Overweight and Obesity Flashcards by Nicole Gaudreau

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

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

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What are the causes of weight gain?

Genetics
Environmental factors
Underlying medical condition or pharmacological agent

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What are the solutions for weight loss?

Less fat
Less sugar
More fiber
More exercise

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What part of the brain regulates hunger and satiety?

Hypothalamus

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What chemicals have effects on food intake?

NT
Receptors
Peptides
Hormones

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What hormones increase eating?

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

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What hormones decrease appetite?

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

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What tissues are used for peripheral storage?

White adipose tissue

Brown adipose tissue

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What is white adipose tissue?

Manufactures, stores, releases lipids

Accumulates from excess caloric storage

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What is brown adipose tissue?

Generates body heat to burn calories

Greater association with lean population

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What is the role of insulin?

Stimulates the liver to store glucose as glycogen

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What are problems we face in the US?

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

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

5lb

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

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

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What is the equation for BMI?

weight (kg) / height (m2)

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What BMI is considered overweight?

25 - 29.9

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What BMI is considered obese?

> /= 30

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How is waist circumference measured?

Between last rib and top of iliac crest

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What is an obese waist circumference?

M > 40 inches

F > 35 inches

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What is intra-abdominal fat associated with?

HTN, dyslipidemia, T2DM, CV disease

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How does obesity affect mortality?

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

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What categories are at risk for obesity?

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

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What is the weight loss goals prior to treatment?

5-10% body weight intially

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Before treatment, what must be ruled out?

Conditions

Medications

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

``` Diet Exercise Behavior PCT may allow for greater physical activity Surgery ```

What are some diets that are options for losing weight?

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

What are activity approaches for weight loss?

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

What are some behavioral approaches to weight loss?

``` 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 ```

What are the types of drug mechanisms for weight management?

Appetite suppression Metabolism alteration Calorie absorption inhibition

What is phentermine's MOA?

Enhances NE and dopamine neurotransmission - appetite suppression

What are the doses of phentermine?

30mg qAM or 8mg ac

Is phentermine recommended by the AACE anymore?

What is phentermine structurally similar to?

amphetamine

What schedule is phentermine?

How long can you take phentermine for?

3 months

What are the adverse effects of phentermine?

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

What are some drug interactions with phentermine?

MAOIs (D/c 14 days priot to use)

What are contraindications for phentermine use?

Untreated hyperthyroidism Agitated states Substance abusers Glaucoma

What are lipase inhibitors?

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

How long can lipase inhibitors be used?

long term

What is the MOA of lipase inhibitors?

Long-chain TG absorption and gastric emptying. | Inhibition induces weight loss by lowering dietary fat absorption and malabsorption of cholesterol

What are some counseling points for lipase inhibitors?

Take within 1 hour of eating | Limit dietary fat intake

What are some adverse effects of lipase inhibitors?

Soft stools Flatulence with discharge Hepatotoxicity

What are some positive effects of lipase inhibitors?

Improved glycemic control | Decreased rate of T2DM developement

What are some drug interactions?

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

What is the MOA of Locaserin?

Serotonin 2C receptor agonist | Increases satiety

What is the dose and schedule of locaserin?

10mg BID | Schedule IV

How long can locaserin be used?

long term

What are some drug interactions with locaserin?

SSRI | SNRI

What are some adverse effects of locaserin?

``` Pregnancy category X HA Dizziness Nausea Depression ```

What is the MOA of Qsymia?

Enhances NE and dopamine neurotransmission/increases GABA activity Appetite suppression

How long can Qsymia be used?

long term

What are the doses and schedule of Qsymia?

3.75/23mg - 15/92mg daily | Schedule IV

Why would you d/c Qsymia?

if < 5% weight loss at 12 weeks

What pregnancy category is Qsymia?

X (topiramate)

What are the adverse effects of Qsymia?

``` Dry mouth Constipation Insomnia Dizziness Anxiety Attention disturbance Tachycardia ```

What are some drug interactions with Qsymia?

MAOI (d/c 14 days prior to use)

What are contraindications for Qsymia?

Glaucoma | Untreated hyperthyroidism

What is Contrave's MOA?

NE-dopamine reuptake inhibitor/opioid receptor antagonist | Appetite suppression

How is dosing titrated for Contrave?

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

What is Contrave made up of?

Bupropion and naltrexone

How long can Contrave be used for?

long term

Why would a patient d/c Contrave?

if < 5% weight loss at 12 weeks

What is a contraindication for Contrave?

BBW for suicidality

What is a drug interaction with Contrave?

MAOI (d/c 14 days prior to use)

What pregnancy category is Contrave?

What are the adverse effects of Contrave?

``` Abdominal pain Nausea HA Constipation Dizziness ```

What is Liraglutide's MOA?

GLP1RA

How is Liraglutide dosed?

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

What are the contraindications of liraglutide?

Medullary thyroid carcinoma

What are the drug interactions for liraglutide?

DPP4i | Hypoglycemia with other DM meds

What are the adverse effects for liraglutide?

Nausea Injection rxns Pancreatitis

What are morbidity and mortality risks of surgical interventions?

DVT PE Infxn Bleeding

What are the candidates for surgical intervention?

``` BMI class 3 (> 40BMI) BMI class 2 w/significant comorbidities ```

What are significant comorbidities?

``` T2DM HTN Dyslipidemia Sleep apnea Non-alcoholic steatohepatitis GERD Asthma Impaired QOL ```

What should be exercised pre-surgery?

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

Where is the adjustable gastric band placed?

Uppermost part of the stomach. | Adjustable balloon via port in abdominal muscle

Where is the vertical gastric banding placed?

Upper stomach stapled about 2.5 inches in

What type of surgery is banding?

restrictive

What type of surgery is the sleeve?

restrictive

How does the sleeve work?

Stomach reduced to 20% | Edges stapled together

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

Restrictive and malabsorptive

How does biolopancreatic diversion with or without duodenal switch work?

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

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

Restrictive and malabsorptive

What is the most common bariatric surgery in the US?

Roux-en-y gastric bypass

How does the Roux-en-Y bypass work?

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

What is the effectiveness of the various surgeries?

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

What are the additional benefits of bariatric surgery?

T2DM HTN Dyslipidemia

What are the types of devices used in bariatric surgery?

Gastric balloon | Maestro system

What is the gastric balloon?

Saline filled balloons in stomach. | Filled with blue dye

What is the Maestro system?

SQ implanted neuroregulator | Blocks vagal nerve signals