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OMA Obesity Medicine Board Review Exam Questions With Correct Detailed Answers.
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Ghrelin - correct answer -only known orexigenic gut hormone -inactive form --ghrelin O-acyltransferase (GOAT)--ghrelin-acyl (active form) -Growth Hormone Release Inducing Peptide -secreted by: gastric fundus/body, proximal small intestine (decreased...

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OMA Obesity Medicine Board Review

Ghrelin - correct answer -only known orexigenic gut hormone

-inactive form --ghrelin O-acyltransferase (GOAT)--ghrelin-acyl (active form)

-Growth Hormone Release Inducing Peptide

-secreted by: gastric fundus/body, proximal small intestine (decreased w/ sleeve gastrectomy--remove
greater curvature of stomach/fundus)

+: empty stomach, weight loss, stress, sleep deprivation, genetics (Prader willi)

-: stomach stretch*^, weight gain, leptin, gastric sleeve--*occurs less in pts w/ obesity, ^inhibited fastest
by CHO, but also rebounds fastes, protein - the longest

-fx: + NPY/AgRP in CNS (arcuate nucleus in hypthalamus) +/- activation of nucleus tractus solitarius
through vagal nerve (vagotomy - ghrelin); + gut motility, - insulin secretion



Ghrelin and weight loss - correct answer -ghrelin levels increase as you lose
weight

-weight regain-->reduced ghrelin levels

-obesity-->reduced decrease in ghrelin post-prandial meals



Small Intestine Hormones - correct answer -short acting, reduce appetite

-goal: cause meal termination

-CCK (cholecystokinin)

-GLP-1 (glucagon-like peptide 1_

-OXM (oxytomodulin)

-PYY (peptide YY)



CCK (Cholecystokinin) - correct answer -released from sm. intestinal I-cells
(duodenum and jejunum)

+: fat/protein ingestion, gastric distension

-short acting (15-30 min)

,-act on rec's in gut and brain:

-CCK-1 rec=GI=slow gastric emptying and + gallbladder contraction

-CCK-2 rec = brain = reduce appetite

-poor pharm studies b/c too short acting and develop tolerance



GLP-1 - correct answer -from L-cells of distal sm. int and colon

+ by: nutrient intake (CHO>protein/fat)

-"incretin" effects: 1) glucose dep't insulin secretion (1st phase insulin response) 2)reduced hepatic
gluconeogenesis (supresses glucagon) 3) delayed gastric emptying (increased satiety) 4) reduced
appetite (weight loss)

-1/2 life = 5min (degraded by DPP-4)



GLP-1 and obesity - correct answer -GLP-1 levels are reduced in: obesity, pre-
DM, T2DM (by enzyme in proximal sm. intestine)

-gastric bypass skips over this inhibitory part of sm. int-->increased GLP-1 levels (why T2DM pts resolve
DM quickly even before they lose weight)



OXM (oxyntomodulin) - correct answer -produced by L-cells of distal small
bowel (co-secreted w/ GLP-1) post-prandially

-works on many rec's-->GLP-1 and glucagon (increases E expenditure)

-fx's: decrease appetite/feeding, increase E expenditure, weight loss

-less GI sx's than GLP-1 (good option for trx)



PYY (Peptide YY) - correct answer -produced b L-cells of distal sm bowel,
colon, rectum

-elevates w/in 1 hr post-feeding

-works on Y2 rec

-fx: potent appetite suppressant/anorexiant, slows gastric emptying and intestinal tract time ("ileal
brake")

-clinical: IV infusion decreased calorie intake x 30% but lots of GI sx's; bariatric surgery -->natural
increase of PYY

,GIP (glucose-dependent insulinotropic polypeptide) - correct answer -
previously gastric-inhibitory peptide

~ GLP-1 (incretin)=together make up 70% postprandial insulin response

-releasted from intestinal K-cells in duodenum and upper jejunum in response to oral glucose load



Large Intestine Hormones - correct answer -same as sm intestine EXCEPT CCK

-GLP-1, OXM, PYY



Pancreatic hormones - correct answer -exocrine (digestion)

-endocrine (glucose homeostatis and reduced feeding):

1. pancreatic polypeptide

2. insulin

3. amylin



Pancreatic Polypeptide (PP) - correct answer -made in F-cells of pancreas in
response to calorie load (~ PYY)

-binds to Y4 rec's:

in gut-->reduced gastric emptying

in hypothalamus--> inhibits NPY mRNA expression-->reduced hunger

-obesity is ass'd with lower PP levels (seen in Prader Willi)



Insulin - correct answer -secreted by pancreatic B-cells in response to feeding

-fx's: glucose homeostasis and fat mgmt (increases nutrient storage peripherally but centrally reduces
appetite)



Insulin's adiposopathy homeostasis fx's - correct answer -1 of 2 long-term
adiposity signaling hormone:

-circulating levels are proportionate to level of body fat

-in hypothalamus it inhibits feeding (AgRP/NPY neurons)

-similar effect to leptin CENTRALLY, but less potent

, -in obesity, insulin resistance attenuates weight-loss effects centrally



Insulin's glucose homeostatis - correct answer Muscle: uptake glucose--
>glycogen; uptake aa's-->protein

Liver: uptake glucose-->glycogen; inhibits fats/protein-->glucose

Adipose: + fat synthesis



Glucagon's glucose homeostasis fx's - correct answer -from alpha cells of
pancreas

-stimulated by low glucose

-inhibited by high glucose, GLP-1, amylin

Liver: +gluconeogenesis (glycogen-->glucose, aa's-->glucose) to keep steady blood sugar through meals



Amylin - correct answer -co-secreted w/ insulin by pancreatic B-cells in
response to meals

-fx's: regulates glucose and bodyweight (1. reduces food intake, 2. slows gastric emptying 3) suppresses
glucagon production/hepatic gluconeogenesis) ~GLP-1 but with less glucose reduction

-makes insulin more effective for glucose lowering

-pharm: pramlintide=amylin analog to reduce insulin need



Pramlintide - correct answer -brand name: Symlin

-amylin analog

-FDA approved for T1DM & T2DM

-administered before meals to reduce insulin req's

-a1c reduction: 0.3-0.6%

-weight loss: 3-4# in 6 mo's (more effective when combined with phentermine--11% TBW loss)



White adipose tissue - correct answer -provides insulation

-helps with mechanical support

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