33 - Obesity Flashcards Preview

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Flashcards in 33 - Obesity Deck (33):
1

Obesity is defined as what BMI ?

BMI > 30 kg/m^2

2

What waist circumference for men and women are markers of an increased cardiometabolic risk?

> 120 cm for men and > 88cm for women

3

Reducing weight by ___% can result in important health benefits

5-10

4

What are the 5 A's of obesity management?

-Ask
-Assess
-Advise
-Agree
-Assist

5

What are the 2 distinct phases of weight loss?

-Induction of weight loss
-Prevention of weight gain

6

Phase 1 - Induction of Weight Loss:
A negative energy balance of about ____ cal/day results in weight loss of about 1-2 kg (2-4 lb) per month

500

7

Phase 1 - Induction of Weight Loss:
1 kg of fat = ______ kcal

7780

8

Phase 1 - Induction of Weight Loss:
1 lb of fat = _____ kcal

3500

9

Phase 1 - Induction of Weight Loss:
How should they prevent the loss of lean body mass?

by ensuring the intake of high quality protein and doing resistance training

10

Phase 1 - Induction of Weight Loss:
How long does this phase last?

until the patient achieves the weight loss plateau (usually about 3-6 months) at which time the focus of tx changes to phase 2

11

Phase 2 - Prevention of Weight Regain:
Describe what the patient must do in this phase

-patient has to continue restricting energy intake indefinitely to the same level as was consumed at the time of weight loss

-any increase in energy intake will result in weight regain

12

What meds are associated with weight gain?

-TCA's, mirtazapine, MAOi's
-VPA, tamoxifen, CBZ
-insulin, meglitinides, SUs, TZDs
-lithium
-FGAs, SGAs
-Dexamethasone, prednisone
-Hormones (estrogen, progesterone, testosterone or other anabolic/androgenic steroids)
-flunarizine, pizotifen

13

Non-pharms for weight loss

diet, exercise, behavioral strategies

carb intake > 100g/day, protein > 1 g/kg/day, fat intake should not exceed 30-35% of total calories consumed with < 10% from trans and saturated fats

14

When should you consider bariatric surgery?

when BMI > 40 or > 35 if there are morbidities

15

What types of drugs should you avoid after bariatric surgery?

NSAIDs and oral bisphosphonates (GI irritants)

16

What are the 3 classes of meds used for obesity?

-Appetite suppressants
-Incretins
-Lipase inhibitors

17

Appetite suppressants:
What is the antidepressant used for obesity?

bupropion - although not approved for obesity

18

Appetite suppressants:
Contrave (bupropion/naltrexone XL) - who is it indicated for?

for those with BMI > 30 or BMI > 27 with at least 1 weight related comorbidity

19

Appetite suppressants:
What is Lorcaserin?

5-HT agonist - not available in Canada

20

Appetite suppressants:
What are 2 other options approved for obesity in the US ?

-topiramate/phentermine
-phentermine

21

Incretins:
Which incretin is approved for obesity?

Liraglutide - GLP 1 agonist

22

Incretins:
Describe Liraglutide (GLP 1 agonist)

SC injection

23

Incretins:
Liraglutide is proven to decrease ___ complications

CV

24

Incretins:
Who is liraglutide indicated for?

for those with BMI > 30 or BMI > 27 with at least 1 weight related comorbidity (such as DM, HTN, dyslipidemia)

25

Lipase Inhibitors:
Give the example

Orlistat

26

Lipase Inhibitors:
How does Orlistat work?

pancreatic and gastric lipase inhibitor that reduces dietary fat absorption by 30%, resulting in decreased 180 kcal/day

27

Lipase Inhibitors:
What kind of diet is poorly tolerated while taking Orlistat?

high fat intake is poorly tolerated on Orlistat therapy because of increased GI s/e

28

Lipase Inhibitors:
Who is Orlistat approved for?

approved for use in those with obesity and T2DM

29

What is the protocol for obese patients who are pregnant?

-do not try to lose weight while pregnant
-gain no more than 5-9.1 kg during pregnancy if they are obese
-eat healthy and exercise

30

Which of the medications mentioned before can be given during pregnancy?

bupropion (assess risk vs benefit tho)

31

Orlistat can cause ______ deficiencies

vitamin

32

Why is Orlistat not recommended during breastfeeding?

bc it can cause vitamin deficiences, even though small amount is transferred through breast milk

33

There were 2 cases of seizure in infants who were breastfed by a mom taking _____

bupropion

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