Assessment & Evaluation Flashcards
5 A’s of Motivational Interviewing
Ask
Assess
Advise
Agree
Arrange/Assist
HPI
-age of onset
-highest weight ever? lowest or best weight
-rate of gain: 1 yr ago, 1 mo ago
-inciting factors: any major life events
-past weight loss attempts/surgeries & outcomes
-motivations
-nutrition understanding
Psych screens
-Trauma
-Anxiety
-Depressions
-Trauma: PCL-5
-Anxiety: GAD7
-Depressions: PHQ9
Sedentary time risk
> 3h/day increases CV risk
Family History & risk of obesity
40%- 1 sibling
50%- 1 parent
80%- 2 parents
90%- monozygotic twin
Sleep & risk of obesity
-ideal
-short
-very short
-ask about duration, quality, etc
-ideal 7-8 hrs
-short 5-6 hrs, 20% inc. overweight, 57% inc. obesity
-very short, <5 hrs, 30% inc. overweight, 2x inc. obesity
Screens for OSA
-STOP-BANG more sensitive
-Epworth Sleepiness Scale more specific
PMH that may require Rx alternatives
-palpitations
-nephrolithiasis
-seizures
Body fat % and obesity cutoffs
-NHANES
-ACE
-OMA
(Male, Female)
-NHANES: 32, 44
-ACE: 25, 32
-OMA: 30, 35
Waist Circumference for abdominal obesity (WHO)
-M, F, cm, in
-Asian
(M, F)
-94, 80 cm inc. risk [37, 31.5 in]
-102, 88 cm highest risk [40, 34.5 in]
Asian: 90, 80 cm [35.5, 31.5 in]
Body Comp Analysis: 8 methods (and limitations of each)
1- Calipers (user dep, not optimal at high BMI)
2- DXA (not all can distinguish visc & subQ, machine wt limits @ high BMI)
3- Air plethysmography [Bod Pod] (clothing and Hydration dependent)
4- BIA (Hydration dependent, no exercise for 8 hrs, try BM before, no caffeine or EtOH x 12 hrs, keto diet can affect bc diuresis)
5- Underwater weighing densitometry (time-consuming, need adequate exhalation)
6- CT/MRI (weight limits)
7- Deuterium Oxide dilution hydrometry (not commercially available)
8- Indirect Calorimetry [Metabolic cart]
PE:
-scale
-BP cuff sizes
-scale up to 600 lbs
-BP level w heart after 5’ rest
L: 14.2-17.7
XL: >17.7 (45 cm)
OSA findings:
-Neck circ
-Mallampati
M: >17”
F: >16”
Mallampati 3 or 4
Acne associated with (2)
PCOS
Cushings
Acrochordons associated with…
= skin tags
insulin resistance
Bruising assoc with…
Cushing
Hypothyroid
Vit def
Lipedema
Hyperpigmentation assoc with…
Acanthosis nigricans - IR & DM
Hyperpig w Cushings
Dry & scaly skin assoc w…
-heels
Hypothyroid
Nutrient def
-Heels: above plus DM & EFA deficiency
Differences (dist, gender, age onset, pain, assoc, genetics)
-MSL-osis (Madelung, Launois), HIV
-DD, FMLosis
-Lipedema, APL-ophy
[] = lookalike condition
-MSL-osis (Madelung, Launois) [HIV]
1. upper (can be global in women)
2. males
3. adult
4. no pain
5. neuropathy, EtOH
6. AD or AR, **tRNALys mut uncommon
-DD [FMLosis]
1. global
2. female
3. any age
4. +pain
5. AutoI dz, DM
6. AD, sex influence
-Lipedema [APL-ophy]
1. Legs +/- arms, **feet spared
2. female only
3. pub-20’s
4. +pain
5. lymphedema
6. AD, incomplete penetrance, sometimes +FH
TDEE =
5 components:
RMR (60-75%) +
TEF (10%) +
NEAT (150-500 cal/d) +
EPOC +
Exercise (15-30%)
RMR formulas (2)
- Mifflin-St Jeor best for obesity (factor of 10x weight)
- Harris Benedict, wt also heavily factored
BMR vs RMR
BMR = 12 hr fast, first thing in AM, dark room, recumbent, calm
RMR = less stringent
RQ
= CO2 prod / O2 consumption
Carbs - 1.0
Fat - 0.7
EKG indications
-symptomatic
-risk factors (DM, obesity, met synd)
-strong FH cardiac dz
-meds
-pre-exercise eval
-pre-op eval
EKG findings in obesity
-L axis dev
-T wave
-PAC’s w OSA
-Hypertrophy (HTN)
-QT abnL
** many reversivle w substantial wt loss!
STOP-BANG
Snoring
Tiredness
Obs apnea
Pressure (HTN)
-
BMI
Age
Neck circ
Gender
AHI
5-15/hr - mild
15-30 - mod
>30 - severe
DM vs pre-DM cutoffs
Pre-DM:
A1C = 5.7-6.4
FG = 100-125
DM:
A1C >= 6.5
FG >= 126
IR
-fasting insulin >= 25
-HOMA-IR:
0.5-1.4 normal
>1.9 early
>2.9 significant IR
-TG:HDL >2.5 in women, >3.5 men
Some slides left out… testing alg for Cushing, etc
