Overweight and Obesity

Question 1

What BMI is classified as Overweight?

Answer 1

25-29.9

Question 2

What BMI is classified as Obese?

Answer 2

> 30

Question 3

What BMI is classified as Clinically Obese?

Answer 3

> 35

Question 4

What BMI is classified as Morbid Obesity?

Answer 4

35-40

Question 5

What BMI is classified as Morbid?

Answer 5

> 40

Question 6

When should you consider pharmacological treatment for obesity?

Answer 6

Adjust to diet and physical activity
Patients should have BMI >30, no other risk factors OR BMI>27 with risk factors

Question 7

What is Basal Metabolic Rate?

Answer 7

How much energy you burn if do nothing all day

Question 8

How do we induce basal weight loss?

Answer 8

1. Increase basal metabolic rate
2. Decrease eating/increase satiety
3. Increase calorie shedding in urine
4. Block calorie absorption from gut

Question 9

What drugs are classified as stimulants?

Answer 9

Bezphetamine
Diethylpropion
Phendimetrazine
Phentermine

Question 10

What is the MOA of stimulants?

Answer 10

Increase levels of NE, inhibit NE reuptake transporter NET = increase basal metabolic rate and decrease appetite

Question 11

What are the A/Es of stimulants?

Answer 11

Increased HR and BP
Cannot be used long term

Question 12

When should you use stimulants in caution?

Answer 12

1. CV
2. Renal impairment
3. Anxiety issues (worsen)
4. Pregnant (CI)
5. Drug abuse
6. Hyperthyroidism (worsen)
7. Glaucoma

Question 13

What are the pearls of stimulants?

Answer 13

Cause toxicity when used with MAOI

Question 14

What is Orlistat and its MOA?

Answer 14

Lipase inhibitor, blocks calorie absorption

Question 15

What are the A/Es of Orlistat?

Answer 15

GI: loose greasy stol, diarrhea, abdominal cramping/bloating

Question 16

What are the pearls of Orlistat?

Answer 16

Taken with each fat-containing meal
Long term use

Question 17

What GLP-1 Agonists can be used for Obesity and how does it work?

Answer 17

Decreases appetite through increase fullness/satiety
Liraglutide and Semaglutide

Question 18

AE of Victoza/Saxenda? (lira)

Answer 18

Pancreatitis, gallbladder, irritation

Question 19

Pearls of Ozempic/Ryblesus? (sema)

Answer 19

Labeled for weight loss, better than Liraglutide

Question 20

What was Lorcaaserin and what is wrong with it?

Answer 20

5-HT2C Receptor Antagonist, decreases hunger/increase satiety
Withdrawn due to increased risk of cancer

Question 21

What is Phentermine + Topiramate?

Answer 21

Qsymia
Phentermine: stimulant
Topiramate: anti-convuslant

Question 22

Pearls about Qsymia?

Answer 22

Greater efficacy than phentermine alone
Abrupt DC = seizures

Question 23

What are the AE and CI of Qsymia?

Answer 23

AE: mood changes, insomnia, fatigue
CI: pregnancy, glaucoma, hyperthyroidism, CV

Question 24

What is Naltrexone + Bupropion?

Answer 24

Contrave
Naltrexone: opioid receptor antagonist
Bupropion: atypical antidepressant

Question 25

AE of Contrave?

Answer 25

Increased risk of suicidal thoughts/behaviors, seizures, CNS depression

Question 26

What is Plenity and its MOA?

Answer 26

Non-Pharmacologic, device that mechanically fills the stomach to encourage less eating

Question 27

What is the dose for Plenity?

Answer 27

3 Capsules, taken 20 mins before meals with water, Cellulose and Citric Acid

Question 28

What are OTC stimulant meds for obesity?

Answer 28

Ephedra, Caffeine, Hoodia, Bitter Orange
Caution CV and HTN

Question 29

What are OTC meds for obesity with no proven significant effect?

Answer 29

Chitosan, Pyruvate, and Chromium