Weight Loss, Obesity, and Metabolic Syndrome

Question 1

Most common eating disorder

Answer 1

Binge eating disorder

Question 2

Binge eating presentation

Answer 2

Over-eating; typically appears overweight

Question 3

Binge eating Tx

Answer 3

Vyvanse in the morning (stimulant)

o Starting dose = 30mg

Question 4

Female college student, BMI 18, athletic with micro fractures:

Answer 4

Anorexic?

- Micro/stress fx d/t malnutrition/not enough nutrients for bone

Question 5

Anorexia comorbidities

Answer 5

Suicide + Malnutrition = comorbidities/typical causes of mortality

Question 6

Anorexia risk factors

Answer 6

anxiety/depression, low BMI, athletics: ballet/gymnastic/runners/aerial silks/wrestling/horseback racing [weigh-ins for different class]

Question 7

Anorexia common signs

Answer 7

Amenorrhea (no longer DSM-5 criteria), lanugo, hypercarotenemia (looks orange, esp. palms), bradycardic

Question 8

Anorexia DSM-5 criteria (requires each of the following criteria):

Answer 8

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

Question 9

Bulimia signs

Answer 9

• 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

Question 10

Bulimia DSM-5 criteria (requires each of the following criteria):

Answer 10

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

Question 11

Diabulimia

Answer 11

intentional misuse of insulin to cause weight loss

Question 12

Cachexia

Answer 12

loss of muscle mass

Question 13

Sarcopenia

Answer 13

loss of muscle mass + loss of strength and performance

Question 14

Excessive weight gain or weight loss, consider?

Answer 14

• Consider thyroid disorder

- Obtain labs: TSH, hA1C, lipids, CMP

Question 15

Comorbid conditions causing obesity

Answer 15

Depression, PCOS, Cushing’s

Question 16

CHF signs

Answer 16

SOB, JVD, edema, fluid retention

o Not always weight gain – patient could be losing muscle mass and retaining fluids so weight could be static

Question 17

CKD:

Answer 17

• 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

Question 18

Meds for DM that causes weight loss:

Answer 18

• Trulicity / Ozempic (GLP-1 receptor agonists)
• Jardiance / Farxiga (SGLT2 inhibitors)
• Pramlintide / Symlin

Question 19

Drugs that can cause weight loss:

Answer 19

• 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

Question 20

Cheilosis

Answer 20

• cracks in corners of mouth d/t badly fitting dentures = cause patient not to eat
• consider nutritional deficiency?

Question 21

Definition of clinically significant weight loss

Answer 21

• More than 5% over 6-12 months

- Most important = obtain H&P!

Question 22

Most prevalent cause of inadequate intake / weight loss

Answer 22

Depression

Tx: Remeron

Question 23

Meds for appetite stimulant:

Answer 23

• Marinol / Dronabinol

- Megace / Megestrol acetate

Question 24

Geriatric patient losing weight:

Answer 24

• 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

Question 25

Concern in malnutrition labs

Answer 25

• Prealbumin = looks at 2-4 days hx of diet

- Albumin = looks at month hx of diet (28 days)

Question 26

B12 supplements:

Answer 26

Elderly dose = 1000mcg

Question 27

Topamax

Answer 27

• Help with weight loss
• SE: can cause kidney stones + hypokalemia
• Draw potassium baseline and recheck every 3-6 months

Question 28

Added sugar = percentage of diet:

Answer 28

• 10% of overall calorie per day

Question 29

Bariatric surgery criteria

Answer 29

• BMI over 40 and no comorbidities

- BMI 35-40 and 1 comorbidity (HTN, untreated depression)

Question 30

Obesity tx:

Answer 30

• Lifestyle changes: diet/exercise/behavior modifications (coping mechanisms)
• High protein / low carb diet – Causes body to burn fat = thermogenesis

Question 31

Very low-calorie diet:

Answer 31

200-800 kcal [net calorie]

Question 32

Starvation diet:

Answer 32

below 200 kcal [net calorie]

Question 33

Hormone that stimulates appetite

Answer 33

ghrelin

Question 34

Hormones that inhibit appetite

Answer 34

leptin, peptide yy, amylin, cholecystokinin

Question 35

Metabolic syndrome – Other names

Answer 35

insulin resistance syndrome, syndrome X, obesity dyslipidemia syndrome

Question 36

Metabolic syndrome criteria

Answer 36

-	Waist circumference size:
o	Women: ≥ 35 inches (88.9 cm)
o	Men: ≥ 40 inches (101.6 cm)
-	HTN: > 130/85
-	Triglycerides > 150
-	HDL < 40 men < 50 women
-	Fasting glucose >110
-	Needs to meet 3 out of 4 criteria*

Question 37

Hypothyroidism

Answer 37

• Not an obesity related disorder; also has a genetic component
• Not only obese patients have hypothyroidism

Question 38

Fatty liver

Answer 38

• Is an obesity related disorder

- You need to have excess fat to have fatty liver