Obesity Management and Risk Factors
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Questions and Answers

What effect does selenium have on the body?

  • It increases cholesterol levels.
  • It decreases immunity.
  • It is primarily found in processed foods.
  • It produces antioxidant enzymes. (correct)

    • What is the primary source of calcium in the diet?

  • Cereals
  • Fruits
  • Dairy products (correct)
  • Red meats

    • What is the first line of therapy for weight loss approved by FDA?

  • Liraglutide or Semaglutide (correct)
  • Lorcaserin
  • Orlistat
  • Phentermine-topiramate

    • Which mineral influences cholesterol levels and glucose metabolism?

    <p>Vanadium</p> Signup and view all the answers

    What was the result of high calcium and high dairy diets on weight loss?

    <p>Higher fat loss compared to lower calcium diets</p> Signup and view all the answers

    What is one effect of consuming small frequent meals compared to large meals?

    <p>Small frequent meals produce stable insulin levels.</p> Signup and view all the answers

    Which of the following medications is NOT commonly associated with weight gain?

    <p>Antibiotics</p> Signup and view all the answers

    Which psychological factor can influence eating habits in some individuals?

    <p>Emotional stress</p> Signup and view all the answers

    What percentage of weight loss is considered the initial goal for therapy?

    <p>5-10%</p> Signup and view all the answers

    In which risk factor category does high cholesterol fall?

    <p>Health Risks</p> Signup and view all the answers

    Candidates for pharmacological therapy must have a BMI greater than which value?

    <p>30 kg/m²</p> Signup and view all the answers

    What is a key goal for any weight-reduction program?

    <p>Energy expenditures must exceed caloric demands.</p> Signup and view all the answers

    Which of the following diseases is known to contribute to obesity?

    <p>Cushing's syndrome</p> Signup and view all the answers

    What is a significant risk factor for sleep apnea in women?

    <p>Being overweight with PCOS</p> Signup and view all the answers

    What could excessive buildup of the uterine lining lead to?

    <p>Endometrial cancer</p> Signup and view all the answers

    Which of the following is NOT one of the three symptoms used to diagnose PCOS?

    <p>Frequent headaches</p> Signup and view all the answers

    What is a potential psychological effect of PCOS?

    <p>Depression and anxiety</p> Signup and view all the answers

    Which dietary approach has been found to be effective for managing PCOS symptoms?

    <p>Low-carbohydrate diet</p> Signup and view all the answers

    What percentage of body weight loss can significantly help regulate menstrual cycles in women with PCOS?

    <p>5 to 10 percent</p> Signup and view all the answers

    Which method is NOT commonly used to diagnose PCOS?

    <p>MRI scan</p> Signup and view all the answers

    What is the minimum recommended duration of moderate-intensity exercise for women with PCOS?

    <p>30 minutes three times a week</p> Signup and view all the answers

    Which combination of treatments is most effective for weight loss and lowering the risks for diabetes and heart disease?

    <p>Diet plus exercise</p> Signup and view all the answers

    What is the main benefit of using combined oral contraceptives (COCs) for women with PCOS?

    <p>Regulate menstrual cycle</p> Signup and view all the answers

    Which progestin is commonly combined with ethinyl estradiol in COCs to balance hormones in PCOS treatment?

    <p>Norethindrone</p> Signup and view all the answers

    What is a potential risk associated with progestins that have lower androgenicity?

    <p>Increased venous thromboembolism (VTE)</p> Signup and view all the answers

    What is the primary function of spironolactone in PCOS treatment?

    <p>Managing hyperandrogenic symptoms</p> Signup and view all the answers

    Which antiandrogen is noted for its potential hepatotoxicity?

    <p>Flutamide</p> Signup and view all the answers

    Which treatment is considered necessary to avoid bone loss when using GnRH agonists?

    <p>Add-back estrogen-progestin therapy</p> Signup and view all the answers

    Which drug is an inhibitor of both 5-alpha-reductase types 1 and 2?

