REVIEW QUESTIONS TO PRACTICE
FOR CSOWM WITH COMPLETE
SOLUTIONS
Roux-en-Y gastric bypass surgery (RYGB) accounts for about 80% of bariatric
procedures in the US and is usually done laparoscopically. During RYGB, a small part
of the proximal stomach is detached from the rest of the stomach, creating a stomach
pouch of < 30 mL. Which of the following preexisting conditions has been shown to go
into remission in up to 62% of patients 6 yr after RYGB?
a. Hypertension
b. Diabetes
c. Obesity
d. Obstructive Sleep Apnea - Correct Answers -Answer: B: Diabetes is particularly likely
to remit. Remission rates are up to 62% after 6 yr. A and D: Other comorbid conditions
that tend to abate or resolve after bariatric surgery include cardiovascular risk factors
(eg, dyslipidemia, hypertension [A], diabetes), cardiovascular disorders, obstructive
sleep apnea (D), osteoarthritis, and depression. C: For RYGB, weight loss is 50 to 65%
after 2 yr; weight loss after RYGB is maintained for up to 10 yr. All-cause mortality
decreases by 25%, primarily because cardiovascular and cancer mortality is reduced.
Which of the following procedures is being used increasingly in the US as definitive
treatment for severe obesity (eg, in patients with a body mass index [BMI] > 60)?
a. Sleeve Gastrectomy
b. Roux-en Y Gastric Bypass
c. Adjustable Gastric Banding
d. Vertical Banded Gastroplasty - Correct Answers -Answer: A: Sleeve gastrectomy;
because this procedure causes substantial and sustained weight loss, it is being used
increasingly in the US as definitive treatment for severe obesity. Part of the stomach is
removed, creating a tubular stomach passage. The procedure does not involve
anatomic changes to the small intestine. B: Nonetheless, Roux-en-Y gastric bypass
surgery accounts for about 80% of bariatric procedures in the US. C: Use of adjustable
gastric banding has dramatically decreased in the US. D: Vertical banded gastroplasty
is no longer commonly done because complication rates are high and the resulting
weight loss is insufficient.
Contraindications to bariatric surgery include which of the following?
a. Body mass index (BMI) < 30 kg/m2
b. Current drug or alcohol abuse
,c. Obstructive sleep apnea
d. High-risk lipid profile - Correct Answers -Answer: B: Current drug or alcohol abuse. A:
The use of bariatric surgery is controversial in patients with a BMI < 30. C and D: To
qualify for bariatric surgery, patients should have a BMI of > 40 or a BMI of > 35 plus a
serious complication (eg, diabetes, hypertension, obstructive sleep apnea [C], high-risk
lipid profile [D]).
Bariatric Surgery Key Points - Correct Answers -Consider weight loss surgery if patients
are motivated, have not succeeded using nonsurgical treatments, and have a BMI of >
40 kg/m2 or a BMI of > 35 kg/m2 plus a serious complication (eg, diabetes,
hypertension, obstructive sleep apnea, high-risk lipid profile) or a BMI of 30 to 34.9 with
type 2 diabetes and inadequate glycemic control despite optimal lifestyle and medical
therapy.
Weight loss surgery is contraindicated if patients have an uncontrolled psychiatric
disorder (eg, major depression), drug or alcohol abuse, cancer that is not in remission,
or another life-threatening disorder or if they cannot comply with nutritional requirements
(including life-long vitamin replacement when indicated).
The most common procedures are sleeve gastrectomy and Roux-en-Y gastric bypass;
use of adjustable gastric banding has decreased dramatically in the US.
Monitor patients regularly after surgery for maintenance of weight loss, resolution of
weight-related comorbid disorders, and complications of surgery (eg, nutritional
deficiencies, metabolic bone disease, gout, cholelithiasis, nephrolithiasis, depression,
alcohol abuse).
Which of the following increases the risk of cardiovascular disorders in patients with
obesity?
a. Osteoporosis
b. Excess abdominal fat
c. Psychological disorders
d. Gastric Ulcer - Correct Answers -Answer: B: Excess abdominal fat. Complications,
including coronary artery disease, are more likely in patients with fat that is
concentrated abdominally. Choices A, C, and D do not increase the risk of
cardiovascular disorders in patients with obesity.
What is the role of ghrelin in food intake-regulating pathways?
a. It increases food intake.
b. It decreases food intake.
c. Level decreases when weight is lost.
d. It integrates energy balance signals. - Correct Answers -Answer: A: Ghrelin, secreted
primarily by the stomach, increases food intake. B, C, and D: Other hormones and
regulatory substances have these effects.
