Obesity Management

Question 1

The different forms of lifestyle changes for obesity management include…

Answer 1

Dietary
Physical activity
Cognitive behavioural therapy

Question 2

Traditional nutritional interventions have focused on weight loss via…

Answer 2

Caloric restriction (expenditure must be greater than intake)

There are dozens of proposed mechanisms - no best fit for eveyrone

Question 3

With dietary restriction, most people return to baseline weight within ____ years. However…

Answer 3

1-2 years. However is not shown to be sustainable long-term

Due to biological mechanisms

Question 4

Regarding nutritional interventions, we should…

Answer 4

Refer to a dietician when available - should be patient-specific and focus on changes that will improve health (not just weight changes)

Question 5

Regular physical activity has shown improvement in…

Answer 5

Cardiometabolic risk factors
Overall QoL
Mood
Body image

Question 6

Cognitive behavioural therapy involves…

Answer 6

Goal setting
Problem solving
Developing confidence
Overcoming barriers

Question 7

Many supplements and natural health products claim to aid in weight loss. We should…

Answer 7

Ensure safety
Consult natural medicines database

Question 8

The main pharmacotherapy options for weight loss include…

Answer 8

Orlistat
Liraglutide
Tirzapetide
Semaglutide
Naltrexone/bupropion

Question 9

Pharmacotherapy is indicated for chronic weight management if…

Answer 9

BMi is over 30 kg/m^2, or over 27 kg/m^2 if there are co-morbidities associated with excess body fat

SHOULD be in conjunction with health behaviour changes

Question 10

Function of lipases are to…

Answer 10

Hydrolyze dietary fats, converting them to monoglycerides and triglycerides

Question 11

MOA of orlistat is to…

Answer 11

Inhibit lipases in the GI tract - inhibiting dietary fat absorption by about 30%

Question 12

Specific dosing instructions for orlistat include…

Answer 12

Take with, or up to 1 hour after, each meal
Skip a meal (or meal has no fat), skip a dose
Follow mildly hypocaloric diet with less than 30% calories from fat

Question 13

AE’s with orlistat include…

Answer 13

Flatulence (sometimes with discharge)
Loose, oily stools, diarrhea
Fecal urgency/incontinence
Abdominal discomfort

Question 14

Orlistat is CI with…

Answer 14

Malabsorption syndromes
Cholestasis

Precaution with GI/hepatic disorders

Question 15

DI’s with orlistat include…

Answer 15

Fat-soluble vitamins (A,D,E,K)
Separate from multivitamin by at least 2 hours. Decreased vitamin K absorption could increase anticoagulation with warfarin

May decrease absorption of cyclosporine, levothyroxine, anti-epileptic drugs, ARV’s - separate dosing times by 3-4 hours

Question 16

MOA of naltrexone/bupropion is to…

Answer 16

Help induce satiety and decrease cravings via actions in the brain

Question 17

Naltrexone/bupropion should be titrated to…

Answer 17

Minimize seizure risk and help with AE’s

Question 18

Common AE’s that may occur with naltrexone/bupropion include…

Answer 18

GI - N/V/D, constipation
Headache, dry mouth, dizziness, insomnia

Question 19

Rare AE’s with naltrexone/bupropion include…

Answer 19

Seizures
Worsening of depression

Question 20

CI’s to using naltrexone/bupropion include…

Answer 20

Opioid usage
Uncontrolled HTN
Hx of, or risk factors for seizures
Bulimia/anorexia

Question 21

Primary drug enzyme interactions with Contrave is with…

Answer 21

2D6

Question 22

____ increases systemic absorption with naltrexone/bupropion, so this should be avoided…

Answer 22

High fat content meal

Question 23

MOA of incretins for weight loss is to…

Answer 23

Enhance satiety
Decrease appetite
Delay gastric emptying
Decrease glucagon and increase insulin levels

Question 24

GLP-1 agonists approved for weight loss include…

Answer 24

Liraglutide
Semaglutide

Question 25

Indication for GLP-1 agonists is...

Answer 25

Adults: BMI above 30, or above 27 + one weight-related co-morbidity 12-18: inadequate response to diet/exercise, body weight above 60kg, and initial BMI above 30

Question 26

Efficacy of the GLP-1 agonists should be evaluated via...

Answer 26

Seeing if weight loss is >5% by week 12. If not, then response is unlikely

Question 27

Common AE's with the GLP-1 agonists include...

Answer 27

N/V/D ## Footnote Dose titration ideal to help with this

Question 28

Rare AE's with the GLP-1 agonists include...

Answer 28

Acute prancreatitis Cholelithiasis

Question 29

CI with the GLP-1 agonists include...

Answer 29

Personal history of thyroid cancers

Question 30

GLP-1 agonists may affect absorption via...

Answer 30

Delaying gastric emptying; longer Tmax

Question 31

Other medications that may cause some weight loss (but are not approved) include...

Answer 31

Bupropion Fluoxetine Topiramate Methylphenidate SGLT2 inhibitors, metformin

Question 32

Obesity, similar to other chronic conditions, requires...

Answer 32

A long-term strategy to manage. If an intervention is discontinued, weight will start to increase again

Question 33

Pharmacotherapy is intended to be part of a long-term strategy. Ideally we should only stop pharmacotherapy if...

Answer 33

>5% weight loss has not been achieved after 3 months on full/maximally tolerated dose

Question 34

Tirzepatide class is unique in that it is both a...

Answer 34

GIP and GLP-1 receptor agonist | Works similary to GLP-1 agonists ## Footnote Currently in Canada, still indicated only for adults with T2DM

Question 35

The amount of weight loss acheieved with tirzepatide was comparable to...

Answer 35

Bariatric surgery ## Footnote Nearly 40% of patients lost >25% of total body weight

Question 36

Bariatric surgery should be considered...

Answer 36

IN those with BMI above 35, with appropriate patient selection, education, and follow-up ## Footnote Had best outcomes with respect to QoL, long-term weight loss, and resolution of obesity related disease

Question 37

Helping children maintain a healthy weight can include...

Answer 37

Healthy eating Adequate physical activity