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HN 320 Clinical Nutrition I > Exam 3 - Obesity II > Flashcards

Exam 3 - Obesity II Flashcards

1
Q

What BMI is the cutoff for increased DM risk?

A

> 22 BMI increases risk for T2DM 25%

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2
Q

Describe the etiology of T2DM in obese individuals

A

• 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

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3
Q

Describe the etiology of why hypertension is an issue for obese individuals

A

Adipocyte-related factors containing angiotensinogen and metabolies of FFA - both stimulate aldosterone release

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4
Q

List some commodities of obesity

A
  • T2DM
  • Hypertension
  • Hepatobiliary disorders
  • Metabolic syndrome
  • IR/pre-diabetes
  • Sleep apnea
  • Acanthosis nigricans
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5
Q

Describe the etiology of hepatobillary disorders in obese individuals

A

• Cholesterol gallstones form when cholesterol concentration in bile becomes supersaturated and crystals grow

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6
Q

Name the five factors of Metabolic Syndrome

A
  1. Elevated WC**
  2. Elevated TAGs
  3. Reduced HDL
  4. Elevated BP
  5. Elevated fasting glucose**

**Dominant underlying risk factors

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7
Q

Name the risk factors for sleep apnea

A
  • Obesity - fatty cells infiltrate throat tissue
  • Habitual snoring - changes in soft palate
  • Family history
  • Immune abnormalities - High TNF-a and IL-y
  • GERD
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8
Q

Describe possible sleep apnea treatments

A 
• 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
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9
Q

Describe acantrosis nigricans and its cause and treatement

A

• 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

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10
Q

What are the general guidelines for medical management of obesity?

A
  1. Diet
  2. Physical activity
  3. Behavioral therapy

*For some, medications and/or bariatric surgery

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11
Q

Describe the use of equations for estimating and measuring energy requirements of obese individuals

A

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

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12
Q

What are the three factors in Nutrition Assessment?

A
  • Anthropocentric measurements
  • Client history and biochemical data
  • Food/nutrition-related history
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13
Q

What might be included in a Nutrition Diagnosis for obesity?

A
  • Excessive energy intake
  • Food and nutrition related knowledge deficit
  • Disordered eating pattern
  • Undesirable food choices
  • Overweight/obesity
  • Involuntary weight gain
  • Physical activity
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14
Q

Describe appropriate nutrition intervention weight loss goals

A

Initial goal of 5-10% baseline weight loss within 6 months (through caloric restriction, increased physical activity, or both)

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15
Q

Give some broad caloric deficit guidelines for BMI<35 to achieve energy defecit

A

500-750 kcal deficit/day to lose 1/2-1lb/week

OR

intake of 1200-1500 kcal/day for women; 1500-1800 for men

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16
Q

Describe High Intensity Comprehensive Lifestyle Intervention

A

• >/= 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

17
Q

Describe weight loss maintenance patterns

A
  • 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

18
Q
  • What are the two goals of successful weight maintenance?
A
  • Weight regain of <3Kg in 2 years

* Sustained reduction in WC of at least 4 cm

19
Q

List some components of successful weight management approaches

A
  • Mobile apps for food recording
  • In-person group sessions
  • Watch less TV
  • Do physical activity ~1hr/day
20
Q

What are the NIH established guidelines for surgical tx of morbid obesity?

A 
BMI>/=40
OR
BMI>/=35 with significant comorbidities 
OR
BMI 30-34.5 with T2DM or metabolic syndrome
21
Q

List some selection criteria for bariatric surgery

A
  • 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
22
Q

Describe the overall weight loss with bariatric surgery

A

Overall 61% of excess weight (person’s actual weight minus a healthy weight) in all patients

23
Q

Describe the Bypass Diet. What are the two stages?

A
  • 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
24
Q

Describe FAT and FIBER in the Bypass Diet

A

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
25
Q

Describe the efficacy of outcome for bariatric surgery

A
  • mean BMI decrease of 14.2
  • T2DM resolved in 76.8%; partially in 86%
  • hyperlipidemia improved in 70%
  • hypertension resolved in 61.7%
  • sleep apnea resolved in 85.7%

HN 320 Clinical Nutrition I (10 decks)

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