Weight Loss, Obesity, and Metabolic Syndrome Flashcards
Most common eating disorder
Binge eating disorder
Binge eating presentation
Over-eating; typically appears overweight
Binge eating Tx
Vyvanse in the morning (stimulant)
o Starting dose = 30mg
Female college student, BMI 18, athletic with micro fractures:
Anorexic?
- Micro/stress fx d/t malnutrition/not enough nutrients for bone
Anorexia comorbidities
Suicide + Malnutrition = comorbidities/typical causes of mortality
Anorexia risk factors
anxiety/depression, low BMI, athletics: ballet/gymnastic/runners/aerial silks/wrestling/horseback racing [weigh-ins for different class]
Anorexia common signs
Amenorrhea (no longer DSM-5 criteria), lanugo, hypercarotenemia (looks orange, esp. palms), bradycardic
Anorexia DSM-5 criteria (requires each of the following criteria):
o Restriction of energy intake that leads to a low body weight, given the patient’s age, sex, developmental trajectory, and physical health
o Intense fear of gaining weight or becoming fat, or persistent behavior that prevents weight gain, despite being underweight
o Distorted perception of body weight and shape, undue influence of weight and shape on self-worth, or denial of the medical seriousness of one’s low body weight
Bulimia signs
- Russell’s sign = knuckle callus
- Destroyed/erosion of teeth enamel
- Throat red/irritated/scar tissue = Esophagitis
- Hide disorder from others = dress in layers, brush their teeth, eat then go to bathroom
Bulimia DSM-5 criteria (requires each of the following criteria):
o Episodes of binge eating, which are defined as eating an unusually large amount of food in a discrete period of time (eg, two hours). Patients feel that they cannot control their eating during the episode.
o Inappropriate compensatory behavior to prevent weight gain.
o Binge eating and inappropriate compensatory behaviors occur, on average, at least once a week for three months.
o The patient’s self-evaluation is unduly influenced by body shape and weight.
o The disturbance does not occur exclusively during episodes of anorexia nervosa
Diabulimia
intentional misuse of insulin to cause weight loss
Cachexia
loss of muscle mass
Sarcopenia
loss of muscle mass + loss of strength and performance
Excessive weight gain or weight loss, consider?
- Consider thyroid disorder
- Obtain labs: TSH, hA1C, lipids, CMP
Comorbid conditions causing obesity
Depression, PCOS, Cushing’s
CHF signs
SOB, JVD, edema, fluid retention
o Not always weight gain – patient could be losing muscle mass and retaining fluids so weight could be static
CKD:
- GFR 75 = Stage 2 [GFR 60-89 ml/min]
- GFR 45 = Stage 3 [GFR 30-59 ml/min]
- Less than 15 = Anorexia / uremia
- Preserve renal function = Med Recs: Avoid NSAIDs, metformin
Meds for DM that causes weight loss:
- Trulicity / Ozempic (GLP-1 receptor agonists)
- Jardiance / Farxiga (SGLT2 inhibitors)
- Pramlintide / Symlin
Drugs that can cause weight loss:
- Stimulants (amphetamines) – release catecholamines for parasympathetic nerve terminals to decrease appetite
- Cocaine – So much energy / no sleep
- Tobacco – Smoke so much, don’t eat; weight gain w/ cessation; Nicotine = stimulant
- Alcohol – Rather drink than eat (empty calories)
- Marijuana withdrawal – cyclical vomiting syndrome, irritability, weight loss, strange dreams
Cheilosis
- cracks in corners of mouth d/t badly fitting dentures = cause patient not to eat
- consider nutritional deficiency?
Definition of clinically significant weight loss
- More than 5% over 6-12 months
- Most important = obtain H&P!
Most prevalent cause of inadequate intake / weight loss
Depression
Tx: Remeron
Meds for appetite stimulant:
- Marinol / Dronabinol
- Megace / Megestrol acetate
Geriatric patient losing weight:
- Do not prescribe appetite stimulant right away!
- Better to treat depression / give high calorie food / supplemental shakes / remove dietary restrictions FIRST.
o If no improvement, then consider appetite stimulant
