Obesity Management & Bariatric Surgery – Review Flashcards

These flashcards cover key definitions, non-pharmacologic therapy, indications for pharmacotherapy, detailed drug facts, special population cautions, follow-up criteria, and bariatric surgery information from the Obesity Management & Bariatric Surgery lecture.

What is the World Health Organization (WHO) definition of obesity?

A chronic, complex disease characterized by excessive fat deposits that can impair health and increase the risk of conditions such as diabetes, heart disease, cancers, and mobility issues.

Which measurement is most widely used to diagnose overweight or obesity?

Body Mass Index (BMI), calculated as weight in kilograms divided by height in meters squared (kg/m²).

Provide the BMI ranges for normal weight, overweight, and obesity (Class I–III).

Normal: 18.5–24.9 kg/m²; Overweight: 25.0–29.9 kg/m²; Obesity Class I: 30.0–34.9 kg/m²; Class II: 35.0–39.9 kg/m²; Class III (extreme): ≥40 kg/m².

At what waist circumference do men and non-pregnant women have higher risk for obesity-related conditions?

Men > 40 in (102 cm); Non-pregnant women > 35 in (89 cm).

What daily calorie reduction usually produces ~1 lb of weight loss per week?

A 500–750 kcal decrease per day.

List four evidence-based, reduced-calorie eating plans for weight loss mentioned in the lecture.

Mediterranean, Low-carbohydrate, Low-fat, DASH diet (others included Volumetric, High-protein, Vegetarian, Plate method).

How much aerobic exercise is recommended weekly for weight-loss therapy?

≥150 minutes of moderate-to-vigorous intensity aerobic activity spread over at least 3 days per week.

Name three key behavioral interventions that support weight loss.

Self-monitoring (food, exercise, weight), goal setting, and stress reduction (also stimulus control and social support).

Why are most OTC weight-loss supplements NOT recommended?

They often contain stimulants/excess caffeine, are generally ineffective, and can be harmful, especially in patients with heart disease.

What BMI criteria indicate starting prescription weight-loss medication?

BMI ≥ 30 kg/m² OR BMI ≥ 27 kg/m² with at least one weight-related comorbidity (e.g., diabetes, hypertension, dyslipidemia, sleep apnea).

State the dual mechanisms of action for phentermine/topiramate ER (Qsymia).

Phentermine: sympathomimetic releasing norepinephrine to increase satiety and decrease appetite; Topiramate: neurotransmitter-mediated appetite suppression (antiepileptic effect leading to increased satiety).

What is the boxed REMS concern for Qsymia?

Teratogenic risk; pregnancy must be avoided and negative pregnancy tests required.

Why should Qsymia be tapered when discontinued?

Abrupt discontinuation can precipitate seizures due to the topiramate component.

List two common CNS side effects of phentermine/topiramate.

Insomnia and anxiety or depression

Which weight-loss drug combines an opioid antagonist with an antidepressant?

Naltrexone/bupropion ER (Contrave).

Why must opioids be discontinued 7–14 days before starting Contrave?

Naltrexone blocks opioid receptors and can precipitate withdrawal in opioid-treated patients.

Name two major contraindications for Contrave.

Uncontrolled hypertension and seizure disorders (others: pregnancy, bulimia/anorexia, MAOI use within 14 days).

What food interaction is important for Contrave administration?

High-fat meals increase drug levels; Contrave should NOT be taken with fatty foods.

What is the shared boxed warning for liraglutide, semaglutide, and tirzepatide?

Risk of thyroid C-cell carcinoma (observed in animal studies; relevance to humans unknown).

At what target dose is liraglutide (Saxenda) administered for weight loss?

3 mg subcutaneously once daily.

How often is semaglutide (Wegovy) administered, and what is its target dose?

Once weekly; target dose 2.4 mg SC weekly.

What dual receptor activity does tirzepatide (Zepbound) possess?

It is both a glucose-dependent insulinotropic polypeptide (GIP) receptor agonist and a GLP-1 receptor agonist.

List three common GI side effects shared by GLP-1/GIP agonists used for obesity.

Nausea, vomiting, and diarrhea (also constipation, pancreatitis risk, gallbladder disease).

Which weight-loss medication inhibits gastrointestinal and pancreatic lipases to reduce fat absorption by ~30 %?

Orlistat (Xenical Rx, Alli OTC).

Why should a multivitamin be taken at bedtime when using Orlistat?