Which type of exercise is MOST effective for increasing BMR?
, a. Aerobic exercise
b. Resistance exercise
c. Balancing exercise
d. Flexibility exercise - Correct Answers -Answer: B: Resistance (strengthening)
exercises are the most effective way to increase BMR. Resistance exercises increase
muscle mass. Because muscle tissue burns more calories at rest than does fat tissue,
increasing muscle mass produces lasting increases in BMR. Choices A, C, and D can
also be effective in a weight management program. A combination of aerobic and
resistance exercise is better than either alone, particularly when patients choose
activities they enjoy.
Obesity Key Points - Correct Answers -Obesity increases the risk of many common
health problems and causes up to 300,000 premature deaths each year in the US,
making it second only to cigarette smoking as a preventable cause of death.
Excess caloric intake and too little physical activity contribute the most to obesity, but
genetic susceptibility and various disorders (including eating disorders) may also
contribute.
Screen patients using BMI and waist circumference and, when body composition
analysis is indicated, by measuring skinfold thickness or using bioelectrical impedance
analysis.
Screen obese patients for common comorbid disorders, such as obstructive sleep
apnea, diabetes, dyslipidemia, hypertension, fatty liver, and depression.
Encourage patients to lose even 5 to 10% of body weight by changing their diet,
increasing physical activity, and using behavioral interventions if possible.
Try treating patients with orlistat, phentermine, phentermine/topiramate,
naltrexone/bupropion, liraglutide, or semaglutide if BMI is ≥ 30 or if BMI is ≥ 27 and they
have complications (eg, hypertension, insulin resistance); however, for severe obesity,
surgery is most effective.
Encourage all patients to exercise, to eat healthily, to get enough sleep, and to manage
stress.
Screening for metabolic syndrome is important. A family history plus measurement of
waist circumference and BP are part of routine care. If patients have a family history of
type 2 diabetes, particularly those ≥ 40 yr, and have a large waist circumference,
laboratory tests are done to evaluate which of the following?
a. Serum uric acid
b. Lipid profile
c. Kidney function
d. Liver function - Correct Answers -Answer: B: Lipid profile. Fasting plasma glucose
should also be measured.
FOR CSOWM WITH COMPLETE
SOLUTIONS
Roux-en-Y gastric bypass surgery (RYGB) accounts for about 80% of bariatric
procedures in the US and is usually done laparoscopically. During RYGB, a small part
of the proximal stomach is detached from the rest of the stomach, creating a stomach
pouch of < 30 mL. Which of the following preexisting conditions has been shown to go
into remission in up to 62% of patients 6 yr after RYGB?
a. Hypertension
b. Diabetes
c. Obesity
d. Obstructive Sleep Apnea - Correct Answers -Answer: B: Diabetes is particularly likely
to remit. Remission rates are up to 62% after 6 yr. A and D: Other comorbid conditions
that tend to abate or resolve after bariatric surgery include cardiovascular risk factors
(eg, dyslipidemia, hypertension [A], diabetes), cardiovascular disorders, obstructive
sleep apnea (D), osteoarthritis, and depression. C: For RYGB, weight loss is 50 to 65%
after 2 yr; weight loss after RYGB is maintained for up to 10 yr. All-cause mortality
decreases by 25%, primarily because cardiovascular and cancer mortality is reduced.
Which of the following procedures is being used increasingly in the US as definitive
treatment for severe obesity (eg, in patients with a body mass index [BMI] > 60)?
a. Sleeve Gastrectomy
b. Roux-en Y Gastric Bypass
c. Adjustable Gastric Banding
d. Vertical Banded Gastroplasty - Correct Answers -Answer: A: Sleeve gastrectomy;
because this procedure causes substantial and sustained weight loss, it is being used
increasingly in the US as definitive treatment for severe obesity. Part of the stomach is
removed, creating a tubular stomach passage. The procedure does not involve
anatomic changes to the small intestine. B: Nonetheless, Roux-en-Y gastric bypass
surgery accounts for about 80% of bariatric procedures in the US. C: Use of adjustable
gastric banding has dramatically decreased in the US. D: Vertical banded gastroplasty
is no longer commonly done because complication rates are high and the resulting
weight loss is insufficient.
