Weight Loss, Obesity, and Metabolic Syndrome Flashcards

1
Q

Most common eating disorder

A

Binge eating disorder

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2
Q

Binge eating presentation

A

Over-eating; typically appears overweight

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3
Q

Binge eating Tx

A

Vyvanse in the morning (stimulant)

o Starting dose = 30mg

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4
Q

Female college student, BMI 18, athletic with micro fractures:

A

Anorexic?

- Micro/stress fx d/t malnutrition/not enough nutrients for bone

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5
Q

Anorexia comorbidities

A

Suicide + Malnutrition = comorbidities/typical causes of mortality

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6
Q

Anorexia risk factors

A

anxiety/depression, low BMI, athletics: ballet/gymnastic/runners/aerial silks/wrestling/horseback racing [weigh-ins for different class]

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7
Q

Anorexia common signs

A

Amenorrhea (no longer DSM-5 criteria), lanugo, hypercarotenemia (looks orange, esp. palms), bradycardic

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8
Q

Anorexia DSM-5 criteria (requires each of the following criteria):

A

o Restriction of energy intake that leads to a low body weight, given the patient’s age, sex, developmental trajectory, and physical health
o Intense fear of gaining weight or becoming fat, or persistent behavior that prevents weight gain, despite being underweight
o Distorted perception of body weight and shape, undue influence of weight and shape on self-worth, or denial of the medical seriousness of one’s low body weight

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9
Q

Bulimia signs

A
  • Russell’s sign = knuckle callus
  • Destroyed/erosion of teeth enamel
  • Throat red/irritated/scar tissue = Esophagitis
  • Hide disorder from others = dress in layers, brush their teeth, eat then go to bathroom
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10
Q

Bulimia DSM-5 criteria (requires each of the following criteria):

A

o Episodes of binge eating, which are defined as eating an unusually large amount of food in a discrete period of time (eg, two hours). Patients feel that they cannot control their eating during the episode.
o Inappropriate compensatory behavior to prevent weight gain.
o Binge eating and inappropriate compensatory behaviors occur, on average, at least once a week for three months.
o The patient’s self-evaluation is unduly influenced by body shape and weight.
o The disturbance does not occur exclusively during episodes of anorexia nervosa

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11
Q

Diabulimia

A

intentional misuse of insulin to cause weight loss

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12
Q

Cachexia

A

loss of muscle mass

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13
Q

Sarcopenia

A

loss of muscle mass + loss of strength and performance

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14
Q

Excessive weight gain or weight loss, consider?

A
  • Consider thyroid disorder

- Obtain labs: TSH, hA1C, lipids, CMP

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15
Q

Comorbid conditions causing obesity

A

Depression, PCOS, Cushing’s

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16
Q

CHF signs

A

SOB, JVD, edema, fluid retention

o Not always weight gain – patient could be losing muscle mass and retaining fluids so weight could be static

17
Q

CKD:

A
  • GFR 75 = Stage 2 [GFR 60-89 ml/min]
  • GFR 45 = Stage 3 [GFR 30-59 ml/min]
  • Less than 15 = Anorexia / uremia
  • Preserve renal function = Med Recs: Avoid NSAIDs, metformin
18
Q

Meds for DM that causes weight loss:

A
  • Trulicity / Ozempic (GLP-1 receptor agonists)
  • Jardiance / Farxiga (SGLT2 inhibitors)
  • Pramlintide / Symlin
19
Q

Drugs that can cause weight loss:

A
  • Stimulants (amphetamines) – release catecholamines for parasympathetic nerve terminals to decrease appetite
  • Cocaine – So much energy / no sleep
  • Tobacco – Smoke so much, don’t eat; weight gain w/ cessation; Nicotine = stimulant
  • Alcohol – Rather drink than eat (empty calories)
  • Marijuana withdrawal – cyclical vomiting syndrome, irritability, weight loss, strange dreams
20
Q

Cheilosis

A
  • cracks in corners of mouth d/t badly fitting dentures = cause patient not to eat
  • consider nutritional deficiency?
21
Q

Definition of clinically significant weight loss

A
  • More than 5% over 6-12 months

- Most important = obtain H&P!

22
Q

Most prevalent cause of inadequate intake / weight loss

A

Depression

Tx: Remeron

23
Q

Meds for appetite stimulant:

A
  • Marinol / Dronabinol

- Megace / Megestrol acetate

24
Q

Geriatric patient losing weight:

A
  • Do not prescribe appetite stimulant right away!
  • Better to treat depression / give high calorie food / supplemental shakes / remove dietary restrictions FIRST.
    o If no improvement, then consider appetite stimulant
25
Q

Concern in malnutrition labs

A
  • Prealbumin = looks at 2-4 days hx of diet

- Albumin = looks at month hx of diet (28 days)

26
Q

B12 supplements:

A

Elderly dose = 1000mcg

27
Q

Topamax

A
  • Help with weight loss
  • SE: can cause kidney stones + hypokalemia
  • Draw potassium baseline and recheck every 3-6 months
28
Q

Added sugar = percentage of diet:

A
  • 10% of overall calorie per day
29
Q

Bariatric surgery criteria

A
  • BMI over 40 and no comorbidities

- BMI 35-40 and 1 comorbidity (HTN, untreated depression)

30
Q

Obesity tx:

A
  • Lifestyle changes: diet/exercise/behavior modifications (coping mechanisms)
  • High protein / low carb diet – Causes body to burn fat = thermogenesis
31
Q

Very low-calorie diet:

A

200-800 kcal [net calorie]

32
Q

Starvation diet:

A

below 200 kcal [net calorie]

33
Q

Hormone that stimulates appetite

A

ghrelin

34
Q

Hormones that inhibit appetite

A

leptin, peptide yy, amylin, cholecystokinin

35
Q

Metabolic syndrome – Other names

A

insulin resistance syndrome, syndrome X, obesity dyslipidemia syndrome

36
Q

Metabolic syndrome criteria

A
-	Waist circumference size:
o	Women: ≥ 35 inches (88.9 cm)
o	Men: ≥ 40 inches (101.6 cm)
-	HTN: > 130/85
-	Triglycerides > 150
-	HDL < 40 men < 50 women
-	Fasting glucose >110
-	Needs to meet 3 out of 4 criteria*
37
Q

Hypothyroidism

A
  • Not an obesity related disorder; also has a genetic component
  • Not only obese patients have hypothyroidism
38
Q

Fatty liver

A
  • Is an obesity related disorder

- You need to have excess fat to have fatty liver