    <p>Dutasteride</p> Signup and view all the answers

    What is the primary reason the Endocrine Society recommends against the routine use of metformin for hirsutism?

    <p>It is less effective than COCs and/or antiandrogens.</p> Signup and view all the answers

    Which statement about Eflornithine (Vaniqa) cream is correct?

    <p>It slows hair growth.</p> Signup and view all the answers

    What is the role of ovarian drilling in the management of infertility?

    <p>It restores normal ovulation.</p> Signup and view all the answers

    What lifestyle modification is recommended for women managing Lean PCOS?

    <p>Incorporate regular exercise.</p> Signup and view all the answers

    Which pharmacologic treatment is used specifically for managing menstrual dysfunction in Lean PCOS?

    <p>Progestin alone or combined OCP.</p> Signup and view all the answers

    Which type of hair removal method includes both laser and electrolysis?

    <p>Mechanical treatment.</p> Signup and view all the answers

    What is an important addition to consider for managing inadequate clinical responses in Lean PCOS?

    <p>Adding metformin +/- myoinositol.</p> Signup and view all the answers

    Which of the following is true regarding the treatment of acne in Lean PCOS?

    <p>Topical retinoids can be employed for management.</p> Signup and view all the answers

    Study Notes

    Weight Gain in Obesity

    • Small, frequent meals may help to stabilize insulin levels, while large meals cause spikes
    • Certain medications, such as antidepressants, anticonvulsants, diabetes medications, hormones, and corticosteroids, can contribute to weight gain
    • Some high blood pressure medications and antihistamines contribute to weight gain
    • Psychological factors, such as sadness, stress, or anger, can influence eating habits
    • Diseases like hypothyroidism, insulin resistance, polycystic ovary syndrome, and Cushing's syndrome can contribute to obesity

    Risk Factors for Obesity

    • Insulin resistance
    • Type 2 diabetes
    • High blood pressure (hypertension)
    • High cholesterol (hypercholesterolemia)
    • Stroke
    • Gallstones
    • Gout and gouty arthritis
    • Osteoarthritis of the knees, hips, and lower back

    Goals of Obesity Therapy

    • Initial weight loss goal: 5-10% decrease from baseline weight every 3 months or over 6 months
    • Example: If a patient weighs 100 kg, the goal is 80 kg after 1 year

    Management of Obesity

    • Weight-reduction therapies aim to affect energy intake, storage, and expenditure
    • Typical treatments include diet restriction, exercise, behavior modification, pharmacologic procedures, and invasive procedures
    • No single weight-loss strategy is effective for everyone
    • Programs should be designed to meet individual needs and lifestyles
    • Energy expenditure must exceed caloric demands for weight loss
    • Changes must be maintained for long-term success
    • Candidates for pharmacological therapy include adults with a BMI greater than 30 kg/m2 or a BMI of 27-29.9 kg/m2 with comorbidities who haven't achieved weight loss goals

    Nutritional Supplementation

    • Zinc:
      • Improved serum zinc levels
      • Significant decrease in triglyceride levels with zinc supplementation
    • Selenium:
      • Helps produce antioxidant enzymes and boost immunity
      • Found in vegetables, grains, seafood, and chicken
      • Positive association with obesity-related parameters like cholesterol
      • Linked to reducing the risk of cardiovascular disease
    • Calcium:
      • Essential for healthy bones and teeth
      • Dairy products and green leafy vegetables are good sources
      • Calcium deficiency is associated with higher body weight
      • 1000mg of calcium per day with a moderately restricted diet
      • High calcium diets, particularly those rich in dairy, are associated with higher weight loss
      • Higher fat loss in groups consuming high calcium and high dairy diets
    • Vanadium:
      • Trace element found in mushrooms, shellfish, and grains
      • Influences cholesterol levels and glucose metabolism
      • Enhances weight-reducing effects of leptin in animal models
      • Supplementation led to reduced body weight and lower glucose levels in diabetic rats
      • Potential agent to protect against diabetic complications

