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Nutrition > Overweight and Obesity > Flashcards

Overweight and Obesity Flashcards

1
Q

What is obesity?

A

An energy balance disorder where there are more calories in than out

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2
Q

What is energy balanced by?

A

Neural and endocrine systems

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3
Q

What is the etiology of obesity?

A

genetics, environmental factors, underlying medical condition/pharmacological agent, more excercise

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4
Q

What regulates appetite?

A

Hypothalamus (regulates hunger and satiety)

- Also regulates reward, pleasure, memory

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5
Q

What has an effect on food intake?

A

NT, receptor, peptide, and hormones

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6
Q

What hormones cause increased eating?

A
  1. Ghrelin
  2. NPY
  3. AgRP
  4. Opioids
  5. Galanin
  6. NEa2
  7. Serotonin 5-HT1A
  8. Orexin
  9. MCH
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7
Q

What hormones cause decreased eating?

A
  1. Leptin
  2. Insulin
  3. GLP-1
  4. PYY
  5. MSH
  6. NEa1 and b2
  7. CRH
  8. CCK
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8
Q

What contributes to obesity in the US?

A
  • Abundance of food (increased availability, less expensive)

- Sedentary lifestyle

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9
Q

AHA and ADA Recommendations for Protein

A

4 kcal/g (15-20% of calories)

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10
Q

AHA and ADA Recommendations for Carbohydrates

A

4 kcal/g (50-55% of calories)

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11
Q

AHA and ADA Recommendations for Fat

A

9 kcal/g (25-30% of calories)

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12
Q

How is obesity diagnosed?

A
  • Body mass index (BMI)

- Waist circumference

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13
Q

BMI Calculation =

A

= weight (kg)/height (m^2)

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14
Q

What is considered an obese BMI?

A

greater than or equal to 30 kg/m^2

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15
Q

Class 1 BMI =

A

30-35 kg/m^2

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16
Q

Class 2 BMI =

A

35-40 kg/m^2

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17
Q

Class 3 BMI =

A

> 40 kg/m^2

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18
Q

What is waist circumference?

A

Narrowest circumference between last rib and top of iliac crest

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19
Q

Males > 40 in waist circumference are considered _

A

obese

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20
Q

Females > 35 in waist circumference are considered _

A

obese

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21
Q

What BMI is waist circumference most useful in?

A

BMI 25-34.9 kg/m^2

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22
Q

Intrabdominal fat is associated with:

A

HTN, dyslipidemia, T2DM, CV disease

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23
Q

Overall mortality and diabetes-related mortality is increased with every _ > _

A

5 kg/m^2 > 25 kg/m^2

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24
Q

Complications are increased in obese patients and category 3 patients expect a _ year reduced life expectancy

A

5-9 year

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25
Q

Who is at risk of obesity?

A
  1. Age (until age 80)
  2. Socioeconomic status (lower status)
  3. Women > Men
  4. Immigrants
  5. Family history
  6. Medications
  7. Conditions (Thyroid disorders)
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26
Q

Prior to treatment, we should…

A
  1. Establish patient and provider weight loss goal (5-10% body weight initially)
  2. Weight maintenance (Long term)
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27
Q

What is non-pharmacological treatment of obesity?

A
  • Identify and manage contributing conditions
  • Remove offending drugs (if possible)
  • Lifestyle changes
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28
Q

What diet is most useful to patients with obesity?

A

Mediterranean diet

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29
Q

(T/F) Fiber can cause a decrease of 15-30% in mortality of CV death, stroke, T2DM, and Colorectal cancer

A

True

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30
Q

How much activity should a patient get?

A

30 minutes most days of the week (moderate)

  • provides modest weight loss
  • improves obesity related comorbidities
  • Titrate slowly to avoid injuries
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31
Q

What behavioral approaches can be taken to reduce weight?

A
  1. Lifestyle modifications
  2. Social support
  3. Relapse prevention
  4. Motivational interviewing
  5. Identifying eating triggers
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32
Q

What criteria must a patient meet to be put on pharmacological interventions for obesity?

A
  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)
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33
Q

MOA of Phentermine (Apipex-P)

A

Enhances norepinephrine and dopamine neurotransmission to cause appetite suppression

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34
Q

What is historically the most commonly prescribed weight loss medication?

A

Phenteramine

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35
Q

Is Phenteramine recommended by the AACE?

A

No

36
Q

What is Phenteramine structually similar to?

A

Amphetamine

37
Q

What schedule is Phenteramine?

A

Schedule IV

38
Q

Adverse effects of Phenteramine

A

Insomnia, Increased BP, Palpitations, Arrhythmias,

39
Q

Phenteramine Contraindications

A

CV Disease, Avoid at bedtime, Glaucoma, Agitated states, Substance abusers, Untreated hyperthyroidism

40
Q

Phenteramine Drug Interactions

A
  1. MAOIs - D/C 14 days prior to use of Phenteramine
41
Q

What drugs are Lipase Inhibitors?

A

Orilistat =
Alli 60 mg ac (OTC)
Xenical 120 mg ac (Rx)

42
Q

Role of Lipase

A

role in long-chain TG absorption and gastric emptying

43
Q

Lipase Inhibitors MOA

A

Induces weight loss by lowering dietary fat absorption and malabsorption of cholesterol

44
Q

(T/F) Lipase Inhibitors can be used long term

A

True

45
Q

What age is Xenical approved for?

