obesity- SB notes

Question 1

What is the primary function of Ghrelin in appetite regulation?

Answer 1

It stimulates appetite and promotes food intake by increasing the activity of NPY/AgRP neurons.

Question 2

How does Leptin, primarily produced by adipose tissue, affect appetite-regulating neurons in the hypothalamus?

Answer 2

It inhibits orexigenic NPY/AgRP neurons and activates anorexigenic POMC/CART neurons, promoting satiety.

Question 3

Mutations in the _____ receptor are one of the most common single-gene causes of pediatric obesity.

Answer 3

Melanocortin-4 Receptor (MC4R)

Question 4

A key clinical feature associated with congenital MC4R deficiency, besides early-onset obesity, is _____.

Answer 4

Taller-than-average height

Question 5

What genetic defect on paternal chromosome 15 causes Prader-Willi Syndrome (PWS)?

Answer 5

A deletion or imprinting defect.

Question 6

List three characteristic features of Prader-Willi Syndrome (PWS).

Answer 6

Hypotonia, intellectual disability, and hyperphagia leading to morbid obesity.

Question 7

Bardet-Biedl Syndrome (BBS) is a genetically heterogeneous disorder that disrupts the function of what cellular organelle?

Answer 7

Cilia.

Question 8

What is the most common single gene associated with typical human obesity in the general population?

Answer 8

FTO (Fat Mass and Obesity-Associated Gene).

Question 9

Which cytokine, secreted by adipose tissue, has insulin-sensitizing and anti-inflammatory effects, and its levels decrease with increasing adiposity?

Answer 9

Adiponectin.

Question 10

Which proinflammatory cytokine, secreted by adipocytes, is correlated with insulin resistance severity and induces adipocyte insulin resistance?

Answer 10

Tumor Necrosis Factor alpha (TNF-alpha).

Question 11

A patient consumes at least 25% of daily calories after dinner, experiences morning anorexia, and is aware of their nighttime eating. What is the likely diagnosis?

Answer 11

Night Eating Syndrome (NES).

Question 12

What is the most effective treatment approach for Night Eating Syndrome (NES)?

Answer 12

A combination of Cognitive Behavioral Therapy (CBT) and Selective Serotonin Reuptake Inhibitors (SSRIs) like Sertraline.

Question 13

Which medication has FDA approval for the treatment of moderate to severe Binge Eating Disorder (BED)?

Answer 13

Lisdexamfetamine.

Question 14

For a patient with type 2 diabetes and obesity, what is the minimum weight loss percentage required to see benefits in glycemic management?

Answer 14

Benefits start at 2.5%, with a goal of 5-15% or more for significant improvement.

Question 15

To achieve regression of steatohepatitis/NASH, what is the recommended weight loss goal?

Answer 15

A weight loss of >10%.

Question 16

A 44-year-old man with diabetes and hypertension has normal LFTs. What is the best first step to evaluate for NASH?

Answer 16

Calculate the FIB-4 score and consider liver elastography.

Question 17

A patient with a FIB-4 score between 1.3 and 2.67 is considered to have what level of likelihood for advanced fibrosis?

Answer 17

Indeterminate or intermediate likelihood.

Question 18

For a patient with NASH but no diabetes, what treatment has shown promise?

Answer 18

Vitamin E 800 international units daily.

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Question 19

For a patient with both NASH and type 2 diabetes, which two classes of glucose-lowering therapy are considered reasonable options?

Answer 19

Pioglitazone or GLP-1 receptor agonists.

Question 20

According to the 2013 AHA/ACC/TOS guidelines, bariatric surgery may be an option for a patient with a BMI of $\ge$ 35 kg/m² and _____.

Answer 20

Uncontrolled comorbidities despite other therapies.

Question 21

What is a potential adverse effect of a ketogenic diet, making it less advisable for individuals with hypercholesterolemia?

Answer 21

Possible elevation of LDL cholesterol.

Question 22

A very-low-calorie diet (VLCD) is defined as a maximum daily intake of _____ calories.

Answer 22

800 calories/day.

Question 23

Patients on a very-low-calorie diet (VLCD) are at an increased risk of developing what condition related to the gallbladder?

Answer 23

Gallstones.

Question 24

Which diet, characterized by limited sodium, saturated fat, and added sugar, has documented benefits for hypertension?

Answer 24

The DASH diet.

Question 25

When a patient starts a very-low-calorie diet (VLCD), which class of medication, such as hydrochlorothiazide, should be discontinued to avoid electrolyte imbalances?

