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Nutrition Final > Overweight and Obesity > Flashcards

Overweight and Obesity Flashcards

1
Q

What is the definition of overweight and obesity per the WHO?

A

“The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended.”

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2
Q

What are the causes of weight gain?

A

Genetics
Environmental factors
Underlying medical condition or pharmacological agent

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3
Q

What are the solutions for weight loss?

A

Less fat
Less sugar
More fiber
More exercise

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4
Q

What part of the brain regulates hunger and satiety?

A

Hypothalamus

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5
Q

What chemicals have effects on food intake?

A

NT
Receptors
Peptides
Hormones

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6
Q

What hormones increase eating?

A 
Ghrelin
NPY
AgRP
Opioids
Galanin
NE a2
Serotonin 5-HT 1a
Cannabinoid CB
Orexin
MCH
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7
Q

What hormones decrease appetite?

A 
Leptin
Insulin
GLP-1
PYY
MSH
NE a1 and b2
Serotonin 5-HT 1b
CRH
CCK
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8
Q

What tissues are used for peripheral storage?

A

White adipose tissue

Brown adipose tissue

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9
Q

What is white adipose tissue?

A

Manufactures, stores, releases lipids

Accumulates from excess caloric storage

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10
Q

What is brown adipose tissue?

A

Generates body heat to burn calories

Greater association with lean population

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11
Q

What is the role of insulin?

A

Stimulates the liver to store glucose as glycogen

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12
Q

What are problems we face in the US?

A 
Abundance of food (increase availability and portion size, less expensive)
Sedentary lifestyle (technology and automation)
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13
Q

If energy balance is +50kcal/day, what is the resulting weight gain over 1 year?

A

5lb

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14
Q

What does the AHA and ADA recommend in terms of protein, carb and fat % of daily calories?

A

Protein: 15-20% (4kcal/g)
Carb: 50-55% (4kcal/g)
Fat: 25-30% (9kcal/g)

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15
Q

What is the equation for BMI?

A

weight (kg) / height (m2)

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16
Q

What BMI is considered overweight?

A

25 - 29.9

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17
Q

What BMI is considered obese?

A

> /= 30

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18
Q

How is waist circumference measured?

A

Between last rib and top of iliac crest

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19
Q

What is an obese waist circumference?

A

M > 40 inches

F > 35 inches

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20
Q

What is intra-abdominal fat associated with?

A

HTN, dyslipidemia, T2DM, CV disease

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21
Q

How does obesity affect mortality?

A

For every 5kg/m2 > 25kg/m2:
Overall mortality increased
Diabetes-related mortality increased
Reduced life expectancy

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22
Q

What categories are at risk for obesity?

A 
Age
Socioeconomic status
W > M
AA, hispanic, (immigrants)
FH
Medications
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23
Q

What is the weight loss goals prior to treatment?

A

5-10% body weight intially

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24
Q

Before treatment, what must be ruled out?

A

Conditions

Medications

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25
Q

According to Endocrine Society Guidelines, all overweight/obesity management approaches should include what?

A 
Diet
Exercise
Behavior
PCT may allow for greater physical activity
Surgery
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26
Q

What are some diets that are options for losing weight?

A 
No specific recommendation
Jenny Craig
Weight Watchers
Adkin's Diet
Paleo Diet
Mediterranean Diet
Releana (hCG)
Track carbs in app
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27
Q

What are activity approaches for weight loss?

A

30 minutes most days of the week.
Provides moderate weight loss.
Improves obesity-related comorbidities.
Titrate slowly to avoid injuries

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28
Q

What are some behavioral approaches to weight loss?

A 
Choose lifestyle modificaitons that can be sustained.
Social support.
Relapse prevention
Petient centered
Identify eating triggers
Plate method
Portioning
Intermittent consumption cessation with fork/water
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29
Q

What are the types of drug mechanisms for weight management?

A

Appetite suppression
Metabolism alteration
Calorie absorption inhibition

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30
Q

What is phentermine’s MOA?

A

Enhances NE and dopamine neurotransmission - appetite suppression

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31
Q

What are the doses of phentermine?

A

30mg qAM or 8mg ac

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32
Q

Is phentermine recommended by the AACE anymore?

A

No

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33
Q

What is phentermine structurally similar to?

A

amphetamine

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34
Q

What schedule is phentermine?

A

IV

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35
Q

How long can you take phentermine for?

A

3 months

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36
Q

What are the adverse effects of phentermine?

A

Insomnia
Increased BP, palpitations, arrhythmias
Contraindicated CV disease, avoid at bedtime

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37
Q

What are some drug interactions with phentermine?

A

MAOIs (D/c 14 days priot to use)

38
Q

What are contraindications for phentermine use?

A

Untreated hyperthyroidism
Agitated states
Substance abusers
Glaucoma

39
Q

What are lipase inhibitors?

A

Orlistat
Xenical (Rx) 120mg ac:
approved for >12yo
Alli (OTC) 60mg ac

40
Q

How long can lipase inhibitors be used?

A

long term

41
Q

What is the MOA of lipase inhibitors?

A

Long-chain TG absorption and gastric emptying.

Inhibition induces weight loss by lowering dietary fat absorption and malabsorption of cholesterol

42
Q

What are some counseling points for lipase inhibitors?

A

Take within 1 hour of eating

Limit dietary fat intake

43
Q

What are some adverse effects of lipase inhibitors?

