Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

DEMS Unit 2.2 > Obesity & Metabolic Syndrome > Flashcards

Obesity & Metabolic Syndrome Flashcards

1
Q

BMI Categories

A 
Underweight: < 18.5 
Normal: 18.5-24.9
Overweight: 25 - 29.9 
Obese: 30-39.9
Severely Obese: 40+
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Weight circumference measurements indicative of high metabolic risk

A

> 40” in men

> 35” in women

*Measured at the top of the iliac crest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Metabolic Syndrome - Diagnostic Critiera

A

Waist circumference > 40” (for men) or > 35” (for women), plus 3 or more of the following:

Elevated triglycerides (>150)  - or on TG lowering meds 
Low HDL (130/85) - or on anti-hypertensives 
Impaired fasting glucose (>100) - or on hypoglycemic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Steps in clinical evaluation of obese patients

A
  1. Measure degree of adiposity
  2. Assess other existing risk factors for cardiovascular disease
  3. Screen for complications of obesity
  4. Rule out medical causes of obesity
  5. Assess readiness for treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diet Guidelines for weight loss

A

Reduce daily calories by 500-1,000 (20-40% of calorie requirement)

Target calorie goal: 1,200-1,500 (< 250 lbs) or 1,500-1,800 (> 250 lbs)

Reduce portion sizes by 1/4 to 1/3

Low fat (55%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Exercise Guidelines

A

Minimum 30 minutes moderate activity/day; ideally 60 minutes

Weight loss maintenance requires physical activity at a threshold level of 328 calories/day; equivalent to 35 minutes vigorous or 70 minutes moderate activity/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Weight loss maintenance lessons

A 
Low calorie intake: 1,300-1,400/day 
Low fat (20-20%) high carbohydrate 
1 hour/day of moderate activity 
Regular self monitoring
Eat breakfast
11,000 steps/day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Lateral hypothalamus

A

“Hunger center” of the brain; stimulation produces voracious eating, lesions produce aphagia

Mediated by melanin concentrating hormone (MCH) and orexins (hypocretins)

Glucose is inhibitory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which centrally released hormones mediate hunger?

A

Melanin concentrating hormone (MCH) and orexins (hypocretins) from the lateral hypothalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Ventromedial nucleus

A

“Satiety center”

Stimulation results in cessation of eating, even in hungry animals; animals with lesions eat excessively and become obese due to re-setting of weight to a higher level

Glucose is excitatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Arcuate nucleus

A

Contains populations of neurons which respond to peripherally generated hormones to either increase hunger or satiety

NPY/AgRP neurons activate feeding
POMC/CART neurons activate satiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

a-MSH

A

a-MSH is a precursor of the proopiomelanocortin (POMC) precursor molecule

Released by cells of the POMC/CART population of the arcuate nucleus in response to leptin and insulin

Interacts with the MCR in the LH/PVN to produce satiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ghrelin

A

Gut peptide secreted from the stomach; blood concentration peaks prior to a meal to induce feeding

Receptors located in the arcuate nucleus; ghrelin activates the NPY/AgRP population of arcuate neurons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

CCK

A

Released from the duodenum in response to the presence of nutrients from the stomach

CCK activates vagal afferents which project to the hypothalamus, signaling satiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

PPY

A

Released from L cells of the distal ileum in response to nutrients

Inhibits hypothalamic NPY/AgRP system, inducing satiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

GLP-1

A

Released by L-cells of the distal ileum in response to the arrival of nutrients

Potentiates insulin release and acts via the NST to induce satiety

17
Q

Insulin

A

Circulates at levels that parallel body fat mass; insulin concentrations are well correlated with body fat content

Insulin receptors are located in the glucose-sensitive regions of the hypothalamus, i.e.:

In the LH (‘hunger center’) where glucose is inhibitory

In the VMN (‘satiety center’) where glucose is excitatory

18
Q

Leptin

A

Peptide hormone produced from adipose tissue; acts on the brain to decrease appetite and increase metabolic rate via activation of POMC/CART and inhibition of NPY/AgRP in the arcuate nucleus

