/C?
< 5% weight loss at 12 weeks
60
Bupropion/naltrexone (Contrave) Contraindications
BBW for suicidality
61
Bupropion/naltrexone (Contrave) should be avoided with...
MAOI - D/C 14 days prior to use
62
Can Bupropion/naltrexone (Contrave) be used in pregnancy?
No, pregnancy category X
63
Bupropion/naltrexone (Contrave) AE
1. Abdominal pain
2. Nausea
3. H/A
4. Constipation
5. Dizziness
64
Liraglutide (Saxenda) MOA
GLP-1 Antagonists
65
Liraglutide (Saxenda) Contraindications
Medullary thyroid carcinoma
66
Liraglutide (Saxenda) Drug interactions
DPP4-I
| Hypoglycemia with other DM meds
67
Liraglutide (Saxenda) AE
Nausea, Injection Rxn, Pancreatitis
68
Semaglutide (Wegovy) MOA
GLP-1 Antagonists
69
What is the most efficacious drug for weight loss?
Semaglutide (Wegovy) - Up to 15% TBW reduction in clinical trials
70
When do we D/C Liraglutide (Saxenda) or Semaglutide (Wegovy)?
at 16 weeks if weight loss <5%
71
When do we D/C Buproprion ER/Naltrexone ER (Contrave)
At 12 weeks if weight loss <5%
72
How many kcal are in 1 lb?
1 lb = 3,500 kcal
73
What is required for sustained weight loss?
Long term use of an agent and non-pharmacological and behavioral approaches
74
What drugs does the FDA recommend caution with using?
Laxatives, caffeine, ephedra
75
What is the most effective therapy?
Surgical intervention
76
What surgical interventions are available to patients?
Gastric restriction, Gastric bypass
77
Morbidity and mortality risks of surgical interventions
DVT, PE, infection, bleeding, <1% mortality
78
Candidates for Surgical Intervention
BMI Class 3 (BMI >/= 40)
BMI Class 2 w/ significant comorbidities (BMI >/= 35) - T2DM, HTN, GERD, asthma, sleep apnea, nonalcoholic, steatohepatitis, impaired QOL
79
Presurgery Requirements
- Comorbidity control
- Smoking cessation
- Psychosocial-behavioral intervention
- Nutritional evaluation (very low cal diet 800 kcal/day)
80
What surgery is Adjustable Gastric Banding?
Restrictive with the adjustable gastric band placed at the uppermost part of stomach. The adjustable balloon is via a port in the abdominal muscle
81
What surgery is Vertical Gastric Banding?
Restrictive with the upper stomach stapled about 2.5 inches
82
What is a gastric sleeve?
Restrictive where the stomach size is reduced 20% and the edges are stapled together
83
What is a biliopancreatic diversion with or without a duodenal switch?
Restrictive and malabsorptive stomach size reduction. Bile and pancreatic digestive juices diverted to come in contact with food closer to the end/middle of small intestine
84
What is a roux-en-y gastric bypass?
Restrictive and malabsorptive (most common in US). Bypass small portion of small intestine and creation of a 15-30 cc stomach pouch.
85
Additional benefits of surgical procedures?
T2DM, HTN, dyslipidemia
86
What devices can be used for weight loss?
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Gastric balloon (saline-filled balloon in the stomach)
Maestro system (SQ neuroregulator that blocks vagal nerve signals)
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