Exam #1: Obesity II

Question 1

What should the assessment of an obese patient focus on in addition to anthropometric data?

Answer 1

• Social hx
• Familial hx
• Food/ nutrition behavior

Question 2

What are the four major categories of barriers to obesity intervention?

Answer 2

1) Mental
2) Economics
3) Mechanical (physical activity)
4) Metabolic

Question 3

What are the five stages of change?

Answer 3

1) Pre-contemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance

Question 4

What is the pre-contemplation stage of change?

Answer 4

No intention to change over next 6 months

Question 5

What is the contemplation stage of change?

Answer 5

Aware of problem; thinking about changing in 6 months

Question 6

What is the preparation stage of change?

Answer 6

Intends to change in 30 days and may have made small changes

Question 7

What is the action stage of change?

Answer 7

Actively engaged in change for less than 6 months

Question 8

What is the maintenance stage of change?

Answer 8

Engaged in behavior for at least 6 months

Question 9

What are the major methods of obesity treatment?

Answer 9

• Altering diet
• Increasing physical activity
• Behavior therapy
• Pharmacology
• Surgery

**A combination of these is key

Question 10

What is key to successful treatment of obesity?

Answer 10

• Lifestyle change (weight loss only is unsuccessful 40% of the time)
• Multidisciplinary approach

Question 11

What is the definition of successful weight loss?

Answer 11

• Losing 10% of initial eight

- Maintaining that for at least one year

Question 12

What can a 10% weight loss improve?

Answer 12

• Lipid levels
• Blood glucose
• Risk of heart disease
• Lifestyle

Question 13

Who is approved for a very low calorie diet (VLCD)?

Answer 13

• BMI is 30+

- 27 w/ comorbidities

Question 14

What is the definition of VCLD?

Answer 14

> 800 calories

Question 15

What is important to remember when a patient has finished a VLCD program?

Answer 15

Must gradually refeed over 4-6 weeks

Question 16

What is the limitation of VLCD?

Answer 16

Modest long-term outcome with common weight regain

Question 17

What is one of the most successful weight loss program types?

Answer 17

Behavior modification

*****Success especially seen when paired with other treatment types

Question 18

What does behavior modification include?

Answer 18

• Goal-setting
• Self-monitoring
• Stimulus control
• Cognitive reconstruction
• Stress management
• Social support
• Relapse prevention

Question 19

What are the three essentials of motivational interviewing?

Answer 19

MI is:

1) A conversation
2) Collaborative
3) Evocative

Question 20

What patients are good candidates for drug therapy?

Answer 20

• BMI >30

- 27 w/ comorbidities

Question 21

What is Orlistat? What is the mechanism of action?

Answer 21

• Weight loss drug
• Approved for peds

*****Lipase inhibitor that blocks fat absorption

Question 22

What is Phentermine/Topiramate ER? What is the mechanism of action?

Answer 22

Phentermine= appetite suppressant

Topiramate= anticonvulsant that decreases hunger and increases satiety

Question 23

What is gastric banding?

Answer 23

Placing a band around the upper stomach to create a 15 mL pouch

Question 24

What are the advantages of gastric banding?

Answer 24

• Easily removed/ reversed
• Faster recovery
• Can be adjusted in office

Question 25

What are the disadvantages to gastric banding?

Answer 25

- Weight loss if less dramatic - More likely to regain weight - Vomiting - Can slip out of place

Question 26

What is a sleeve gastrectomy?

Answer 26

75% of stomach is removed in line with the greater curvature

Question 27

What are the advantages to sleeve gastrectomy?

Answer 27

- Simpler than bypass - Lower risk than bypass - Doesn't effect absorption - Rare nutritional deficiencies

Question 28

What are the disadvantages to sleeve gastrectomy?

Answer 28

- Irreversible - New - No long term data

Question 29

What is Roux-en-Y Gastric Bypass?

Answer 29

- 15-25 mL pouch made w/ outlet | - Bypass distal stomach, duodenum, and jejunum

Question 30

What are the pros of Roux-en-Y Gastric Bypass?

Answer 30

- Dramatic weight loss - C-morbid conditions improve - Good long term results

Question 31

What are the cons of Roux-en-Y Gastric Bypass?

Answer 31

- Irreversible - Nutritional deficiency common - Need life long supplements - Dumping Syndrome

Question 32

What are the common complications of bariatric surgery?

Answer 32

- Leaks - Stomal ulceration - Dumping syndrome - Constipation* *Most common

Question 33

What is dumping syndrome?

Answer 33

Weakness, abdominal discomfort, and sometimes abnormally rapid bowel evacuation, occurring after meals in some patients who have undergone gastric surgery.

Question 34

What foods will worsen Dumping Sydrome?

Answer 34

High sugar foods and beverages

Question 35

What are the major deficiencies seen following bariatric surgery?

Answer 35

- Iron deficiency anemia - B12 - Folate - Ca++ and Vitamin D