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Outpatient Medicine > Obesity and Weight Loss > Flashcards

Obesity and Weight Loss Flashcards

1
Q

What are the #1 and #2 causes of preventable deaths in the US?

A
  1. Smoking

2. Obesity

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2
Q

What is the best treatment for obesity?

A

prevention

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3
Q

What weight gain per year is a red flag?

A

> 1-2 pounds a year

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4
Q

Why is measuring waist circumference improtant?

A

waist circumference is a surrogate estimate for visceral fat, which is more metabolically active than other fats meaning it releases FFA and contributes to HLD, atherogenesis, hyperinsulin

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5
Q

In which patients should you consider drug therapy for weight loss?

A

BMI>30 or BMI>27 with comorbidity (hypertension, diabetes, heart failure, CAD, OSA, arthritis)

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6
Q

What criteria are used to say a weight loss drug is considered effective?

A

> 4lbs lost at 4 weeks
5% weight loss at 6 months
5% weight loss at 1 year

I think ALL criteria must be met to be successful

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7
Q

What is the name of the only weight loss drug available in the US for long-term use, and which also doesn’t require prescription?

A

Orlistat

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8
Q

What is the MOA of Orlistat?

A

Blocks lipase. So it blocks fat absorption in the intestine.

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9
Q

What is the FDA warning for Orlistat?

A

Rare cases of liver toxicity

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10
Q

What are the most common side effects of Orlistat?

A
  1. Abdominal discomfort

2. Increased frequency of defecation

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11
Q

Name 4 noradrenergic sympathomimetic drugs that can be used for short term appetite suppression in the US?

A
  1. Diethylpropion
  2. Benzphetamine
  3. Phendimetrazine
  4. Phenteramine
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12
Q

What are side effects of oradrenergic sympathomimetic drugs that can be used for short term appetite suppression?

A

hypertension

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13
Q

Which two antidepressants can be used for treatment of obesity?

A
  1. Fluoxetine

2. Bupropion

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14
Q

What is exenatide (byetta)?

A

Injectionable drug that mimicks the action of incretin. Used for diabetics and also to treat obesity. Believed to delay gastric emptying.

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15
Q

When should bariatric surgery be considered?

A

Only if have already tried lifestyle attempts and drug therapy, AND…

BMI>=35 with serious obesity-related comorbidities
OR
BMI>=40
OR
Progressive obesity >11 lbs per year before age 30

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16
Q

What is the hormone pattern in patients with PCOS?

A

Increased LH/FSH ratio
High testosterone level
Low SHBG level

17
Q

What is the definition of involuntary weight loss?

A

loss of >5% total body weight in 6 months, or >10% in 12 months

18
Q

What is sarcopenia?

A

age related muscle loss that occurs without other precipitating causes

19
Q

What is cachexia?

A

weight loss associated with inflam condition and cytokine production and muscle wasting

20
Q

reduce mid upper arm circumference is a sign of what?

A

protein-energy malnutrition

21
Q

Which drugs are known to cause weight loss in the elderly?

A 
digoxin
ace inhibitors
NSAIDs
SSRIs
cholinesterase inhibitors
anticholinergic agents
theophyllie
dopamine agents (L-dopa, metoclopramide)
22
Q

What does a low albumin and elevated alk phos suggest?

A

cancer (87% specific, 17% sensitive)

23
Q

Patients with weight loss and diagnosed with cancer, but have normal CBC and liver tests, should get what next?

A

upper endoscopy and abdominal CT

24
Q

Patients with weight loss and diagnosed with cancer, btu have abnormal CBC or liver tests, should get what next?

A

abdominal ultrasound and abdominal CT

25
Q

What are the 5 criteria for predicting malignancy as a cause of isolated weight loss?*******

A
  1. Age>80 ((+1))
  2. Serum albumin >3.5 ((-2)) *cancer usually has LOW albumin
  3. WBC>12,000 ((+1))
  4. Alk Phos>300 ((+2))
  5. LDH>500 ((+3))
26
Q

What screening tests should be done on all patients with BMI>25?

A
  • blood glucose
  • serum creatinine
  • fasting lipids

Also:

  • blood pressure
  • TSH

Not cbc or electrolytes!!

27
Q

what should you do for a patient with recent gastric bypass who is throwing up a lot?

A

Suspect stomal stenosis, so do an upper endoscopy to prove it and also dilate the stricture.

Second line: barium swallow to diagnose it

28
Q

In a patient with weight loss, what normal results should be present in order for you to do no intervention and just follow-up in 6 months?

A

normal labs
normal CXR
normal abdominal US

Outpatient Medicine (16 decks)

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