19
Q

Phentermine

A

Chemically related to amphetamine; increases brain NE without risk of abuse, acts centrally to increase satiety and decrease food intake

Adverse effects: Nervousness, insomnia, headache, xerostomia, hypertension

FDA approved for 3 months; achieves ~5% baseline weight loss

20
Q

Orlistat (Xenica, Alli)

A

Pancreatic lipase inhibitor; inhibits absorption of dietary fat from GI tract

No systemic side effects (not systemically absorbed); may cause fatty stools, diarrhea, fat soluble vitamin deficiency

DDIs: Warfarin (increased INR), cyclosporine

Achieves ~5% baseline weight loss; may prevent development of diabetes in high risk individuals; improves blood lipids and lowers HbA1C in people with diabetes

21
Q

Lorcarsin

A

Serotonin 2C receptor agonist; serotonin 2C receptors are found only in the brain (no cardiotoxicity)

Achieves ~5% baseline weight loss

22
Q

Phentermine/Topiramate

A

Significantly greater weight loss efficacy (10-12% of baseline weight)

Side effects: Paresthesias, insomnia, irritability, anxiety; topiramate is teratogenic and requires monthly pregnancy monitoring

23
Q

Naltrexone / Buproprion

A

Opioid antagonist / NDRI

Achieves ~5% baseline weight loss

Side effects: Black box warning for suicidal ideation, reduced seizure threshold, hypertension, tachycardia, elevated LFTs, glaucoma

24
Q

Atypical antipsychotics least associated with weight gain

A

Ziprasidone (Geodon)

Aripriprazole (Abilify)

25
Q

Mood stabilizers least associated with weight gain

A

Topiramate

26
Q

Antidepressants least associated with weight gain

A

Buproprion (Wellbutrin)

27
Q

Glucose-lowering meds that cause weight gain

A

Insulin
Sulfonylureas
TZDs

28
Q

Glucose-lowering meds less associated with weight gain

A

GLP-1 agonists
DPP-4 antagonists
SGLT2 antagonists

29
Q

Roux en Y Gastric Bypass (RYGP)

A

Most effective surgery - 28-30% baseline weight loss, most retain 25-28% weight loss at 15 years; most associated with post-op resolution of T2DM (40%)

Risks: perioperative (thromboembolism, pneumonia, infection); chronic (nutritional deficiency - niacin, B12, D)

30
Q

Laparoscopic Banding

A

Advantages: reversible, does not structurally alter viscera, easier procedure with less risk of complication

Disadvantages: Least effective (20-24% of baseline weight loss), less success over the long term than RYGP, requires follow-up with periodic adjustment of the band, risk of mechanical failure

Approved for BMI > 30 and at least 1 co-morbid condition

31
Q

Sleeve gastrectomy

A

Intermediate choice between RYGP and laparoscopic banding procedure; achieves intermediate weight loss (24-27% of baseline weight)

Does not require adjustment (like lap band); not associated with nutritional deficiencies (like RYGP)

32
Q

Indications for medical / surgical treatment of obesity

A

Medications: BMI > 30 (or > 27 with weight-related comorbidity)

Surgery: BMI > 40 (or > 35 with weight-related comorbidity)

33
Q

Childhood Obesity - BMI Guidelines

A

Overweight: BMI for age and sex 85-95%tile

Obese: BMI for age and sex > 95%tile

Severe obesity: BMI for age and sex > 99%tile

34
Q

Pediatric Obesity - US Epidemiology

A

30% of children ages 2-19 are either overweight or obese

18% of children are obese, defined as BMI for age and sex > 95th percentile

35
Q

How is infant obesity measured?

A

95th percentile weight for length defined as overweight

36
Q

AAP Stages of Treatment for Pediatric Obesity

A
  1. Prevention (5210+)
  2. Structured weight management involving PCP plus dietician
  3. Comprehensive, multidisciplinary weight management (diet + exercise + behavior program)
  4. Tertiary care intervention (controlled / supervised diet, meds, surgery)
37
Q

5210+

A

5 fruits/vegetables
< 2 hours TV
1 hour activity
0 sugar sweetened beverages

DEMS Unit 2.2 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions