4910:C12 Energy Balance & Body Weight

Question 1

kilojoule

Answer 1

The amount of work required to move 1 kilogram for 1 meter with the force of 1 newton. 1kcal = 4.2kJ.

Question 2

Ghrelin

Answer 2

A peptide hormone produced in the stomach & stimulates appetite. Levels increase during fasting.

Question 3

adiponectin

Answer 3

Hormone released by adipocytes, signals that the body has capacity to store more fat, low levels are associated with obesity

Question 4

leptin

Answer 4

A peptide hormone released by adipocytes, signals that the body has enough fat stored. Acts on hypothalamus to suppress appetite. Influences reproduction. Inhibits action of NPY. Down regulated in obesity.

Question 5

Overweight BMI in adults

Answer 5

25.0-29.9kg/m^2

Question 6

Healthy Weight BMI (adult)

Answer 6

18.5-24.9kg/m^2

Question 7

Underweight BMI (adult)

Answer 7

<18.5kg/m^2

Question 8

Overweight BMI for children

Answer 8

BMI for age range ≥ 85th percentile but < 95th percentile.

Question 9

Obese BMI for children

Answer 9

BMI-for-age ≥ 95th percentile

Question 10

Waist Circumference in males and females

Answer 10

40in males; 35in females. High waist circumference is associated with increased cardio metabolic disease. Useful in assessing risk in those within healthy to overweight BMIs.

Question 11

Waist-to-Hip Ratio (WHR)

Answer 11

Calculated by dividing waist circumference by hip circumference. WHR > 0.95 in males & > 0.8 in females = higher risk.

Question 12

steatosis

Answer 12

increased accumulation of fat in the hepatocytes.

Question 13

Hormones that have an anorexigenic effect

Answer 13

CCK, glucagon-like peptide-1, Peptide YY

Question 14

Adiposity rebound

Answer 14

The increase in % body fat in children haver decreasing between 1 & 6 years of age.

Question 15

Regulation of food intake is controlled by what hormones?

Answer 15

Leptin, adiponectin, ghrelin, neuropeptide Y (NPY)

Question 16

Factors that contribute to obesity

Answer 16

Hormonal regulation of food intake. Meta-inflammation. Genetics. Food intake. PA. Sleep disturbances.

Question 17

NPY

Answer 17

Synthesis is increased with food deprivation; it is released during starvation &/or fasting. Promotes storage & synthesis of fat.

Question 18

Ghrelin

Answer 18

Hormone produced in the stomach that stimulates hunger and decreases energy expenditure.

Question 19

Theory of why ghrelin levels increase in obesity?

Answer 19

Possibly sensitivity increases or receptors increase.

Question 20

adiponectin

Answer 20

Protein hormone produced by adipocytes. Causes sensitivity of peripheral tissues to insulin. Synthesis is down regulated in obesity and insulin resistance.

Question 21

Meta-inflammation

Answer 21

Imbalance of pro-inflammatory (interleukin, TNF a, CRP) cytokines with anti-inflammatory cytokines (adiponectin) produced by adipose tissue.

Question 22

The main source of obesity related pro-inflammatory cytokines?

Answer 22

Adipose tissue macrophages, they’re numbers increase with visceral fat.

Question 23

How does inflammation impact the glut-4 transporter.

Answer 23

The glut-4 transporter is inhibited by inflammation leading to insulin resistance, hyperglycemia, and DM2.

Question 24

Mechanisms for circadian disruption & obesity

Answer 24

High snacking frequency. Reduction in total daily sleep. Increased exposure to bright light during the night. The brain losing “feeling” for internal vs. external rhythms

Question 25

Factors used to assess weight status and health risk

Answer 25

BMI, body composition, body fat distribution

Question 26

What does an at risk waist circumference put one at risk for?

Answer 26

2DM, metabolic syndrome, HTN, dyslipidemia, CHD. >40in males, > 35 in females. Central adiposity = increased risk factors.

Question 27

At risk W:H?

Answer 27

> 0.95 men. > 0.8 women

Question 28

Recommended treatment for BMI 25-26.9

Answer 28

Diet, PA, and behavior therapy with comorbidities

Question 29

Recommended treatment for BMI 27-29.9

Answer 29

Diet, PA, and behavior therapy with comorbidities. Rx- with comorbidities

Question 30

Recommended treatment for BMI 30-34.9

Answer 30

Diet, PA, & behavior therapy. Pharmacotherapy.

Question 31

Recommended treatment for BMI 35-39.9

Answer 31

Diet, PA, behavior therapy. Pharmacotherapy. Surgery with comorbidities.

Question 32

Recommended treatment for BMI > 40

Answer 32

Diet, PA, behavior therapy. Pharmacotherapy. Surgery with comorbidities.

Question 33

Outcome measures for interventions in overweight?

Answer 33

Weight. Biochemical labs - improvement in glucose, lipids, & CRP. Self-image.

Question 34

EAL recommendations for creating an energy deficit?

Answer 34

An individualized reduced calorie diet. Reducing fat &/or CHOs is practical way. 500-1000kcal deficit. 1-2 lb./week wt loss is goal.

Question 35

Nutrition Intervention of Overweight & Obesity

Answer 35

Avoid wt gain once goal is reached. Reduce energy intake. Decrease intake of energy dense foods.

Question 36

EAL Recommendation for Pharmacotherapy in Nutrition Intervention?

Answer 36

Research indicated that in some individuals Rx aid in wt loss. Follow NHLBI criteria. Are part of comprehensive wt management program.

Question 37

Pharmacologic treatment for wt loss is indicated at what BMI?

Answer 37

BMI > 30 or >27 w/ comorbidities.

Question 38

Types of wt loss Rx

Answer 38

Lipase inhibitors - orlistat-xenical. Appetite suppressants. Others prescribed off-label - anti-depressants; anti-seizure

Question 39

Appetite Suppressant Drugs

Answer 39

Qsymia. Belviq. Sibutramine. phentermine. phendimetrazine. diethylpropion

Question 40

Roux-en-Y

Answer 40

The most commonly preformed gastric bypass surgery. A small pouch is created, the jejunum is attached to this, then the duodenum is attached to the jejunum to allow for secretions to enter, and the stomach is by passed. Deficiencies are common

Question 41

Vertical Sleeve

Answer 41

Restricts stomach's capacity, but stomach function remains intact. Less deficiency, dumping syndrome.

Question 42

Duodenal Switch

Answer 42

Intestinal pathways is re-routed to separate the flow of food from the flow of bile and pancreatic juices to inhibit absorption of energy-yielding nutrients. Pylorus is intact,

Question 43

Gastric banding

Answer 43

Silicone ring or band is laparoscopically introduced into the abdominal cavity & secured around the upper part of the stomach - creates a small pouch with a narrow opening at the bottom of the pouch.

Question 44

Medical complications of wt loss

Answer 44

Electrolyte abnormalities - arrhythmias. Catabolism of heart. If on diuretic - Hypokalemia - monitor and supplement as needed.

Question 45

Why is hyperuricemia a complication of wt loss surgery?

Answer 45

Pt is in ketosis which increases uric acid and incidence of gout. A low purine diet is recommended to prevent

Question 46

Why is cholecystitis a common complication of wt loss surgery?

Answer 46

The very low-fat diet post op cause bile to build up in the gallbladder.

Question 47

Medical complications of wt loss surgery: Fatty liver disease

Answer 47

wt loss may result in inflammation - increased liver enzymes.

Question 48

Drugs to decrease absorption of energy?

Answer 48

Block lipoprotein lipase Alli - OTC. Orlistat- Rx - is controlled substance and only prescribed for 12 wks.