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*CLINICAL EXERCISE PHYSIOLOGY > FINAL/CH8- Obesity > Flashcards

FINAL/CH8- Obesity Flashcards

1
Q

overweight + obesity definition by WHO

A

excessive fat accumulation that is a risk to health

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2
Q

how is obesity commonly rated

A

using BMI

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3
Q

BMI

A

weight (kg) / height^2 (m^2)

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4
Q

what else can be useful to determine risk

A

body composition + waist circumference

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5
Q

risk waist circumference for men

A

40+ inches

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6
Q

risk waist circumference for women

A

35+ inches

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7
Q

android/gynoid figure is associated with comorbidities like diabetes, high cholesterol, cancer, etc.

A

android

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8
Q

when does obesity commonly occur

A

can begin in childhood but 70% of occurrences begin in adulthood

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9
Q
A
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10
Q

multifactoral influences on obesity

A

-decreased physical activity
-increased food intake
-societal influences
-individual psychology
-biology

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11
Q

result of obesity pathophysiology

A

longstanding eneryg imbalance (positive energy balance)

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12
Q

obesity increases risk of…

A

-diabetes
-hypertension
-dyslipidemia
-breathlessness
-anesthesia complications
-osteoarthritis
-depression
-gallbladder disease
-eating disorders
-coronary heart disease/heart failure
-fetal defects
-sleep apnea
-hyperuricemia + gout
-cancer
-polycystic ovary syndrome
-LBP + other joint pain
-complications during pregnancy

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13
Q

obesity is a ____ issue

A

SYSTEMIC
-affects various parts of body

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14
Q

signs/symptoms of obesity

A

-fatigue
-dyspnea
-difficulty with physical activity

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15
Q

history + physical examination

A

review risks with pt
-assess physical factors at each visit
-assess exercise history

-also want to gauge the likelihood that the pt will change their behavior to combat this issue

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16
Q

how do you determine pt’s readiness to lose weight

A

ask “have you been trying to lose weight?”

-no, and I do not intend to in the next 6 mo. (precontemplation)
-no, but I intend to in the next 6 mo. (contemplation)
-no, but I intend to in the next 30 d. (preparation)
-yes, but for less than 6 mo. (action)
-yes, for more than 6 mo. (maintenance)

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17
Q

obesity treatment

A

-diet therapy
-behavioral therapy
-exercise therapy
-pharmacotherapy
-surgical therapy (typically reserved for severely obses)

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18
Q

treatment goals

A

-BMI 25 kg/m^2 or LESS is considered normal weight
-need to determine goals with respect to pt expectations + timeline (pts commonly want to lose 35% current weight)

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19
Q

diet therapy

A

-calorie reduction (should be based on RMR + physical activity)
-micro + macronutrients
-types of diets

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20
Q

____ kcal deficit for 1 lb weight loss

A

3500

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21
Q

hypocaloric diet

A

restrict to 500-750 kcal/day

22
Q

2 types of meal replacement diets

A

-partial
-complete (very low calorie diet, aka VLCD)

23
Q

partial meal replacement

A

just having a shake/bar for breakfast

24
Q

complete meal replacement

A

3 shakes per day, each only 300 calories
-effective for someone MORBIDLY obese

25
Q

behavioral therapy

A

use of behavior change to promote adherence
-stages of change (transtheoretical model)
-cognitive restructuring (used to avoid all-or-nothing mindset)
-individual or group therapy (accountability, motivation, skill-building)
-lapse/relapse planning (problem-solving)

-address emotional, societal, familial, environmental issues

26
Q

stages of change (transtheoretical model)

A

-precontemplation
-comtemplation
-preparation
-action
-maintenance

27
Q

exercise therapy

A

-accelerated rate of weight loss when combined with diet + behavior change
-maintenance of weight loss
-National Weight Control Registry suggests 2500-2800 kcal/wk expenditure for best results
-this may require 60-90 min/day of exercise

-not needed to lose weight because you can lose weight through diet alone but exercsie ACCELERATES rate of weight loss

