Exam 3 - Obesity II Flashcards
What BMI is the cutoff for increased DM risk?
> 22 BMI increases risk for T2DM 25%
Describe the etiology of T2DM in obese individuals
• Excess fat elevates fasting and post-prandial FFA
• Increased FFA
- increases pancreatic b-cell secretion of insulin
- inhibits cellular insulin resistance
- causes peripheral IR
- reduces glycogen storage
- increases hepatic glucose production
**HYPERGLYCEMIA, HYPERINSULINEMIA, IMPAIRED GTT and eventually T2DM
Describe the etiology of why hypertension is an issue for obese individuals
Adipocyte-related factors containing angiotensinogen and metabolies of FFA - both stimulate aldosterone release
List some commodities of obesity
- T2DM
- Hypertension
- Hepatobiliary disorders
- Metabolic syndrome
- IR/pre-diabetes
- Sleep apnea
- Acanthosis nigricans
Describe the etiology of hepatobillary disorders in obese individuals
• Cholesterol gallstones form when cholesterol concentration in bile becomes supersaturated and crystals grow
Name the five factors of Metabolic Syndrome
- Elevated WC**
- Elevated TAGs
- Reduced HDL
- Elevated BP
- Elevated fasting glucose**
**Dominant underlying risk factors
Name the risk factors for sleep apnea
- Obesity - fatty cells infiltrate throat tissue
- Habitual snoring - changes in soft palate
- Family history
- Immune abnormalities - High TNF-a and IL-y
- GERD
Describe possible sleep apnea treatments
• LIFESTYLE CHANGES - sleep on side - nasal strips • WEIGHT LOSS • SUBSTANCE USE - quit smoking - no alcohol w/in 4 hrs of sleep - no sleeping pills and tranquilizers • CPAP
Describe acantrosis nigricans and its cause and treatement
• Velvety, light brown to black markings
- usually on neck, under arms or in groin
•Cause: insulin “spillover” into skin
• Treatment: reduce circulating insulin by weight reduction
What are the general guidelines for medical management of obesity?
- Diet
- Physical activity
- Behavioral therapy
*For some, medications and/or bariatric surgery
Describe the use of equations for estimating and measuring energy requirements of obese individuals
The best method is to do a “usual intake” recall and go from there in terms of cutting calories
•Mifflin-St Jeor can be helpful, bc used some obese people were included
What are the three factors in Nutrition Assessment?
- Anthropocentric measurements
- Client history and biochemical data
- Food/nutrition-related history
What might be included in a Nutrition Diagnosis for obesity?
- Excessive energy intake
- Food and nutrition related knowledge deficit
- Disordered eating pattern
- Undesirable food choices
- Overweight/obesity
- Involuntary weight gain
- Physical activity
Describe appropriate nutrition intervention weight loss goals
Initial goal of 5-10% baseline weight loss within 6 months (through caloric restriction, increased physical activity, or both)
Give some broad caloric deficit guidelines for BMI<35 to achieve energy defecit
500-750 kcal deficit/day to lose 1/2-1lb/week
OR
intake of 1200-1500 kcal/day for women; 1500-1800 for men
Describe High Intensity Comprehensive Lifestyle Intervention
• >/= 14 sessions in 6 months as individual or group by trained interventionist
- prescribe moderately reduced kcal diet
- increased PA
- use of behavioral strategies to facilitate adherence to diet and activity patterns (so client is individually invested in it)
• Produces ~5-10% of initial weight loss; ~8kg loss in 6 months
Describe weight loss maintenance patterns
- Max loss achieved at 6 months
- Plateaus then gradual regain of ~71% over next 1-2 years
• Long-term patterns include: monthly contact/phone; freq weighing; high activity (~200 min/wk); continued kcal restriction
- What are the two goals of successful weight maintenance?
- Weight regain of <3Kg in 2 years
* Sustained reduction in WC of at least 4 cm
List some components of successful weight management approaches
- Mobile apps for food recording
- In-person group sessions
- Watch less TV
- Do physical activity ~1hr/day
What are the NIH established guidelines for surgical tx of morbid obesity?
BMI>/=40 OR BMI>/=35 with significant comorbidities OR BMI 30-34.5 with T2DM or metabolic syndrome
List some selection criteria for bariatric surgery
- BMI>40 or 30-40 with other associated diseases
- Ages between 18-55 years
- Stable obesity for 5+ years
- Failure of dietary therapy for 1+ year
- Absence of glandular dz like hypothyroidism
- Comprehension of procedure
- No dependency on ETOH or drugs
- Acceptable operative risk
Describe the overall weight loss with bariatric surgery
Overall 61% of excess weight (person’s actual weight minus a healthy weight) in all patients
Describe the Bypass Diet. What are the two stages?
- Diet in several stages, from liquids only to small meals of soft, high-protein foods
- Much small than normal meals
- Foods eaten must be smooth in texture
- Important to drink enough water and take MVI
STAGE 1: CLEAR LIQUIDS
- start with sips of water, cl liq in small amounts, ~2-3oz
STAGE 2: LOW-FAT FULL LIQUIDS - high-protein liquids like diet Carnation Instant Breakfast, etc • Started before hospital d/c • ~1-2 weeks • Begin taking chewable MVI supplement
Describe FAT and FIBER in the Bypass Diet
FAT LIMITED
- excess delays gastric emptying
- may cause reflux and heartburn
- may cause diarrhea and nausea
FIBER LIMITED
- limited space in stomach, less gastric acid to digest
- could get stuck in pouch or block sm intestine opening
- no fiber pills or laxatives