Answer 25

Diuretics.

Question 26

In patients with hyperlipidemia, a low-carb ketogenic diet can lead to an increase in which lipid parameter?

Answer 26

Increased LDL.

Question 27

What metabolic adaptations occur with weight loss that promote weight regain?

Answer 27

Reduced total daily energy expenditure, resting metabolic rate, and exercise energy expenditure.

Question 28

Replacing dietary saturated fat with _____ has been shown in randomized controlled trials to reduce cardiovascular disease incidence.

Answer 28

Polyunsaturated vegetable oil (like soybean oil).

Question 29

What is the suggested first-line pharmacologic therapy for chronic weight management in individuals who are overweight or obese, according to a March 2024 update?

Answer 29

Subcutaneous tirzepatide or semaglutide.

Question 30

GLP-1 agonists like tirzepatide, semaglutide, and liraglutide are contraindicated in patients with a personal or family history of _____.

Answer 30

Medullary thyroid cancer or MEN2.

Question 31

The anti-obesity medication phentermine is contraindicated in patients with cardiovascular disease or _____.

Answer 31

Uncontrolled hypertension.

Question 32

Due to its teratogenic potential (oral cleft defects), which component of a common weight-loss drug combination is contraindicated in pregnancy?

Answer 32

Topiramate.

Question 33

The combination drug naltrexone/bupropion should be avoided in patients with a seizure disorder or those with chronic use of _____.

Answer 33

Opioids.

Question 34

For a patient with obesity and depression who is seeking weight loss, which antidepressant is also a component of an FDA-approved weight-loss medication?

Answer 34

Bupropion.

Question 35

For a patient with obesity who also suffers from migraines, which combination weight-loss medication would be a good choice?

Answer 35

Phentermine/topiramate ER.

Question 36

Which anti-obesity medication is most effective for reducing food cravings due to its mechanism as an opioid antagonist and dopamine/norepinephrine reuptake inhibitor?

Answer 36

Naltrexone/Bupropion Extended-Release.

Question 37

Which anti-seizure medication is commonly associated with weight gain, often within the first 3 months of therapy?

Answer 37

Gabapentin.

Question 38

A patient who had a Roux-en-Y gastric bypass presents with fatigue, brittle nails, and hair thinning. This is most likely a deficiency in what micronutrient?

Answer 38

Iron.

Question 39

Which bariatric surgical procedure typically results in the greatest average excess weight loss (70-80%) within two years?

Answer 39

Biliopancreatic Diversion.

Question 40

What are three preoperative predictors of type 2 diabetes remission following bariatric surgery?

Answer 40

Shorter duration of diabetes, younger age, and use of oral medications versus insulin.

Question 41

A patient who is 6 weeks post-bariatric surgery presents with vomiting, confusion, ataxia, and nystagmus. What is the diagnosis?

Answer 41

Thiamine deficiency (Wernicke's encephalopathy).

Question 42

How can one differentiate post-bariatric hyperinsulinemic hypoglycemia from dumping syndrome based on timing?

Answer 42

Dumping syndrome occurs soon after a meal (minutes to an hour), while hyperinsulinemic hypoglycemia typically manifests about one year post-surgery.

Question 43

What is the diagnostic test of choice for a patient with suspected post-gastric bypass hyperinsulinemic hypoglycemia?

Answer 43

A mixed meal tolerance test.

Question 44

What is the recommended first-line pharmacologic management for post-gastric bypass hyperinsulinemic hypoglycemia after lifestyle modifications fail?

Answer 44

Acarbose.

Question 45

What is the guideline for women regarding pregnancy after bariatric surgery?

Answer 45

It is recommended to defer pregnancy for at least 12 months post-surgery until weight has stabilized.

Question 46

What routine health screening is recommended for all patients at 2 years following any bariatric surgery to monitor bone health?

Answer 46

A bone density scan (DEXA).

Question 47

Supplementing with high doses of zinc after bariatric surgery can lead to a deficiency in which other essential micronutrient?

Answer 47

Copper.

Question 48

What is a common gastrointestinal complication that can be new-onset or worsen after a sleeve gastrectomy?

Answer 48

Gastroesophageal reflux (GERD).

Question 49

For Asian individuals, what BMI is considered the threshold for obesity?

Answer 49

A BMI >25 kg/m².

Question 50

What is the waist circumference threshold that indicates increased metabolic risk for Asian men?

Answer 50

> 90 cm (or >35.4 inches).

