Rapidly rising obesity rates in the US threaten to reverse decades of effort against cardiometabolic disease. How well do you know what experts recommend for your at-risk patients?
1. Guidelines from the ACC/AHA recommend that an individual with obesity consume a maximum of how many calories/day to promote weight loss as part of a comprehensive lifestyle program?
Answer: D. 1500 kcal/day. The 2019 ACC/AHA guidelines on the primary prevention of CVD recommend that persons with overweight/obesity take part in a comprehensive lifestyle program for at least 6 month: • Low calorie diet (800 - 1500 kcal/day) • Increased physical activity of 200 - 300 mins/wk • Regular monitoring of body weight
Answer: D. Metformin. Metformin, alpha glucosidase inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, and amylin mimetics all areassociated with weight loss. • DPP4 inhibitors (eg, sitagliptin) are weight neutral. • Insulin secretagogues (ie, glinides, sulfonylureas like glyburide), thiazolidinediones (eg, pioglitazone), and insulin are associated with weight gain. See the ADA 2020 Standards of Care for additional information.
3. Which of the measures above is recommended by the 2019 Endocrine Society guidelines as the cutoff for waist circumference for the clinical diagnosis of metabolic syndrome (MetS) in an African American woman?
Answer: B. ≥ 88 cm. The 2019 Endocrine Society practice guidelines on prevention of ASCVD and T2D recommend screening for all 5 components of MetS every 3 yrs in adults aged 40-75 yrs. • A finding of 3 out of 5 components indicates increased metabolic risk:
•Elevated blood pressure
•Increased waist circumference
•Elevated fasting triglycerides
•Elevated blood sugar
Answer: B. ≥88 cm (African-American woman). The Endocrine Society recommends the following cutoffs for waist circumference:
•Women: ≥ 88 cm (non-Asian origin), ≥ 80 cm (East Asian and South Asian origin)
•Men: ≥ 102 cm (non-Asian origin), ≥ 90 cm (East Asian and South Asian origin)
Answer: A. Lorcaserin. Four weight-loss medications are FDA-approved for use of >12 wks in patients with obesity who have ≥ 1
obesity-associated comorbidity (eg, T2D, HTN).
• Orlistat, phentermine/topiramate ER, naltrexone/bupropion ER, liraglutide.
• FDA in 2020 requested withdrawal of lorcaserin from the US market after a safety clinical trial showed increased occurrence of cancer.