Orlistat impairs absorption of fat-soluble vitamins (A, D, E, K); bedtime multivitamin helps replenish stores.

Give two counseling points to reduce GI side effects with Orlistat.

Use a low-fat diet with no more than 30 % of calories from fat and omit the dose if a meal is skipped or contains no fat.

Which class of agents (phentermine, diethylpropion, phendimetrazine, benzphetamine) is limited to short-term (≤12 weeks) use?

Sympathomimetic appetite suppressants/stimulants (C-IV or C-III controlled substances).

Why are stimulant appetite suppressants generally avoided in patients with cardiovascular disease?

They can cause tachycardia, elevated blood pressure, arrhythmias, and other adrenergic side effects.

What novel weight-loss drug targets the melanocortin-4 receptor (MC4R) pathway in specific genetic syndromes?

Setmelanotide (Imcivree).

Before prescribing setmelanotide, what must be confirmed?

Genetic testing demonstrating POMC, PCSK1, LEPR deficiency, or Bardet-Biedl syndrome–related MC4R pathway impairment.

Which weight-loss medications are specifically contraindicated during pregnancy?

All prescription weight-loss drugs.

Which weight-loss medication is contraindicated in uncontrolled hypertension and lowers seizure threshold?

Contrave (naltrexone/bupropion).

When should prescription weight-loss drugs be discontinued due to lack of efficacy?

If ≥5 % of baseline body weight is not lost after 12 weeks on the optimal dose.

What BMI thresholds make an adult eligible for bariatric (weight-loss) surgery under guidelines?

BMI ≥ 40 kg/m² or BMI ≥ 35 kg/m² with at least one obesity-related condition (e.g., diabetes, HTN, dyslipidemia, sleep apnea).

Name the ‘gold standard’ bariatric procedure discussed in the lecture.

Roux-en-Y gastric bypass surgery.

List two ways gastric bypass contributes to weight loss beyond stomach restriction.

Limits calorie/nutrient absorption and alters gut hormones to increase satiety and reverse metabolic syndrome.

Why are gallstones a potential complication after rapid weight loss from bariatric surgery?

Rapid fat mobilization increases cholesterol saturation in bile, leading to gallstone formation; ursodiol may be used prophylactically or therapeutically.

Which calcium salt is preferred after gastric bypass and why?

Calcium citrate because its absorption is not acid-dependent, compensating for bypassed duodenum and reduced gastric acidity.

Which vitamin/mineral deficiencies commonly contribute to post-bariatric anemia?

Vitamin B12 and iron deficiencies.

What lifelong supplementation is recommended to prevent fat-soluble vitamin deficiencies after malabsorptive bariatric surgery?

Vitamins A, D, E, and K.

Give two medication-related considerations immediately after gastric bypass surgery.

Some drugs may require dose reductions and may need to be crushed, given in liquid, or transdermal form for up to 2 months post-surgery.

What percentage of genetics contributes to BMI and body-fat distribution according to the lecture?

About 40 % for BMI and 50 % for body-fat distribution.

Name three medication classes commonly associated with unintended weight gain.

Second-generation antipsychotics (e.g., clozapine, olanzapine), insulin or sulfonylureas, corticosteroids (also TZDs, tricyclic antidepressants).

Why is BMI criticized as a measure of obesity?

It does not distinguish between fat and lean tissue (e.g., muscular individuals may have high BMI but low body fat).

What follow-up counseling should accompany every weight-loss medication appointment?

Reinforce diet, exercise, and behavioral interventions and monitor for drug side effects.

Identify two comorbidities the AACE/ACE guidelines flag as ‘disease risk’ associated with increasing BMI and waist circumference.

Type 2 diabetes mellitus and cardiovascular disease (others: hypertension).

Which GLP-1 agonist is FDA-approved for adolescents >12 years with BMI > 30 kg/m²?

Liraglutide (Saxenda).

How does waist-to-hip ratio differ from waist circumference in assessing obesity?

Waist-to-hip ratio predicts disease/death risk but is harder to measure accurately, whereas waist circumference is easier and used clinically.

What is the caloric value of 1 lb of body fat that guides weekly weight-loss calculations?

Approximately 3,500 kcal.

What weight-loss drug must be taken separately from levothyroxine by at least 4 hours?

Orlistat (Xenical Rx, Alli OTC).

Oily/fatty stools is a known side effect to which weight-loss drug?

Orlistat (Xenical Rx, Alli OTC).