Contraindications to bariatric surgery include which of the following?
a. Body mass index (BMI) < 30 kg/m2
b. Current drug or alcohol abuse
,c. Obstructive sleep apnea
d. High-risk lipid profile - Correct Answers -Answer: B: Current drug or alcohol abuse. A:
The use of bariatric surgery is controversial in patients with a BMI < 30. C and D: To
qualify for bariatric surgery, patients should have a BMI of > 40 or a BMI of > 35 plus a
serious complication (eg, diabetes, hypertension, obstructive sleep apnea [C], high-risk
lipid profile [D]).
Bariatric Surgery Key Points - Correct Answers -Consider weight loss surgery if patients
are motivated, have not succeeded using nonsurgical treatments, and have a BMI of >
40 kg/m2 or a BMI of > 35 kg/m2 plus a serious complication (eg, diabetes,
hypertension, obstructive sleep apnea, high-risk lipid profile) or a BMI of 30 to 34.9 with
type 2 diabetes and inadequate glycemic control despite optimal lifestyle and medical
therapy.
Weight loss surgery is contraindicated if patients have an uncontrolled psychiatric
disorder (eg, major depression), drug or alcohol abuse, cancer that is not in remission,
or another life-threatening disorder or if they cannot comply with nutritional requirements
(including life-long vitamin replacement when indicated).
The most common procedures are sleeve gastrectomy and Roux-en-Y gastric bypass;
use of adjustable gastric banding has decreased dramatically in the US.
Monitor patients regularly after surgery for maintenance of weight loss, resolution of
weight-related comorbid disorders, and complications of surgery (eg, nutritional
deficiencies, metabolic bone disease, gout, cholelithiasis, nephrolithiasis, depression,
alcohol abuse).
Which of the following increases the risk of cardiovascular disorders in patients with
obesity?
a. Osteoporosis
b. Excess abdominal fat
c. Psychological disorders
d. Gastric Ulcer - Correct Answers -Answer: B: Excess abdominal fat. Complications,
including coronary artery disease, are more likely in patients with fat that is
concentrated abdominally. Choices A, C, and D do not increase the risk of
cardiovascular disorders in patients with obesity.
What is the role of ghrelin in food intake-regulating pathways?
a. It increases food intake.
b. It decreases food intake.
c. Level decreases when weight is lost.
d. It integrates energy balance signals. - Correct Answers -Answer: A: Ghrelin, secreted
primarily by the stomach, increases food intake. B, C, and D: Other hormones and
regulatory substances have these effects.
Which type of exercise is MOST effective for increasing BMR?
, a. Aerobic exercise
b. Resistance exercise
c. Balancing exercise
d. Flexibility exercise - Correct Answers -Answer: B: Resistance (strengthening)
exercises are the most effective way to increase BMR. Resistance exercises increase
muscle mass. Because muscle tissue burns more calories at rest than does fat tissue,
increasing muscle mass produces lasting increases in BMR. Choices A, C, and D can
also be effective in a weight management program. A combination of aerobic and
resistance exercise is better than either alone, particularly when patients choose
activities they enjoy.
Obesity Key Points - Correct Answers -Obesity increases the risk of many common
health problems and causes up to 300,000 premature deaths each year in the US,
making it second only to cigarette smoking as a preventable cause of death.
Excess caloric intake and too little physical activity contribute the most to obesity, but
genetic susceptibility and various disorders (including eating disorders) may also
contribute.
Screen patients using BMI and waist circumference and, when body composition
analysis is indicated, by measuring skinfold thickness or using bioelectrical impedance
analysis.
Screen obese patients for common comorbid disorders, such as obstructive sleep
apnea, diabetes, dyslipidemia, hypertension, fatty liver, and depression.
Encourage patients to lose even 5 to 10% of body weight by changing their diet,
increasing physical activity, and using behavioral interventions if possible.
Try treating patients with orlistat, phentermine, phentermine/topiramate,
naltrexone/bupropion, liraglutide, or semaglutide if BMI is ≥ 30 or if BMI is ≥ 27 and they
have complications (eg, hypertension, insulin resistance); however, for severe obesity,
surgery is most effective.
Encourage all patients to exercise, to eat healthily, to get enough sleep, and to manage
stress.
Screening for metabolic syndrome is important. A family history plus measurement of
waist circumference and BP are part of routine care. If patients have a family history of
type 2 diabetes, particularly those ≥ 40 yr, and have a large waist circumference,
laboratory tests are done to evaluate which of the following?
a. Serum uric acid
b. Lipid profile
c. Kidney function
d. Liver function - Correct Answers -Answer: B: Lipid profile. Fasting plasma glucose
should also be measured.