    FDA Approved Treatments

    • 1st Line: Liraglutide or Semaglutide for 3 months
    • If no benefit or intolerance: Switch to 2nd line: Orlistat
    • 3rd Line: Phentermine-topiramate
    • 4th Line: Bupropion-naltrexone
    • 5th Line: Lorcaserin

    Polycystic Ovary Syndrome (PCOS)

    • Overproduction of androgens (male hormones)
    • Irregular periods (oligomenorrhea) and infrequent ovulation
    • Presence of multiple cysts in the ovaries
    • Can affect fertility, increase risk of heart disease, and diabetes

    PCOS Symptoms

    • Irregular periods and infrequent ovulation
    • Acne
    • Facial and body hair growth (hirsutism)
    • Weight gain
    • Depression and anxiety

    PCOS Risk Factors

    • Family history of PCOS
    • Hormonal imbalances
    • Insulin resistance
    • Low-grade chronic inflammation

    PCOS Complications

    • Infertility
    • Miscarriage
    • Premature birth
    • Gestational diabetes
    • Sleep apnea
    • Endometrial cancer
    • Heart disease
    • Type 2 diabetes

    PCOS Diagnosis

    • Two out of three criteria: High androgen levels, irregular menstrual cycles, and ovarian cysts
    • Pelvic exam to check for abnormalities in ovaries and reproductive tract
    • Blood tests for elevated male hormones, cholesterol, insulin, and triglycerides
    • Ultrasounds to visualize ovarian follicles and uterine structures

    PCOS Management

    • Lifestyle changes: Weight loss, diet, and exercise
    • Weight loss can help regulate periods, improve symptoms, lower insulin levels, and reduce heart disease and diabetes risks
    • Diets: Low-carbohydrate and low-glycemic index (low-GI) diets
    • Exercise: 30 minutes of moderate-intensity exercise at least three times a week
    • Evidence suggests acupuncture may be beneficial but more research is needed

    Medical Treatments

    • Birth control pills and other medications can help regulate periods and treat symptoms, like hair growth and acne
    • Combined oral contraceptives (COCs): Restore hormone balance, regulate ovulation, reduce hair growth, and protect against endometrial cancer
    • Antiandrogens: Help reduce excess androgen production
      • Spironolactone: First-line option, typically added after six months of COC monotherapy
      • Finasteride: Inhibits 5-alpha-reductase type 2, converting testosterone to dihydrotestosterone (DHT)
      • Dutasteride: Inhibits both types of 5-alpha-reductase
      • Cyproterone acetate: Available in many countries but not the United States
      • Flutamide: Effective but not recommended due to potential liver issues
      • GnRH agonists: Suppress ovarian androgen production, but "add-back" hormone therapy is needed
    • Metformin: Can reduce insulin levels and ovarian androgen production, but it is not recommended for hirsutism
    • Hair Removal:
      • Eflornithine (Vaniqa) cream slows hair growth
      • Laser hair removal and electrolysis are permanent options
    • Surgery: Ovarian drilling may improve fertility if other treatments fail

    Management Algorithm for Lean PCOS

    • Lifestyle Modifications:
      • Weight maintenance through diet and exercise
      • Diet: Including vegetables, fruits, vitamin D, calcium, and herbs
      • Regular exercise
    • Inadequate Clinical Response:
      • Metformin + myoinositol
      • Additional management for:
        • Hirsutism: Mechanical (shaving, electrolysis, laser) or pharmacologic (OCPs, androgen receptor blockers, finasteride)
        • Menstrual Dysfunction: Progestin alone or combined OCPs
        • Acne: Topical treatments (benzoyl peroxide and/or retinoids), antibiotics (dorycycline), and isotretinoin in severe cases
        • Infertility: Pharmacotherapy (clomiphene and/or gonadotropins), surgery (laparoscopic ovarian drilling), and IVF

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    Description

    This quiz explores the concepts surrounding obesity, including weight gain causes, risk factors, and therapeutic goals. Topics such as insulin resistance, psychological influences, and medication impacts are covered to provide a comprehensive understanding of obesity management.

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