A

Soft stools
Flatulence with discharge
Hepatotoxicity

44
Q

What are some positive effects of lipase inhibitors?

A

Improved glycemic control

Decreased rate of T2DM developement

45
Q

What are some drug interactions?

A

Fat soluble vitamins (ADEK)
Diarrhea
Separate dosing by 2 hours

46
Q

What is the MOA of Locaserin?

A

Serotonin 2C receptor agonist

Increases satiety

47
Q

What is the dose and schedule of locaserin?

A

10mg BID

Schedule IV

48
Q

How long can locaserin be used?

A

long term

49
Q

What are some drug interactions with locaserin?

A

SSRI

SNRI

50
Q

What are some adverse effects of locaserin?

A 
Pregnancy category X 
HA
Dizziness
Nausea
Depression
51
Q

What is the MOA of Qsymia?

A

Enhances NE and dopamine neurotransmission/increases GABA activity
Appetite suppression

52
Q

How long can Qsymia be used?

A

long term

53
Q

What are the doses and schedule of Qsymia?

A

3.75/23mg - 15/92mg daily

Schedule IV

54
Q

Why would you d/c Qsymia?

A

if < 5% weight loss at 12 weeks

55
Q

What pregnancy category is Qsymia?

A

X (topiramate)

56
Q

What are the adverse effects of Qsymia?

A 
Dry mouth
Constipation
Insomnia
Dizziness
Anxiety
Attention disturbance
Tachycardia
57
Q

What are some drug interactions with Qsymia?

A

MAOI (d/c 14 days prior to use)

58
Q

What are contraindications for Qsymia?

A

Glaucoma

Untreated hyperthyroidism

59
Q

What is Contrave’s MOA?

A

NE-dopamine reuptake inhibitor/opioid receptor antagonist

Appetite suppression

60
Q

How is dosing titrated for Contrave?

A

Over 4 weeks to max of naltrexone 32mg and bupropion 360mg daily (split BID)

61
Q

What is Contrave made up of?

A

Bupropion and naltrexone

62
Q

How long can Contrave be used for?

A

long term

63
Q

Why would a patient d/c Contrave?

A

if < 5% weight loss at 12 weeks

64
Q

What is a contraindication for Contrave?

A

BBW for suicidality

65
Q

What is a drug interaction with Contrave?

A

MAOI (d/c 14 days prior to use)

66
Q

What pregnancy category is Contrave?

A

X

67
Q

What are the adverse effects of Contrave?

A 
Abdominal pain
Nausea
HA
Constipation
Dizziness
68
Q

What is Liraglutide’s MOA?

A

GLP1RA

69
Q

How is Liraglutide dosed?

A

Titrate dosing, 0.6mg daily, increase by 0.6mg weekly until at target dose of 3mg daily

70
Q

What are the contraindications of liraglutide?

A

Medullary thyroid carcinoma

71
Q

What are the drug interactions for liraglutide?

A

DPP4i

Hypoglycemia with other DM meds

72
Q

What are the adverse effects for liraglutide?

A

Nausea
Injection rxns
Pancreatitis

73
Q

What are morbidity and mortality risks of surgical interventions?

A

DVT
PE
Infxn
Bleeding

74
Q

What are the candidates for surgical intervention?

A 
BMI class 3 (> 40BMI)
BMI class 2 w/significant comorbidities
75
Q

What are significant comorbidities?

A 
T2DM
HTN
Dyslipidemia
Sleep apnea
Non-alcoholic steatohepatitis
GERD
Asthma
Impaired QOL
76
Q

What should be exercised pre-surgery?

A

Comorbidity control (lipids, flucose, etc)
Smoking cessation
Psychosocial-behavioral intervention
Nutritional evaluation

77
Q

Where is the adjustable gastric band placed?

A

Uppermost part of the stomach.

Adjustable balloon via port in abdominal muscle

78
Q

Where is the vertical gastric banding placed?

A

Upper stomach stapled about 2.5 inches in

79
Q

What type of surgery is banding?

A

restrictive

80
Q

What type of surgery is the sleeve?

A

restrictive

81
Q

How does the sleeve work?

A

Stomach reduced to 20%

Edges stapled together

82
Q

What type of surgery is biliopancreatic diversion with or without duodenal switch?

A

Restrictive and malabsorptive

83
Q

How does biolopancreatic diversion with or without duodenal switch work?

A

Stomach size reduction

Bile and pancreatic juices diverted to come in contact with food closer to end/middle of small intestines.

84
Q

What type of surgery is the Roux-en-Y gastric bypass?

A

Restrictive and malabsorptive

85
Q

What is the most common bariatric surgery in the US?

A

Roux-en-y gastric bypass

86
Q

How does the Roux-en-Y bypass work?

A

Bypass portion of small intestine and creation of 15-30cc stomach pouch.

87
Q

What is the effectiveness of the various surgeries?

A

Banding/sling: 35-65% excess weight loss
Roux-en-Y: 70% excess weight loss
Malabsorptive procedures: 75-85% excess weight loss

88
Q

What are the additional benefits of bariatric surgery?

A

T2DM
HTN
Dyslipidemia

89
Q

What are the types of devices used in bariatric surgery?

A

Gastric balloon

Maestro system

90
Q

What is the gastric balloon?

A

Saline filled balloons in stomach.

Filled with blue dye

91
Q

What is the Maestro system?

A

SQ implanted neuroregulator

Blocks vagal nerve signals

Nutrition Final (4 decks)

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