28
Q

pharmacotherapy

A

-weight loss drugs are recommended for BMI of 30

29
Q

approved drugs for treatment

A

-phentermine (adipex)
-orlistat (zenical, alli)
-additional medications are pending FDA approval

30
Q

phentermine (adipex)

A

appetite suppressant
-capsule taken as short-term adjunct to weight loss

31
Q

orlistat (zenical, alli)

A

intestinal lipase inhibitor

32
Q

undesired side effects of pharmacotherapy

A

-loose/oily stool
-abdominal pain
-flatulence

33
Q

lipase

A

enzyme that catalyzes fat metabolism
-inhibiting lipase will allow fat to pass through digestive tract without being digested

34
Q

flatulence

A

accumulation of gas

35
Q

surgical therapy

A

-fastest-growing area of obesity treatment
-possible loss of >50% excess weight
-10 yr loss ranges from 15-25%
-not without risk of death/infection (1% death risk, 15% morbidity risk)

36
Q

which 2 effects are most common in surgical therapy

A

-restrictive effect
-malasorptive effect

37
Q

Roux-en-Y gastric bypass

A

-stomach stapled to size of an egg (reduced amount of food you can eat)
-reduced portion stapled directly to jejenum (bypassing duodenum, reduces food absorption)

38
Q

adjustable gastric banding (lap band)

A

silicone band placed around stomach to reduce amount of food you can eat

39
Q

metabolic syndrome definition

A

collection of interrelated cardiometabolic risk factors that are present in a given individual more frequently than may be expected with a chance combination
-uually presence of overweight/obesity
-greater risk for developing atherosclerotic CV disease

40
Q

prevalene of metabolic syndrome

A

nearly 35% of adults 20+ y/o

41
Q

etiology of metabolic syndrome

A

widely debated
-likely a combination of obesity/abdominal adiposity, insulin resistance, + mitochondrial dysfunction

42
Q

HDL

A

good cholesterol

43
Q

5 risk factors for metabolic syndrmoe

A

-abdominal obesity
-high fasting blood sugar
-low HDL cholesterol
-high BP
-high triglycerides

44
Q

**presence of 3+ of the following abnormal findings reflects presence of metabolic syndrome

A

-elevated waist circumference
-elevated triglycerides (or on drug for elevated triglycerides)
-reduced HDLc (or on drug for reduced HDLc)
-high BP (or on drug for hypertension)
-elevated fasting glucose (or on drug for elevated glucose)

45
Q

metabolic syndrome treatment

A

similar to obesity treatment
-promote weight loss + physical activity
-diet quality
-pharmacological agents
-surgical procedures, when necessary

46
Q

exercise testing for both obesity + metabolic syndrome

A

-routine testing is not necessary but it is helpful
-one of the reasons you may not have to do it is- testing may be a barrier to exercise participation, particularly if announced just before a class occurs
-alternative modes should be available for those with difficulty walking
-IF testing occurs, it should follow standardized treadmill protocols/procedures

47
Q

ExRx for both obesity + metabolic syndrome

A

-aim for at least 2000+ kcal expended per week
-combination of aerobic + resistance training necessary to preserve lean mass during weight loss

48
Q

**remember net deficit of 3500 kcal to lose 1 lb

A
49
Q

ExRx for ROM + balance

A

-little is known about structural effects/plasticity on CT + muscle in those with extreme weight loss or metabolic syndrome
-greater ROM shown in hip, knee, + ankle with weight loss
-may need to focus on balance in cases of extreme weight loss (shift in center of gravity)

50
Q

conclusion

A

-exercise + behavioral modification are vitally important for successful weight management in obese individuals as well as those with metabolic syndrome

-clinical exercise physiologists play a vital role in prevention and treatment of overweight + obesity

-development as a competent clinical exercise physiologist should include knowledge + understanding of behavior theory used to develop programming + educate patients

*CLINICAL EXERCISE PHYSIOLOGY (18 decks)

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