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PHAR 359 > Obesity > Flashcards

Obesity Flashcards

(54 cards)

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1
Q

What BMI is considered underweight?

A

<18.5

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2
Q

What BMI is considered healthy range

A

18.5 to <25

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3
Q

What BMI is considered overweight?

A

25 to <30

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4
Q

What BMI is class 1 obesity?

A

30-34.9

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5
Q

What BMI is class 2 obesity?

A

35-39.9

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6
Q

What BMI is class 3 obesity?

A

40+

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7
Q

Waist circumference is strongly associated with CV and all-cause mortality, particularly when adjusting for BMI. What values are considered very high risk for men and women?

A

WC 40.2+ inches (102cm) for men
34.6+ inches (88cm) for women

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8
Q

True or False? BMI is an accurate tool for identifying adiposity-related complications

A

False - it’s not really

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9
Q

Why are we concerned about obesity?

A

Excess adipose tissue is associated with increased morbidity and mortality

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10
Q

Obesity increases the risk of the following cancers: (5)

A
  1. Colon (both sexes)
  2. Kidney (both sexes)
  3. Esophagus (both sexes)
  4. Endometrium (women)
  5. Postmenopausal breast (women)
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11
Q

What are some potential risk factors for obesity? (10)

A
  1. Lower socioeconomic status
  2. Genetic predisposition
  3. Highly processed diet
  4. Physical inactivity
  5. Disordered/insufficient sleep
  6. Stress
  7. Depression, some eating disorders, other mental health conditions
  8. Medications
  9. Childhood obesity
  10. Gut microbiota?
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12
Q

What 2 classes of diabetes meds produce weight loss?

A
  1. SGLT2I’s
  2. GLP1RA’s
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13
Q

What 3 classes of diabetes meds are weight neutral?

A
  1. DPP-4 inhibitors
  2. Acarbose
  3. Metformin
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14
Q

What 4 classes of diabetes meds cause weight gain?

A
  1. Insulin
  2. Sulfonylureas
  3. Meglitinides
  4. TZDs
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15
Q

Obesity has not received official recognition as a chronic disease by the federal/provincial governments. Why?

A

This would be extremely expensive for the government to cover

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16
Q

What are some examples of weight bias/stigma? (2)

A
  1. People who are overweight face judgement
    - From individual people/HCPs
    - From society
  2. People who have overweight or obesity may take all the negative noise and turn it inwards on themselves (internalized weight bias)
    - Important to evaluate mental health
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17
Q

How is the hypothalamus associated with eating?

A

The hypothalamus: helps regulate energy intake and expenditure
- When activated, stimulates hunger sensation and food-seeking behaviour

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18
Q

How is the mesolimbic area associated with eating?

A

The mesolimbic (hedonic area): provides the emotional, pleasurable, rewarding aspects of eating
- Smells, sights, and emotions signal a desire to eat

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19
Q

How is the cognitive lobe associated with eating?

A

The cognitive lobe (executive functioning): helps one control adverse situations (such as overeating at night)
- May be impaired in those with obesity

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20
Q

What are 3 forms of obesity management?

A
  1. Lifestyle (dietary, physical activity, CBT)
  2. Pharmacotherapy
  3. Bariatric surgery
    (Combination of these 3 should be used for ideal outcome)
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21
Q

Most people return to baseline weight within 1-2 years after calorie restriction. Why?

A

Not due to willpower, but rather strong biological mechanisms that protect the body against weight loss

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22
Q

What to consider when it comes to nutritional interventions? (3)

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A
  1. There are various diets that can be tried, but they should be patient-specific
    - Refer to dietician when available!
  2. Focus on changes that will improve health, not just weight changes
  3. Consider what is acceptable and affordable for the patient
23
Q

What to know about physical activity and weight loss? (4)

Study These Flashcards
A
  1. Regular physical activity can improve cardiometabolic risk factors and QOL, mood, body image – benefits are partly independent of weight loss
  2. Aerobic Exercise:
    - Goal of 30-60min of moderate to vigorous aerobic activity on most days (≥ 150min/week)
  3. Resistance training:
    - May promote weight maintenance
    - Increase muscle mass
  4. Decrease sedentary time
24
Q

True or False? The more weight a person can lose, the more health benefits they can expect to see