A

> /= 12 y/o

46
Q

Lipase Inhibitors Counseling

A
  1. Take within 1 hour of eating

2. Limit dietary intake of fat

47
Q

Lipase Inhibitors AE

A
  1. Soft stools
  2. Flatulence with discharge
  3. Hepatotoxicity
48
Q

Lipase Inhibitors Drug Interactions

A
  1. Fat soluble vitamines (ADEK)
  2. Diarrhea (NTI, OC, Lipohilic drugs)
  3. Separate dosing by 2 hours
49
Q

Phentermine/topiramate (Qsymia) MOA

A

Enhances norepinephrine and dopamine neurotransmission/increases GABA activity (Suppresses appetite)

50
Q

Can Phentermine/topiramate (Qsymia) be used long term?

A

Yes

51
Q

What schedule is Phentermine/topiramate (Qsymia) ?

A

Schedule IV

52
Q

When should Phentermine/topiramate (Qsymia) be D/C?

A

< 5% weight loss at 12 weeks at max dose
OR
< 3% weight loss at 12 weeks or increase dose

53
Q

Can Phentermine/topiramate (Qsymia) be used in pregnancy?

A

No! Topiramate is a Category X

54
Q

Phentermine/topiramate (Qsymia) AE

A
  1. Dry mouth
  2. Constipation
  3. Insomnia
  4. Dizziness
  5. Anxiety
  6. Attention disturbance
  7. Tachycardia
55
Q

What should Phentermine/topiramate (Qsymia) be avoided with?

A

MAOI - D/C 14 days prior to use of Phentermine/topiramate (Qsymia)

56
Q

Contraindications of Phentermine/topiramate (Qsymia)

A
  1. Glaucoma

2. Untreated hyperthyroidism

57
Q

Bupropion/naltrexone (Contrave) MOA

A

Norepinephrine-dopamine reuptake inhibitor/opioid receptor antagonist which causes appetite to be suppressed

58
Q

(T/F) Bupropion/naltrexone (Contrave) can be used long term

A

True

59
Q

When should Bupropion/naltrexone (Contrave) be D/C?

A

< 5% weight loss at 12 weeks

60
Q

Bupropion/naltrexone (Contrave) Contraindications

A

BBW for suicidality

61
Q

Bupropion/naltrexone (Contrave) should be avoided with…

A

MAOI - D/C 14 days prior to use

62
Q

Can Bupropion/naltrexone (Contrave) be used in pregnancy?

A

No, pregnancy category X

63
Q

Bupropion/naltrexone (Contrave) AE

A
  1. Abdominal pain
  2. Nausea
  3. H/A
  4. Constipation
  5. Dizziness
64
Q

Liraglutide (Saxenda) MOA

A

GLP-1 Antagonists

65
Q

Liraglutide (Saxenda) Contraindications

A

Medullary thyroid carcinoma

66
Q

Liraglutide (Saxenda) Drug interactions

A

DPP4-I

Hypoglycemia with other DM meds

67
Q

Liraglutide (Saxenda) AE

A

Nausea, Injection Rxn, Pancreatitis

68
Q

Semaglutide (Wegovy) MOA

A

GLP-1 Antagonists

69
Q

What is the most efficacious drug for weight loss?

A

Semaglutide (Wegovy) - Up to 15% TBW reduction in clinical trials

70
Q

When do we D/C Liraglutide (Saxenda) or Semaglutide (Wegovy)?

A

at 16 weeks if weight loss <5%

71
Q

When do we D/C Buproprion ER/Naltrexone ER (Contrave)

A

At 12 weeks if weight loss <5%

72
Q

How many kcal are in 1 lb?

A

1 lb = 3,500 kcal

73
Q

What is required for sustained weight loss?

A

Long term use of an agent and non-pharmacological and behavioral approaches

74
Q

What drugs does the FDA recommend caution with using?

A

Laxatives, caffeine, ephedra

75
Q

What is the most effective therapy?

A

Surgical intervention

76
Q

What surgical interventions are available to patients?

A

Gastric restriction, Gastric bypass

77
Q

Morbidity and mortality risks of surgical interventions

A

DVT, PE, infection, bleeding, <1% mortality

78
Q

Candidates for Surgical Intervention

A

BMI Class 3 (BMI >/= 40)
BMI Class 2 w/ significant comorbidities (BMI >/= 35) - T2DM, HTN, GERD, asthma, sleep apnea, nonalcoholic, steatohepatitis, impaired QOL

79
Q

Presurgery Requirements

A
  • Comorbidity control
  • Smoking cessation
  • Psychosocial-behavioral intervention
  • Nutritional evaluation (very low cal diet 800 kcal/day)
80
Q

What surgery is Adjustable Gastric Banding?

A

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
Q

What surgery is Vertical Gastric Banding?

A

Restrictive with the upper stomach stapled about 2.5 inches

82
Q

What is a gastric sleeve?

A

Restrictive where the stomach size is reduced 20% and the edges are stapled together

83
Q

What is a biliopancreatic diversion with or without a duodenal switch?

A

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
Q

What is a roux-en-y gastric bypass?

A

Restrictive and malabsorptive (most common in US). Bypass small portion of small intestine and creation of a 15-30 cc stomach pouch.

85
Q

Additional benefits of surgical procedures?

A

T2DM, HTN, dyslipidemia

86
Q

What devices can be used for weight loss?

A 
Gastric balloon (saline-filled balloon in the stomach)
Maestro system (SQ neuroregulator that blocks vagal nerve signals)

Nutrition (3 decks)

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