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CSOWM REVIEW QUESTIONS TO
PRACTICE AND ANSWERS 2024/2025
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
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
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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
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
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).
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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
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.
Answer: A: Ghrelin, secreted primarily by the stomach, increases food intake. B, C,
and D: Other hormones and regulatory substances have these effects.
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Which type of exercise is MOST effective for increasing BMR?
a. Aerobic exercise
b. Resistance exercise
c. Balancing exercise
d. Flexibility exercise
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
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.
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