Exam #1: Obesity II Flashcards
What should the assessment of an obese patient focus on in addition to anthropometric data?
- Social hx
- Familial hx
- Food/ nutrition behavior
What are the four major categories of barriers to obesity intervention?
1) Mental
2) Economics
3) Mechanical (physical activity)
4) Metabolic
What are the five stages of change?
1) Pre-contemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance
What is the pre-contemplation stage of change?
No intention to change over next 6 months
What is the contemplation stage of change?
Aware of problem; thinking about changing in 6 months
What is the preparation stage of change?
Intends to change in 30 days and may have made small changes
What is the action stage of change?
Actively engaged in change for less than 6 months
What is the maintenance stage of change?
Engaged in behavior for at least 6 months
What are the major methods of obesity treatment?
- Altering diet
- Increasing physical activity
- Behavior therapy
- Pharmacology
- Surgery
**A combination of these is key
What is key to successful treatment of obesity?
- Lifestyle change (weight loss only is unsuccessful 40% of the time)
- Multidisciplinary approach
What is the definition of successful weight loss?
- Losing 10% of initial eight
- Maintaining that for at least one year
What can a 10% weight loss improve?
- Lipid levels
- Blood glucose
- Risk of heart disease
- Lifestyle
Who is approved for a very low calorie diet (VLCD)?
- BMI is 30+
- 27 w/ comorbidities
What is the definition of VCLD?
> 800 calories
What is important to remember when a patient has finished a VLCD program?
Must gradually refeed over 4-6 weeks
What is the limitation of VLCD?
Modest long-term outcome with common weight regain
What is one of the most successful weight loss program types?
Behavior modification
*****Success especially seen when paired with other treatment types
What does behavior modification include?
- Goal-setting
- Self-monitoring
- Stimulus control
- Cognitive reconstruction
- Stress management
- Social support
- Relapse prevention
What are the three essentials of motivational interviewing?
MI is:
1) A conversation
2) Collaborative
3) Evocative
What patients are good candidates for drug therapy?
- BMI >30
- 27 w/ comorbidities
What is Orlistat? What is the mechanism of action?
- Weight loss drug
- Approved for peds
*****Lipase inhibitor that blocks fat absorption
What is Phentermine/Topiramate ER? What is the mechanism of action?
Phentermine= appetite suppressant
Topiramate= anticonvulsant that decreases hunger and increases satiety
What is gastric banding?
Placing a band around the upper stomach to create a 15 mL pouch
What are the advantages of gastric banding?
- Easily removed/ reversed
- Faster recovery
- Can be adjusted in office
What are the disadvantages to gastric banding?
- Weight loss if less dramatic
- More likely to regain weight
- Vomiting
- Can slip out of place
What is a sleeve gastrectomy?
75% of stomach is removed in line with the greater curvature
What are the advantages to sleeve gastrectomy?
- Simpler than bypass
- Lower risk than bypass
- Doesn’t effect absorption
- Rare nutritional deficiencies
What are the disadvantages to sleeve gastrectomy?
- Irreversible
- New
- No long term data
What is Roux-en-Y Gastric Bypass?
- 15-25 mL pouch made w/ outlet
- Bypass distal stomach, duodenum, and jejunum
What are the pros of Roux-en-Y Gastric Bypass?
- Dramatic weight loss
- C-morbid conditions improve
- Good long term results
What are the cons of Roux-en-Y Gastric Bypass?
- Irreversible
- Nutritional deficiency common
- Need life long supplements
- Dumping Syndrome
What are the common complications of bariatric surgery?
- Leaks
- Stomal ulceration
- Dumping syndrome
- Constipation*
*Most common
What is dumping syndrome?
Weakness, abdominal discomfort, and sometimes abnormally rapid bowel evacuation, occurring after meals in some patients who have undergone gastric surgery.
What foods will worsen Dumping Sydrome?
High sugar foods and beverages
What are the major deficiencies seen following bariatric surgery?
- Iron deficiency anemia
- B12
- Folate
- Ca++ and Vitamin D
