Ch 35 Obesity Flashcards
Which weight loss strategy is most effective for inducing weight loss?
No specific weight loss strategy has consistently been shown to both safely reduce weight and result in long term maintenance for most participants
Regardless of diet composition, negative energy balance induced by decreased intake will reduce weight
Deficiencies of fat-soluble vitamins are common in which type of bariatric surgery
Deficiencies of fat-soluble vitamins are rare in RYGB but are common in BPD who may need additional supps of these micros
How to bariatric procedures work?
They may be restrictive, malabsorptive, or both
What are some reasons hypocaloric high protein feeds are recommended in obesity?
Metabolic rate may not be markedly increased in patients with critical illness
Weight gain during nutrition support in critical illness usually involves increase if fat mass out of proportion to LBM
Provision of glucose in excess of needs causes increased lipogenesis and fatty liver
Hyperglycemia increases risk of infectious complications
What is the obesity paradox?
Despite higher pre-ICU risk for morbidity/mortality and ICU challenges, obesity has been associated with improved ICU outcomes, the “obesity paradox”. Reason for improved outcomes is unclear
How to exercise contribute to overweight/obesity treatment?
Increasing physical activity is unlikely to result in significant weight loss w/o a concomitant decrease in energy intake
Exercising during weight loss promotes preservation of LBM and can help prevent weight regain after successful weight loss from dieting
What are the qualifications for bariatric surgery?
BMI > 40 or have BMI greater than 35 with at least 1 severe obesity associated comorbidity (sleep apnea, DM2, OSA, cardiomyopathy, NAFLD or severe joint disease)
In 2011, FDA approved expanding the indication for lap band to include patients with BMI between 30-35 and at highest risk of obesity related complications
All candidates must have h/o failed attempts to control weight by medical means including supervised lifestyle intervention programs
Adiposity hormones are secreted not in response to meal but as result of what?
Amount of adipose tissue present in host organism
What factors contribute to the development of obesity?
Genetics, Environment, and Neuroendocrine Pathophysiology
What are the goals for weight loss in an obese patient?
Goals of obesity treatment are to achieve and sustain weight loss and reduce health
Reasonable initial goal is 10% weight loss in 6 months
Patients may lose more than 10% of initial weight, but these larger losses are less likely to be sustained; after 10% weight loss achieved, efforts should focus on maintenance
Which vit/minerals should be supplemented in a malabsorptive bariatric procedure?
Current recs for routine vit/mineral supplementation in RYGB and BPD include standard adult or prenatal MVI BID, Ca Citrate, Vit D, Vit B12, folic acid, and elemental iron
What criteria must be met for pharmacological treatment of overweight/obesity?
In those with BMI equal or greater to 30, or in those w/ existing comorbid conditions that BMI equal or greater than 27
Weight loss goals remain between 5-10% with drugs, and patient need to understand that meds serve only as adjunct to diet/lifestyle changes
Following diet and exercise induced weight loss, serum concentrations of what increase?
ghrelin; these compensatory changes may help explain why weight loss is difficult to maintain long term
What is considered elevated waist circumference in men? In women?
women > 88 cm (35’’)
Men > 102 cm (40’’)
Waist circumference is another variable that can predict risk associated w/ adiposity and is a surrogate for organ fat (visceral); most useful when preformed in people w/ BMI between 25-35 In these BMI classifications, elevated WC increases health risk when compared w/ BMI alone
How is a low calorie diet defined? How is a very low calorie diet defined?
Low calorie: Energy intake to lower limit of 800 kcal/d is considered low calorie
Very low calorie: • Typically contain 400-800 kcal/day but decrease in intake below 800 kcal/d are associated with little additional weight loss (likely d/t poor compliance and/or reduced REE) ``
