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PEBC > 33 - Obesity > Flashcards

33 - Obesity Flashcards

1
Q

Obesity is defined as what BMI ?

A

BMI > 30 kg/m^2

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2
Q

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

A

> 120 cm for men and > 88cm for women

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3
Q

Reducing weight by ___% can result in important health benefits

A

5-10

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4
Q

What are the 5 A’s of obesity management?

A
  • Ask
  • Assess
  • Advise
  • Agree
  • Assist
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5
Q

What are the 2 distinct phases of weight loss?

A
  • Induction of weight loss

- Prevention of weight gain

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6
Q

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

A

500

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7
Q

Phase 1 - Induction of Weight Loss:

1 kg of fat = ______ kcal

A

7780

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8
Q

Phase 1 - Induction of Weight Loss:

1 lb of fat = _____ kcal

A

3500

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9
Q

Phase 1 - Induction of Weight Loss:

How should they prevent the loss of lean body mass?

A

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

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10
Q

Phase 1 - Induction of Weight Loss:

How long does this phase last?

A

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

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11
Q

Phase 2 - Prevention of Weight Regain:

Describe what the patient must do in this phase

A
  • 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
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12
Q

What meds are associated with weight gain?

A
  • 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
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13
Q

Non-pharms for weight loss

A

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

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14
Q

When should you consider bariatric surgery?

A

when BMI > 40 or > 35 if there are morbidities

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15
Q

What types of drugs should you avoid after bariatric surgery?

A

NSAIDs and oral bisphosphonates (GI irritants)

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16
Q

What are the 3 classes of meds used for obesity?

A
  • Appetite suppressants
  • Incretins
  • Lipase inhibitors
17
Q

Appetite suppressants:

What is the antidepressant used for obesity?

A

bupropion - although not approved for obesity

18
Q

Appetite suppressants:

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

A

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

19
Q

Appetite suppressants:

What is Lorcaserin?

A

5-HT agonist - not available in Canada

20
Q

Appetite suppressants:

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

A
  • topiramate/phentermine

- phentermine

21
Q

Incretins:

Which incretin is approved for obesity?

A

Liraglutide - GLP 1 agonist

22
Q 
Incretins:
Describe Liraglutide (GLP 1 agonist)
A

SC injection

23
Q

Incretins:

Liraglutide is proven to decrease ___ complications

A

CV

24
Q

Incretins:

Who is liraglutide indicated for?

A

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

25
Q

Lipase Inhibitors:

Give the example

A

Orlistat

26
Q

Lipase Inhibitors:

How does Orlistat work?

A

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

27
Q

Lipase Inhibitors:

What kind of diet is poorly tolerated while taking Orlistat?

A

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

28
Q

Lipase Inhibitors:

Who is Orlistat approved for?

A

approved for use in those with obesity and T2DM

29
Q

What is the protocol for obese patients who are pregnant?

A
  • 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
Q

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

A

bupropion (assess risk vs benefit tho)

31
Q

Orlistat can cause ______ deficiencies

A

vitamin

32
Q

Why is Orlistat not recommended during breastfeeding?

A

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

33
Q

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

A

bupropion

PEBC (130 decks)

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