Surgical Interventions

Question 1

What is the twin epidemic to obesity?

Answer 1

Type II DIabetes

Diabesity Epidemic

Question 2

What must solutions to obesity do?

Answer 2

Change the physiological set point

Question 3

Does Obesity directly cause Type II Diabetes?

Answer 3

YES. not just linked, causative.

Question 4

What percentage of Diabetes is Type II Diabetes in U.S.?

Answer 4

over 95% Whoa!

Question 5

Does telling your patients to cut calories & exercise work?

Answer 5

usu not…so it is an ineffective treatment

Question 6

How old is this obesity epidemic?

Answer 6

only about 40 years

Question 7

What have been the changes to the food supply in recent years?

Answer 7

it is sweeter, white, less green, less purple, less bitter

*wheat has a higher glycemic index than table sugar

Question 8

Is the obesity more about physical activity or food supply?

Answer 8

More about the food supply

**the change in physical activity isn’t significant enough to account for the current epidemic

Question 9

What types of cancer are attributable to obesity?

Answer 9

breast & colon cancer

Question 10

If you get the obesity to go away does the Type II Diabetes go away?

Answer 10

yes

Question 11

What does a spike in blood sugar do?

Answer 11

It causes a hormone cascade that is partially responsible for obesity

Question 12

What are 4 environmental drivers of obesity?

Answer 12

Altered Food Supply
Decreased Physical Activity
Stress & Distress
Drugs

Question 13

In order to treat Type I Diabetes…what do you take & what does this dO?

Answer 13

insulin & that causes weight gain

there are similar side effects with other common drugs

Question 14

Diabetes is the #1 cause of what 3 things?

Answer 14

blindness
kidney failure
amputations

Question 15

What’s the deal with Pre-Diabetes?

Answer 15

there are 79 million people in US who are just below diabetes & 1/3 of them will become diabetic in 3 years.
HgbA1c over 5.7%; Diabetic: over 6.5%

Question 16

What’s the Hgb A1c?

Answer 16

indication b/c of the glycation of molecules of long term blood sugar levels…indicative of like a month’s worth data or something…

Question 17

Obesity causes CO2 retention. How?

Answer 17

inadequate ventilation
obesity hypoventilation syndrome
don’t breathe hard enough b/c of weight?

Question 18

What is the hunger hormone?

Answer 18

ghrelin

Question 19

What can cause ghrelin to increase?

Answer 19

diet

Question 20

What is the nickname of CCK? What happens to it when you go on a diet?

Answer 20

hormone of satiety

it goes down on a diet!

Question 21

When you go on a diet & decrease your set point…what happens to your absorption & metabolic burn rate?

Answer 21

Your absorption increases

Your metabolic burn rate decreases…

Question 22

Where is the glimmer of hope @ the end of your diet w/ hormonal changes & angry body defense of your set point?

Answer 22

after about a year…these effects will decrease…your body will not push you as hard to your set point

Question 23

How do we get a higher set point?

Answer 23

we just continuously get a higher point…b/c it is an evolutionary advantage. Live 3 months 5 pounds heavier–>that’s your new set point

Question 24

Who created the BMI standards?

Answer 24

insurance industry!!

as a predictor for longevity

Question 25

At what BMI does a surgical intervention improve mortality risk, health, quality of life?

Answer 25

27

**not that you should do it, but this recognizes the lethality of a higher BMI

Question 26

What’s the deal w/ fenfluramine?

Answer 26

5-HT 2b receptor valvulopathy

resulted in cardiac valvular abnormalities, people had to have cardiac valve replacements

Question 27

What’s the deal w/ sibutramine (Meridia)?

Answer 27

acts on 5-HT

cardiovascular disease issues

Question 28

What’s the deal w/ Xenical/Alli?

Answer 28

it blocks the pancreatic lipase enzyme
you can’t break down fat & is excreted out.
doesn’t help obesity, but it does help w/ constipation

Question 29

What’s the deal w/ phentermine?

Answer 29

mild stimulant, like caffeine
somewhat effective
people lose 2-3% of body weight
it is half the drug of fen fen, but safer.

Question 30

What are the 2 new weapons/drugs we have?

Answer 30

Qsymia

Belviq

Question 31

What’s the deal w/ Qsymia?

Answer 31

phentermine & topiramate (these aren’t new)

works a little bit

Question 32

What’s the deal w/ belviq?

Answer 32

acts on 5-HT but doesn’t seem to be dangerous yet

some people lose significant weight on it

Question 33

What is the spectrum of surgical interventions…from mild to extreme?

Answer 33

diet & exercise
some other stuff
Lap Band
gastric sleeve
gastric bypass

Question 34

Who qualifies for weight loss surgery?

Answer 34

BMI 30 & above w/ comorbidities (diabetes, HTN, sleep apnea)

Question 35

The risk of the gastric sleeve on par w/ what?

Answer 35

a C-section

about 20% of the people regain their weight.

Question 36

What’s the hormonal aspect of the gastric sleeve procedure?

Answer 36

the body of the stomach w/ the greater curvature…the mucosa there releases hormones thought to be responsible for absorption & fat deposition.

Question 37

What does the sleeve do to the set point?

Answer 37

it changes the sleeve set point
they are less hungry
their metabolic rate goes up

Question 38

Why is the sleeve better than gastric bypass?

Answer 38

less invasive
safer
simpler

Question 39

What percentage of the stomach is removed during the sleeve?

Answer 39

75-80%

Question 40

What are the things that can change the physiologic set point?

Answer 40

surgery–assuredly
weight loss maintenance for one year–maybe
walking 60-90minutes per day, probably.

Question 41

What is the #1 reason for liver transplants?

Answer 41

obesity–Non fatty liver disease

then cirrhosis from alcohol & hepatitis

Question 42

What 3 things determine whether you will get Diabetes?

Answer 42

age
weight
genetic predisposition
**we will all probably get diabetes if we live long enough

Question 43

What are the big 3 vitamin deficiencies w/ gastric bypass surgery?

Answer 43

Vitamin D, B12, & iron