25
Weight loss drugs face some challenges, such as? (4)
1. Perception of obesity not being a disease 2. Perception these drugs are not effective 3. Skepticism 4. Cost
26
What are 4 big options for obesity drugs?
1. Orlistat 2. Liraglutide 3. Naltrexone/bupropion 4. Semaglutide
27
What is the MOA of orlistat? (4)
1. Reversible lipase inhibitor in the GI tract 2. Lipases hydrolyze dietary fats, converting them to monoglycerides and triglycerides 3. Inhibits dietary fat absorption by approximately 30% 4. As a result, increased fecal fat excretion
28
Describe how orlistat is taken (4)
1. Dose: 120 mg oral capsule TID 2. Take with, or up to 1 hour after, each meal 3. Skip a meal (or meal has no fat), skip a dose 4. Follow a mildly hypocaloric diet with ≤30% calories from fat
29
What are the adverse effects of orlistat? (4)
Orlistat is not absorbed significantly; most AE’s are GI 1. Flatulence (sometimes with discharge) 2. Loose, oily stools 3. Fecal urgency / incontinence 4. Abdominal discomfort
30
What are the contraindications of orlistat? (2)
1. Malabsorption syndromes 2. Cholestasis
31
What are 2 precautions for orlistat use?
1. GI disorders 2. Hepatic disorders
32
What are some drug interactions to be aware of with orlistat? (3)
1. Separate from multivitamin by at least 2 hours - Reduces absorption of fat-soluble vitamins (A,D,E,K) 2. Decreased Vit. K absorption can increase anticoagulation with warfarin 3. May decrease the absorption of cyclosporine, levothyroxine, anti-epileptic drugs and antiretrovirals – separate dosing times by 3-4 hours
33
What is the MOA of naltrexone/bupropion for weight loss? (3)
1. Naltrexone: an opioid receptor antagonist - Prevents beta endorphin-mediated pro-opiomelanocortin autoregulation (works in the brain) 2. Bupropion: inhibits the reuptake of DA and NE - Increases DA in the mesolimbic pathway 3. Help induce satiety and decrease cravings via actions in the brain (i.e. less cravings and less appetite lead to less food intake)
34
What to know about dosing/administration of naltrexone/bupropion? (3)
1. Follow dosing instructions to minimize seizure risk (rare) and AEs 2. Avoid taking with high fat meals 3. Tablets should not be split
35
How to evaluate for efficacy of naltrexone/bupropion?
At week 12 of full dose, if 5%+ weight loss not achieved, a response is unlikely
36
What are some common AE's of naltrexone/bupropion? (6)
1. N/V/D 2. Constipation 3. Headache 4. Dry mouth 5. Dizziness 6. Insomnia
37
What are some rare AE's of naltrexone/bupropion? (2)
1. Seizure 2. Worsening of depression
38
What are some contraindications of naltrexone/bupropion? (4)
1. Opioid use 2. Uncontrolled HTN 3. History of or risk factors for seizures 4. Bulimia/anorexia
39
What are some drug interactions of naltrexone/bupropion? (3)
1. DI = CYP2B6 & 2D6 - Inhibitor of 2D6 - Primarily metabolized by 2B6 2. MAOIs - do not use within 14 days - increased risk of hypertensive reactions 3. High fat meal increases systemic absorption
40
What are incretins?
Incretins are hormones secreted from the gut in response to food which then stimulates insulin secretion
41
What is the MOA of GLP1RAs? (5)
1. Enhance satiety 2. Decrease appetite 3. Delay gastric emptying 4. Decrease glucagon 5. Increase insulin
42
Liraglutide is actually indicated for weight loss. What are the adult and peds (12-17) criteria?
1. Adults: BMI ≥30 or ≥27 with at least one weight-related co-morbidity 2. 12-17yo: inadequate response to diet/exercise & body weight >60kg & an initial BMI ≥30kg/m2
43
What are some common AE's of liraglutide? (3)
NVD
44
What are some rare AE's of liraglutide? (2)
1. Acute pancreatitis 2. Cholelithiasis (Monitor BG and signs/symptoms of pancreatitis)
45
What is a contraindication of liraglutide?
Personal history of thyroid cancers
46
What is the dosing of liraglutide (weight loss)
Start at 0.6mg SQ daily and increase by 0.6mg weekly until 3mg daily
47
How often is semaglutide dosed?
Once weekly
48
What semaglutide brand is technically indicated for weight loss (America)?
Wegovy
49
What is the dosing for semaglutide (for weight loss specifically)?
Starting dose = 0.25mg/week and gradually increase every 4 weeks. Target dose = 2.4mg/week
50
What are some "other" medications that may cause some weight loss (not approved for weight loss) (6)
1. Bupropion 2. Fluoxetine 3. Topiramate 4. Methylphenidate 5. SGLT2i's 6. Metformin
51
With a person using drugs for weight loss, when should pharmacotherapy be stopped?
1. Intended to be part of a long-term treatment strategy 2. If 5%+ weight loss not achieved after 3 months on full/maximum tolerated dose - probably not going to see more.
52
What is the MOA of tirzepatide?
GIP and GLP-1RA dual agonist
53
What to know about bariatric surgery for obesity? That is: Who? Success? Weight loss? Complications? When we see best outcomes?
1. Consider in those with BMI 35+ 2. Success depends on appropriate patient selection, education, and follow-up 3. Can lead to sustainable weight loss - 20-45% weight loss 4. Post-op complications in ~17%; re-operation rate is ~7% 5. Has the best outcomes on pts with respect to QoL, long-term weight loss, and resolution of obesity-related diseases
54
How to help children maintain a healthy weight? (2)
1. Healthy eating - Eat together as a family - Remove distractions 2. Physical activity - Recommendation - 60 minutes of physical activity per day - Limit sedentary activities

PHAR 359 (26 decks)

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