Question 51

According to the 2013 guidelines, drug therapy for obesity is indicated for individuals with a BMI >30 kg/m² or a BMI of _____ with weight-related comorbidities.

Answer 51

27 to 29.9 kg/m².

Question 52

A college student with chronic sleep deprivation is at risk for weight gain due to hormonal changes, specifically an increase in the appetite-stimulating hormone _____.

Answer 52

Ghrelin.

Question 53

A patient has difficulty losing weight despite adherence to a diet. A resting energy expenditure study shows a low basal metabolic rate. What type of exercise is recommended to increase fat-free mass and BMR?

Answer 53

Resistance exercises.

Question 54

What is Auto-Brewery Syndrome (ABS), a rare complication of RYGB surgery?

Answer 54

A condition of endogenous ethanol production by gut microbiota, leading to intoxication without alcohol consumption.

Question 55

In the STEP trials, what was the average weight loss achieved after 68 weeks with semaglutide 2.4 mg weekly combined with lifestyle intervention?

Answer 55

Approximately 15% of body weight.

Question 56

A patient post-gastric bypass has a high-normal MCV despite adequate B12 and elevated LFTs. What condition should be screened for?

Answer 56

Alcohol use disorder.

Question 57

A patient with obesity and mirtazapine-exacerbated binge eating is being considered for bariatric surgery. What is the most appropriate next step in management?

Answer 57

Discontinue the weight-promoting medication (mirtazapine) and manage the eating disorder before considering surgery.

Question 58

Severe acquired hypercholesterolemia in a patient with a very low BMI, amenorrhea, and body image distortion is strongly suggestive of what underlying condition?

Answer 58

Anorexia nervosa.

Question 59

A post-Roux-en-Y gastric bypass patient develops secondary hyperparathyroidism. This is often a consequence of malabsorption of which two nutrients?

Answer 59

Calcium and vitamin D.

Question 60

What is the effect of bariatric surgery on the risk of developing obesity-associated cancers?

Answer 60

Bariatric surgery is associated with a significantly lower incidence of obesity-associated cancer and cancer-related mortality.

Question 61

Term: Lipodystrophy

Answer 61

A group of disorders characterized by a partial or complete lack of adipose tissue (lipoatrophy), often leading to severe insulin resistance and hyperlipidemia.

Question 62

What is the indicated therapy for patients with generalized lipodystrophy who have persistent metabolic disturbances despite lifestyle and standard drug therapy?

Answer 62

Metreleptin therapy (a recombinant analog of human leptin).

Question 63

The FDA-approved MC4R agonist, setmelanotide, is specifically used for weight management in patients with obesity due to certain rare genetic disorders, including _____.

Answer 63

Bardet-Biedl syndrome (BBS).

Question 64

Which antidepressant class is most associated with weight gain?

Answer 64

Tricyclic antidepressants (e.g., amitriptyline) and certain SSRIs (e.g., paroxetine).

Question 65

Which bariatric procedure is generally superior for the regression of type 2 diabetes?

Answer 65

Roux-en-Y gastric bypass (is superior to sleeve gastrectomy).

Question 66

The primary predictor of weight loss success, irrespective of the specific diet plan followed, is _____.

Answer 66

Dietary adherence.

Question 67

For a low-income patient with obesity and mechanical joint pain, what is a practical and effective strategy to promote weight loss?

Answer 67

Set up frequent visits with local health coaches and prescribe a graduated, non-weight-bearing physical activity regimen.

Question 68

Which intestinal lipase inhibitor causes fat malabsorption and is associated with gastrointestinal side effects like oily spotting and flatulence?

Answer 68

Orlistat.

Question 69

In the arcuate nucleus, POMC/CART neurons are considered _____ because their activation leads to reduced food intake.

Answer 69

Anorexigenic.

Question 70

What is the recommended weekly amount of moderate-intensity aerobic activity for adults for general health and weight management?

Answer 70

At least 150-300 minutes.

Question 71

Paresthesias, a potential side effect of _____, would likely resolve upon discontinuation of the drug.

Answer 71

Topiramate.

Question 72

Neurologic symptoms such as sensory ataxia and spastic gait, along with hematologic issues like anemia and neutropenia, can be manifestations of what micronutrient deficiency post-bariatric surgery?

Answer 72

Copper deficiency.

Question 73

A patient with a history of seizures should not be prescribed which combination anti-obesity medication?

Answer 73

Naltrexone SR/bupropion SR.