BMI and Diets Flashcards
How do you calculate BMI?
BMI= body weight (kg)/ height (m)2
Underweight: <18.5
Overweight: 25-29.9
Obesity: >30
Morbid Obesity: >35 w/ obesity related comorbidities or BMI >40
What is the significance of the BMI on the health of the patient?
Risk factor for multiple diseases
- All causes of death (mortality)
- HTN
- Dyslipidemia
- Type 2 DM
- CAD
- CVA
- GB disease
- OA
- Sleep apnea and breathing issues
- Some cancers (endometrial, breast, colon, kidney, GB, liver)
- Low quality of life/mental illness
- Body pain and difficulty with physical functioning
How do you perform an obesity assessment?
H&P
Fasting lipid profile
TSH
fasting glucose or HgbA1C
liver enzymes
Weight loss in obesity
Elimination of all caloric beverages and processed foods
- protion control
- Self-monitoring (food diary, activity record, self-weighing and recording)
What percent of hospitalized adults are at nutritional risk or malnourished?
71%
protein calorie malnutrition is a highly weighted secondary diagnosis that impacts your patients severity of illness, risk or mortality and other risk adjusted outcomes
Underweight BMI= <18.5
What are the 9 Ds of risks for wieght loss/malnutrition?
Dementia
depression
disease
dysphagia
dysgeusia
diarrhea
drugs
dentition
dysfunction
What are risks for weight loss/malnutrition- “MEALS ON WHEELS”
Medication effects
Emotional problems
Anorexia nervosa or alcoholism
Late life paranoia
Swallowing disorders
Oral factors (carries, poor dentures)
No money
Wandering and other demetia related behaviors
Hyperthyroidism or hypothyroidism or hyperparathyroidism or hypoadrenalism
Enteric problems
Eating problems (inability to feed self)
Low salt, low cholesterol diet
Stones, social problems
When is a patient at risk for malnutrition?
if one or more of the following criteria are met?
- Unintentional weight loss of ~10% or usual body weight in the preceding 3 months
- Body weight <90% of ideal for height
- BMI<18.5
What are the causes of malnutrition?
Starvation
abnormal assimilation of the diet
stress response of illness
abnormal nutrient metabolism
what is treatment for weight loss?
- Treat underlying condition (psych, inability to chew food, medical illness)
- Address inadequate food intake
How to adress inadequate food intake as a treatment for weight loss
◦Lift dietary restrictions
◦Feeding or shopping assistance available
◦Foods meet taste
◦Supplement patient’s diet by increasing nutrient dense food
◦Give multivitamin and mineral supplement as needed
◦Consider dietary supplement
◦Appetite stimulant sometimes required
Megestrol acetate
Dronabinol (significant CNS side effects)
Mirtazapine
Weight loss
- Initial weight loss of 5-7 % carries numerous health benefits in the overweight/obese
- Goal of dietary therapy= reduce total #of calories consumed.
- Weight loss directly related to the difference between energy intake and energy requirements.
- Behavior modifications are important to increase adherence to weight loss diet
- Most patients will regain weight lost if diet is not sustainable
- Better success rates occur when diet modifications are accompanied by exercise and behavior interventions
What are some different diet options?
- Low carbohydrate diet (Ketogenic)
- Low carbohydrate diet/Glycemic Control
- Low fat diet
- Very low calorie diet
- Macronutrient balance diet
Low carb/Ketogenic diet
- Used for weight loss and treatment of epilepsy when medications are not enough
- Consists of 4 parts fat:1 part protein & carb
- Calories restricted to 80-90% recommended values for age for epilepsy and varies for weight loss
- Should start on a carb free multivitamin, Calcium and Vitamin D supplement
- Potassium citrate supplement (2 mEq/kg/day) to reduce kidney stone risk.
****Difficult to sustain
Low Carbohydrate Diet
60-130 grams
Short-term weight loss
Glycemic index diet:
◦Optimal health Glycemic Index Count <100/day
◦Configure with kcal reduction for age and activity
Adverse effects of ketogenic diet
- GI sxs: Diarrhea, constipation, N/V, dyspepsia
- Dyslipidemia
- Hypoglycemia
- Hyperuricemia
- Hypoproteinemia
- Low mag, low sodium
- Hepatitis
- Metabolic acidosis
- Bone disease
- Nephrolithiasis
- Selenium deficiency (20% on diet)–> Irreversible Cardiomyopathy and sudden death (prolonged QT)
**Diet should be under careful watch of Doctor
Low fat diet
- Fat limited to <30% of energy intake (total calories)
- Fat has 9.4 kcals/g
- Best for long term weight loss
Recommended to eat no more than 33g of fat for each 1000 kcals in the diet
Example) 1500 kcal diet=45gm or < of fat/day
High protein diet
Suggested for the obese
◦More filling of a diet and thermogenic
May help improve weight maintenance
**Recommended for obese pts becaue it fill them up
Very low calorie diets
- Energy levels between 200-800 kcals/day
- Looking for rapid weight loss
- Not suggested for the obese
- Not shown to be superior to conventional diets
◦No difference in long-term weight loss
- Sometimes used to prepare for a surgery
Advere effects of very low calorie diets
- Hair loss
- Thinning of skin
- Coldness
- Increased risk for gallstones
Macrobalance diet
- Little consensus on the best mix of macronutrients for a diet
- Difficult to study because of high drop out rates
- Promises for sustained weight loss have been noted in groups who are eating high protein, low glycemic index groups–> but still inconclusive.
What should be prescribed to patients on a low carb/ketogenic diet
- carb free multivitamin
- Calcium supplement
- Vitamin D supplement
- Potassium citrate supplement (2 mEq/kg/day)- to reduce kidney stone risk.
