Endo Block 2 Flashcards
What is the most convenient population level measure of overweight and obesity currently available?
BMIs of what percentage are categorized as overweight, Class 1-3?
BMI- kg/m^2
Normal: 18.5-24.9 Over: 25-29.9 Class 1: 30-34.9 Class 2: 35-39.9 Class 3: Greater than 40
What are four cons of using BMI as a measurement tool?
Upper body obesity that is located ? and ? is more significant than lower body obesity of fat located ? or ?
Mis-classifies 25% of PTs
No account for fat location
Not accurate for sedentary/body builders
Not distinguished between fat/lean mass
Abdomen/flank
Thigh/buttocks
Fat that is located ? is more hazardous to health and is composed of ? fat
Females must have a minimum body fat of -% to have a regular menstruation?
Abdominal fat
Visceral
13-17%
Upper body obesity and abdominal fat is associated w/ abnormal adipose lipolysis leading to ? and higher incidences of ? complications
What is the number one cause of high output heart failure?
What is the number one public health concern linked to increasing levels of obesity?
Insulin resistance
Metabolic
Obesity
DM
Men must have _% body fat
What is the name of an environment that can increase the chance of a PT becoming obese?
3%
Obesigenic
What are the 5 parts of the motivational interview?
What is the most common genetic cause of obesity?
What is an independent predictor of metabolic abnormalities associated w/ obesity over and above the effects of exercise?
Nutrition intervention Physical activity Behavior therapy Pharmacotherapy Bariatric surgery
Prader-Willi Syndrome- demonstrates hyperphagia (compulsive overeating over long periods of time)
Sedentary activities
If an adopted PT is concerned about weight gain, how can this be predicted?
What are the typical features of Prader-Willi Syndrome?
Biological parents weight
Hypotonia
Almond shaped eyes
Narrow bifrontal diameter
Thin upper lip
What is done during PE for an obesity work up?
What diabetic drugs can cause weight gain?
BMI, degree/distribution of body fat, nutritional status, signs of secondary cause
Insulin
Sulfonyureas
Thizolidinediones
How much weight loss can be expected with conventional diet techniques?
What is the more important part of obesity management?
20% lose 20lbs and maintain for 2yrs
5% maintain a 40lbs loss
Avg= 7% loss from baseline
PT-Provider contact
Trimble’s obesity management plan and associated goals?
Define Very Low Calorie Diet
Diet/Exercise= greatest loss
Only diet= moderate loss
Only exercise= small loss
No Tx= no loss
800-1000cal/day x 4-6mon w/ average loss of 15%
Significant weight gain after 18mon
What are six classes of drugs that are known to cause weight gain?
What class of medication can be considered for these PTs that have underlying psych issues?
Psych/Neurological Steroid hormones Anti-diabetes (Insulin, Sulfonylureas, Thiazolidinediones) Anti-histamines Anti-HTN Anti-retroviral therapy
SSRIs
How much exercise is recommended per week by the College of Sports Med?
How much moderate exercise is recommended per day?
150min moderate
75min vigorous
Equivalent mod/vigorous combo
Weights 2x/wk
1hr
When are meds added to obesity management?
What GI agent is used for management and how does it exert it’s effect in PTs?
BMI >30
BMI >27 w/ obesity related RFs: HTN, DM2, CVD
Orlistat- Inhibits intestinal lipase/fat absorption
S/e- oily stool/diarrhea, incontinence
What CNS stimulant/anorexants are used for obesity management and how does it do it?
Lorcaserin- SSRA, promotes satiety for moderate weight loss >5%
S/e= HA, breast tumors
Phentermine- inc NorEpi/dopamine uptake suppressing appetite x 3mon
Phen/Topiramte- migraine prophylaxis, weight loss effect. C/i- hypothyroid, glaucoma
D/c if no loss in 4wks
What antidepressant/opioid agonist is used for obesity management?
Bupropion/Naltrexone- regulates dopamine reward system, cravings and overeating behaviors
S/e- GI upset
Caution in Psych Hx
C/i- HTN, opioid use, seizure, eating d/o
What GLP-1 agonist can be used for obesity management
Liraglutide- DM management med, increases insulin secretion, decreases inappropriate glucagon and slows gastric emptying
S/e- tachy, HA, hypoglycemia, nausea
C/i- medullary thyroid CA, MEN2a
What are the general contraindications for using weight loss meds?
Uncontrolled CAD Pregnancy/feeding Hx of psych dz <18y/o Certain med use- MAOIs
When is bariatric surgery a consideration for obesity management?
What is the name of the gastric bypass procedure?
> 40% BMI or >35 w/ co-morbidities
Roux-en-Y gastric bypass
Restrictive/malabsorptive surgery, distal stomach resected. Remaining pouch is anastomosed to retro-colic segment of jejunum leaving gastric capacity at 30-50mL
Dec food intake/absorption of ingested food
What is the name of the Lap Band procedure?
Define Sleeve Gastronomy
Vertical banded gastroplasty
Prosthetic band dec size of gastric outlet
Multiple f/u visits for adjustment
Creation of sleeve over bougie, removing portion of greater curvature
Dec ghrelin levels x 1yr
Restricts food intake
Define Dumping Syndrome
What does Hirsutism mean?
Bariatric surgery complication when PT has to defecate nearly immediately after eating
Latin- shaggy, hairy
Excessive terminal hair growth that appears in women in a male pattern
Androgens act on sex-hormone responsive hair follicles causing a transition from ? to ?
Half of women with Hirsutism will have ?
Vellus into terminal
Hyperandrogenism
What will be seen in women with hirsutism that have increased follicle sensitivity to normal levels of androgens?
What is the Hirsutism is pathological?
How is Hirsutism scored?
Normal labs- genetics
Elevated circulating androgens, will have elevated labs
Ferriman-Gallwey score
Norm: <8
Max: 36
Where does DHEA S come from?
Where does Androstenedione released from?
Where is testosterone ( the most potent) secreted from?
Adrenal gland
Ovary and adrenal gland
Ovary/adrenal gland
What is the most potent androgen in females?
65% is bound to ? protein
33% is bound to ? protein
Testosterone
Sex hormone binding globulin
Albumin