Obesity

Question 1

1 cause of preventable disease and disability

Answer 1

Obesity

Question 2

BMI classifications

Answer 2

Overweight: 25-29.9
Obesity>30
Class I: 30-34.9
Class II: 35-39.9
Class III: >40 (severe obesity)

Question 3

When might BMI not be accurate?

Answer 3

Body builder

Question 4

When do you measure waist circumference?

Answer 4

When a pt has a BMI b/w 25-35 kg/m2

Question 5

Based on waist circumference, who is at increased risk of obesity?

Answer 5

> 40 inches in men

>35 inched in women

Question 6

Ethnic variability of waist circumference

Answer 6

35.4 inches for males and 31.5 inches for female in the Asian population

Question 7

How do you create a negative energy balance?

Answer 7

Increase activity and decrease calories consumed

Create 500-1000 calories per day deficit=weight loss of 1-2 lbs per week

Question 8

Labs important for obesity

Answer 8

History and PE
Fasting glucose and/or HbA1C
TSH
Liver enzymes
Fasting lipids

Question 9

Ideas for nutrition counseling

Answer 9

Balance calories
Enjoy food but eat less
Avoid oversize portions
Know foods to eat more and less often
Make 1/2 plate fruits and veggies
Switch to skin or 1% milk
1/2 of grains are whole grain
Reduce sodium
Drink water instead of sugary drinks

Question 10

DASH diet

Answer 10

Emphasize vegetables, fruits, low-dat dairy with moderate whole grains, fish, poultry and nuts

Question 11

Mediterranean diet

Answer 11

Plant-based: fruits, veggies, whole grain braids and cereals, beans, nuts and seeds
Principal source of dietary fat is olive oil
Fish and poultry but limit red meat

Question 12

Recommended diets for type 2 DM

Answer 12

DASH, mediterranean, carb counting, limit sugar

Question 13

Recommended diets for CVD

Answer 13

DASH, low Na, mediterranean diet

Question 14

Recommended diets for CKD

Answer 14

DASH, renal diet (less animal protein)

Question 15

Recommended diets for celiac disease

Answer 15

Gluten free

Question 16

Very important modifiable risk factor

Answer 16

Sedentary lifestyle

Question 17

Who do you screen for obesity?

Answer 17

ALL adults

Question 18

Most effective high intensity obesity interventions

Answer 18

Two x mo for >3 mos (12-26 sessions a year) or intensive, multicomponent behavioral intervention

Question 19

Strategies for counseling

Answer 19

Ask/address
Advise
Assess (readiness to change)
Assist
Arrange f/u

Question 20

Goals of obesity intervention

Answer 20

Prevent, treat or reverse complications of obesity

Question 21

When do you see significant health benefits with weight loss?

Answer 21

5% body weight loss

Question 22

Obesity tx based on low risk

Answer 22

(BMI of 25-29.9 with no CVD RF or other comorbidities)

Diet and counseling to prevent weight gain

Question 23

Obesity tx based on moderate risk

Answer 23

(BMI 25-29.9 AND >1 CVD RF or BMI 30-34.9)

Intensive multicomponent behavioral modification and SOME drug therapy (>27)

Question 24

Obesity tx based on high risk and very high risk

Answer 24

(BMI of 35-40 is high and >40 is very high)

Intensive multicomponent modification and consider drug therapy, bariatric surgery

Question 25

When do you consider drug therapy?

Answer 25

BMI>30 or >27 with comorbidities | <5% weight loss in 3-6 mos is when to start discussing-with a goof lifestyle program

Question 26

Goals of drug therapy

Answer 26

Reduce weight (4-8% in 6-12 mos) Improve health Minimize adverse effects

Question 27

What does Orlistat (Alli/ Xenical) do?

Answer 27

Alter fat digestion by inhibiting pancreatic lipases | Increases fat in stools

Question 28

Side effects of Orlistat

Answer 28

May decrease absorption of fat soluble vits (ADEK) so much take a multi vitamin daily Unpleasant GI side effects

Question 29

What does liraglutide do?

Answer 29

GLP-1 receptor agonist (daily SQ injection) | Pts with type 2 DM

Question 30

Side effects of liraglutide

Answer 30

N/v

Question 31

What does lorcaserin (belviq) do?

Answer 31

Selective serotonin agonist to decrease appetite

Question 32

When do you not use phentermine/topiramate (qysmia) for weight loss?

Answer 32

Pts with HTN, CAD or hyperthyroidism

Question 33

When is phentermine?

Answer 33

Sympathomimetic (only for 12 wk use)

Question 34

Most widely prescribed weight loss drug

Answer 34

Phentermine (lots of SEs like neuro ones and potential for abuse)

Question 35

Necessary monitoring for obesity drug therapy

Answer 35

Monitor weight BP, HR and SEs (weekly for 4 weeks and monthly for 3-4 mos)

Question 36

What should you do if pt does not lose 3-4% of weight in first 3 mos on a drug?

Answer 36

Discontinue

Question 37

What are some therapies that are not recommended for weight loss?

Answer 37

Dietary supplements (caution with OTC weight loss supplements) hCG (requires 500 cal/day diet) Calcium

Question 38

When do you consider bariatric surgery?

Answer 38

BMI>40 BMI 35-39.9 and >1 or 1 serious comorbidity BMI 30-34.9 and difficult to control type 2 DM or metabolic syndrome

Question 39

What must you do before bariatric surgery to lead to greater weight loss post op?

Answer 39

Lose 8% excess body weight

Question 40

Contraindications for bariatric surgery

Answer 40

Eating disorders, untreated mental illness, drug of EtOH abuse, coagulopathy, severe cardiac disease, inability to comply with lifelong dietary requirements

Question 41

How does bariatric surgery affect weight loss?

Answer 41

Restrict caloric intake Malabsorption Decrease appetite and improve metabolism by changing release of hormones

Question 42

Types of bariatric surgery

Answer 42

Sleeve gastrectomy Roux-en-Y gastric bypass Adjustable gastric band Intragastric balloon and duodenal switch

Question 43

What is the physical activity vital sign?

Answer 43

How many days/wk do you engage in moderate or greater physical activity (>brisk walk) On the days you exercised, how many minutes was it?

Question 44

Physical activity guidelines

Answer 44

At least 150-300 min/wk of moderate intensity exercise of 75-150 min/wk of vigorous intensity aerobic physical activity (or combo of 2) AND muscle strengthening >2 days/wk

Question 45

FITT exercise prescription

Answer 45

Frequency (aim for >5 days/wk but set a goal) Intensity (aim for moderate to vigorous) Time (aim for >30 min but no minimum sessions) Type (walking is good start when sedentary)

Question 46

What do you use for awareness of exertion?

Answer 46

Talk test: moderate is can talk but not sing and vigorous is cannot say more than a few words w/o pausing to breathe