Obesity Lecture (final)

underweight BMI

< 18.5 kg/m^2

healthy BMI

18.5-24.9 kg/m^2

overweight BMI

25-29.9 kg/m^2

obesity class I BMI

30-34.9 kg/m^2

obesity class II BMI

35-39.9 kg/m^2

obesity class III BMI

> or equal to 40 kg/m^2

stimulation of 5-HT2c

decreses food intake

stimulation of 5-HT1a

increases food intake

stimulation of alpha 1 receptor

decreses food intake

stimulation of alpha 2 receptor

increases food intake

what are the 3 neuropeptides

orexin; MCH; leptin

orexin...

increases food intake

leptin...

decreases food intake, increases energy use

what are the 3 GI hormones

GLP-1; ghrelin; GIP

GLP-1...

supresses eating

ghrelin...

stimulates appetite

GLP-1 mechanism of action

slows gastric emptying; tells the brain not to eat

GIP stands for?

glucose-dependent insulinotropic polypeptide

GIP...

further regulates food intake in combination with GLP-1's

what are the 2 pancreatic hormones?

insulin; amylin

GIP and GLP are released from where?

gut

amylin derivatives (pramlintide) mimic what other hormone?

GLP-1

pramlintide MOA

slows gastric emptying; tells the brain not to eat

amitriptyline and olanzapine are biogenic amines that cause weight...?

gain

tirzepatide, with a concept of a GI hormone, will have what effect on weight?

loss

topiramate, with a concept of working in the limbic system, will have what effect on weight?

loss

pramlintide, a pancreatic hormone, will have what effect on weight?

loss

brown adipose tissue, related to energy expenditure, is classified as good or bad adipose tissue?

good

white adipose tissue, related to energy intake/storage, is classified as good or bad adipose tissue?

bad

the general desired percentage to reduce weight from baseline is?

5-10%

desired weight loss goal for a patient who is overweight?

0.5 lbs/week/6 months

desired weight loss goal for a patient who is obese?

1-2 lbs/week/6 months

to calculate BMI you need what 2 things?

kg; meters

regarding clinical obesity management, what are the 4 pillars for success determined by the obesity medicine association?

nutrition, activity, behavior modification, and pct/surgery

what are the 5 lifestyle therapy focuses?

nutrition, activity, behavior modification, sleep, and stress

regarding non-pharmacologic interventions, generally, how many calories should be reduced to lose 1 lb/week?

500

regarding non-pharmacologic interventions, for WEIGHT LOSS, how many minutes of physical activity per week is the goal?

150

regarding indications for PCT, medications are indicated as ? with non-pharmacologic interventions

adjunct therapy

what 2 inclusion criteria points, regarding indications for PCT, are noted as key?

BMI > or equal to 27 kg/m^2 with comorbidities

or BMI > or equal to 30 kg/m^2

what 5 comorbidities are noted in the inclusion criteria for an indication towards PCT adjunct therapy?

HTN, DLD, DM, CAD, and OSA

what are the 2 noradrenergic appetite suppressants?

phentermine and diethylpropion

generic name for Tenuate?

diethylpropion

generic for Adipex-P?

phentermine

what are 2 additional appetite suppressants?

Qsymia and Contrave

Contrave generic?

bupropion/naltrexone

Qsymia generic?

phentermine/topiramate

Saxenda generic?

liraglutide

which drug is a dual receptor agonist?

tirzepatide

according to the AACE algorithm, stages 1 and 2 of obesity targets 5-15% of weight loss, with a recommendation for which kind of PCT adjunct therapy?

first-generation weight loss medications

according to the AACE algorithm, stage 3 of obesity targets > or equal to 15% weight loss, with a recommendation for which kind of PCT adjunct therapy?

second-generation weight loss medications

what are the first-gen weight loss drugs?

Qsymia, Contrave, Saxenda, and Adipex-P

what are the second-generation weight loss drugs?

tirzepatide and semaglutide

which 2 drugs are preferred due to weight loss efficacy and weight-independent benefits?

semaglutide and tirzepatide

incomplete, describes what percent range of weight lost from baseline, especially at 3-6 months?

0-5%

good, describes what percent range of weight loss from baseline?

5-15%

excellent, describes what percent range of weight loss from baseline?

> or equal to 15%