Potpourri
List 3 SDOH. Provide one way of how it may relate to obesity.
Income and social status, Employment and working conditions, Education and literacy, Childhood experiences, Physical environments, Social supports and coping skills, Healthy behaviours, Access to health services, Biology and genetic endowment, Gender, Culture, Race / Racism
There is a significant association between obesity and SDOH
In urban areas, obesity is high in low socioeconomic status (SES) neightbourhoods.
Access to physical activity facilities and affordable healthy foods influence obesity risk
Obesity rates are low in immigrants (17%) compared to non-immigrants (30%)
Indigenous populations face a significant obesity burden
On reserve has obesity rates of 30-51% compared to off-reserve rates of 21-42%
Provide 1 statistic related to obesity in Canada
obesity rates have increased threefold since 1985
Severe obesity (BMI > 40) has quadrupuled
Approximately one in four Canadian adults are obese, Of children and youth aged six to 17, 8.6% are obese.
The economic costs of obesity are estimated at $4.6 billion
Factors that influence obesity include physical activity, diet, socioeconomic status, ethnicity, immigration, and environmental factors.
List 5 classes of medications related to drug-induced obesity.
Antipsychotics, Antidepressants, Anti-Hyperglycemic (Insulin, sulfonylureas), Steroids, Combined oral contraceptives
What are tools (3) to estimate and classify obesity?
What is a common contraindication found in drugs used for obesity management?
• Pregnancy, conception attempts, breastfeeding.
What resource would you use to find obesity and bariatric care programs?
Define obesity. Why is it important?
Obesity is a global epidemic characterized by excess body fat
It is a chronic medical disease associated with an increased risk in mortality and several chronic conditions
What do we look for in clinical presentation? List at least 3.
What laboratory investigations are used as needed? List 4.
Laboratory investigations as needed:
List at least 7 drugs that can be used in obesity management (on-label and off-label)
On label: Orlistat (Xenical), Bupropion/naltrexone (Contrave), Semaglutide (Wegovy), Liraglutide (Saxenda)
Off-label: tirzepatide (Mounjaro), Metformin, Buproprion, Fluoxetine, Topiramate
What is first-line therapy for obesity?
Diet
Exercise
Lifestyle modifications
Define weight bias.
Patients with obesity often encounter blame in a healthcare system as a personal or moral failing.
Patients facing weight bias in health care may delay or avoid medical care due to internalized weight stigma.
What comorbidities are associated with obesity? List at least 7.
Comorbidities (Type 2 diabetes, hypertension, dyslipidemia, coronary artery disease, stroke, sleep apnea, certain cancers, osteoarthritis, gallbladder disease, difficulty breathing,depression, gout, poor self-image, non-alcoholic fatty liver disease)
What stages of Edmonton Obesity Staging System is this patient?
An 52M with a BMI of 33 kg/m^2 who has established hypertension and borderline dyslipidemia.
Assess patients’ medical, mental and functional symptoms
Stage 2 of EOSS.
Stage 0-4
What can you recommend to patients for Orlistat? List at least 3 things.
May start on weekend to avoid embarrassing AE
Omit dose if no meal, or no fat in meal.
Can decrease absorption of fat-soluble vitamins, recommend multivitamin 2hr before or after orlistat to prevent fat soluble vitamin deficiency.
Metamucil may help ↓GI AE.
What BMI do you consider pharmacotherapy for obesity? What BMI do you consider bariatric surgery?
• PHARMACOLOGIC THERAPY: BMI ≥ 30 kg/m² or ≥ 27 kg/m² with adiposity-related complications
Bariatric surgery may be considered in some cases (BMI≥40 kg/m2 or BMI ≥ 35 kg/m2 with at least 1 adiposity-related disease) to acheive:
What are the 4M's? List 2 examples for each.
Mental Health,Mechanical, Metabolic, Monetary Health/milieu
Mental Health: Self-image, weight bias, sleep, mood, anxiety, ADHD, trauma, addiction, binge eating, obesogenic medications for mental health
Mechanical: Osteoarthritis, pain, gout, sleep apnea, urinary incontinence, plantar fasciitis, intertrigo
Metabolic: T2DM, hyperlipidemia, nutritional deficiency, gout, HTN, endocrine disorder (PCOS, infertility), CVD, metabolic liver disease, gallstones, GERD
Monetary health/milieu:SES, education, access to food, occupation, disability
What can you do when assessing clinical presentation that makes the patient more comfortable? List at least 3.
What do you need to investigate during diagnosis? List at least 5 things.
Physical exam (height, weight, BMI, waist circumference)
Medication history
Weight history (trajectories over time, previous weight loss attempts)
Physical activity: Current activities or limitations
Family history and SDOH, race, ethnicity, age)
Social history: Smoking status, alcohol intake, sugary beverages, recreational drugs.
Nutrition: Nutritional literacy, dietary habits, nutritional restrictions.
List 4 contraindications to Contrave. Cannot use pregnancy/planned conception/breastfeeding.
Contraindicated with concurrent opioid or MAOI use and Brugada syndrome. Uncontrolled HTN, seizure history or risk factors, abrupt disruption of alcohol, ESRD. Pregnancy, conception attempts, breastfeeding.
List the options for bariatric surgery in Canada and adverse effects for each.
Adjustable gastric binding: total weight loss 20%, AE: dysphagia and vomiting, long-term risk of weight regain, band erosion and band intolerance
Sleeve gastrectomy: total weight loss 25%, AE: constipation and vomiting, long-term risk of weight regain, Barret esophagus and GERD
Roux-en-Y Gastric Bypass: total weight loss 30%, AE: Dumping syndrome, long-term risk of internal hernia, small bowel obstruction, anastomotic ulcer, nephrolithiasis
Define and list the 5 A's of obesity?
Ask: Permission to discuss weight & Determine readiness to change
Assess: Use BMI and WC to classify and evaluate risk & Assess potential causes
Advise: Health risks of obesity & Appropriate treatment and therapy
Agree: Realistic goals and weight management plan
Assist: Address any barriers & Provide helpful resources
List 4 risk factors associated with obesity and give 2 examples of each. Cannot use drug-induced.
Health Conditions: Hypothyroidism, Cushing’s Syndrome, PCOS, Pregnancy
Emotional: Boredom, Depression, Stress
Environmental: Social/cultural background, food prices, lack of availability
Dietary: High fat, high sugar
Eating Patterns: Overeating, binging, frequency
Lifestyle: Sleep deprivation, Sedentary lifestyle, Smoking cessation
Family History
Genetics
What is BMI and what is it's disadvantage? When is BMI not useful? What populations have different BMIs?
BMI is measure of size, not health - does not accurately predict health (esp in inc age, muscular indiv, extreme height)
BMI is only useful for BMI 25-34.9 for assessing visceral adiposity and associated health risks, not rec above BMI > 35.
south asian, southeast asian and east asian have complications at lower BMIs, overweight for them is BMI > 23
What are the considerations for PCT in obesity?
• BMI ≥ 30 kg/m² or ≥ 27 kg/m² with adiposity-related complications
• Want to maintain weight loss achieved by behavioral changes and to prevent regain
• Unsatisfied with their progress after lifestyle changes
• Pharmacotherapy must be used as an adjunct to lifestyle changes