2-6: 6/1: Obesity Management Ii

Front 1

BMI Cutoffs for:

Pharmacotherapy
Surgery

Back 1

Pharmacotherapy: 27-29.9 with comorbidities, or >30 ONLY

Surgery: 35+

Front 2

Central Acting Mechanism

Back 2

Appetite suppression

Induce satiety, control, satisfaction

Reduce caloric intake while being satisfied

Front 3

Orlistat:
Mechanism
AE's
Long Term or Short Term

Back 3

Peripherally Acting Drug

GI Lipase inhibitor: malabsorption of fat
Pass out fat (blocks 1/3 dietary fat)

8-10% weight loss in 1 year vs weight loss

Benefits: improves glucose tolerance, reduces diabetes

AE's:
Medications not absorbed
TG's not absorbed in GIT
Inc'd flatulence, fecal incontinence, oily discharge

LONG TERM

Front 4

Phentermine:
Mechanism
AE's
Long Term or Short Term

Back 4

SHORT TERM weight loss drug

Increases availability of NE and DA by inhibiting their reuptake inhibitors (sympatheticomimetic)

AE's
Addiction potential
Overstimulation, euphoria
Tolerance

SHORT TERM ONLY

Front 5

Fluoxetine and bupropion treat depression in addition to weight loss. How?

Back 5

Increased DA availability (inhibit DA uptake inhibitor)

Front 6

Metformin:
Mechanism in weight loss

Back 6

Increases peripheral insulin sensitivity

Front 7

Rimonabant:
Mechanism

Back 7

Blocks cannabinoid receptor to reduce effects of marijuana

Weight loss improvement.

Still under review by FDA...

Front 8

Issues with pharmacotherapy in treating obesity

Back 8

Avg weight loss in modest (5-10%), most are short term use (obesity is long term), there are other factors contributing to obesity (not just hunger)

No long term data
Need more research on kids

Front 9

BMI cutoff for morbid obesity

Back 9

>40

Front 10

Long-term success rate of medical weight loss for morbid obesity (diet, exercise, and behavior modification) is _______

Back 10

5%

Front 11

Surgical weight loss intervention is indicated for patients with _________

Back 11

A BMI of 40 or higher

BMI of 35-40 with significant co-morbidity (sleep apnea)

Documented ineffective dietary attempts

Front 12

Who qualifies for weight loss surgery?

Back 12

At least 100 pounds over ideal body weight

BMI >40

Complications of obesity: DM, sleep apnea, HTN, venous ulcers AND BMI >35

Front 13

Disqualifications for surgical candidates?

Back 13

Active substance abuser INCLUDING SMOKING
Cardiac or pulmonary contraindications
Psych Disorders
Patients with defined noncompliance

Front 14

Benefits of laparaoscopic approaches (when compared to open approaches).

Back 14

Fewer wound complications
Less infection
Fewer hernias
Less pain, faster recovery

Front 15

Restrictive Operations:
Mechanism
Contraindications
Ideal for _____

Back 15

Limits volume of food (solids)
Limits speed and consistency of food

Not good for sweet eaters (can drink milkshakes)
Avoid in large hiatal hernia, Lupus (foreign body-->autoimmune reaction!!)

Best option for high risk and young women with less weight to lose (adjustable for pregnancy)

40-60% excess weight loss in 2-3 years

Front 16

Adjustable Gastric Band:
Surgical Mechanism
Associated Problems

Back 16

Restrictive Operations

Placed laparoscopically

Adjustable! Inject saline into balloon and restricts food entry into stomach

No malabsorption

AE's
Slippage, erosion
Vomiting, reflux
Nausea
SLOW weight loss

Front 17

Which surgical approach is apprpoved for BMI >30?

Back 17

Lap Band

Front 18

Sleeve Gastrectomy:
Mechanism

Back 18

70% of stomach removed, tubular stomach, no malabsorption

No foreign body

40-60% excess weight loss

Front 19

Vertical Banded Gastroplasty:
Mechanism

Back 19

Mostly abandoned!
Restrictive
Small pouch created by stapling stomach and banding

50% failure in 5 year follow up because staples come loose

Front 20

Jejuno-Ileal Bypass
Surgery Type
Mechanism

Back 20

Type: Malabsorptive Operation

Weight loss by bypassing majority of small bowel, create a shortcut and leave a blind loop of bowel (with bacteria!!)

Best for pts with BMI > 60 (SUPER morbidly obese)

ABANDONED!!!!
Don't leave a long blind loop

Front 21

This procedure is reserved for patients with a BMI >60.

Back 21

Malabsorptive

Front 22

Biliopancreatic diversion with duodenal switch:
Surgery Type
Mechanism

Back 22

Malabsorptive

Lesser degree of nutrient absorption

No blind loop, less likely bacterial growth into isolate limb

Front 23

This procedure requires patients to take a post-op nutritional supplement for the rest of their lives.

Back 23

Combination restrictive and malabsorptive surgery

Front 24

Roux-En Y Gastric Bypass:
Surgery Type
Benefits

Back 24

Combination restrictive and malabsorptive

GOLD STANDARD

Diverts acid from esophagus (no reflux or GERD)

Faster weight loss compared to restrictive

Metabolic surgery--immediate effects on DM (hormonal axis affected before weight)

Front 25

Best/Worst for Sweet Eaters

Why is the best one so good for sweet eaters?

Back 25

Worst: Restrictive (band)
Best: Roux-En Y Gastric

High sugar load direct to jejunum causes watery diarrhea, hyperglycemia

Front 26

Why is combination surgery considered a metabolic surgery?

Back 26

By bypassing duodenum and getting food to ileum faster, same amount of insulin will work much better OVERNIGHT

Front 27

Overall, how does bariatric surgery's mortality rate compare to other major surgeries?

Back 27

LOW LOW LOW

IN fact, if you're obese and diet and exercise, you are more likely to DIE than someone who gets surgery!