General Obesity, Random Info Flashcards
What is 5-2-1-0 for peds patients
5 defining a of fruits and veggies daily
2 or less hours of screen time
1 or more hour physical activity
0 sugary drinks
Advantages to higher protein diets
- Evidence exists that proteins exert an increased thermic effect of food
- Evidence is also growing that higher protein diets increase satiety when compared to lower protein diets
- Higher protein intake may increase weight loss and possibly increase percentage of fat loss
- Dietary protein helps maintain lean mass during weight loss, which is directly proportional to resting energy expenditure
Recommended protein intake during normal circumstances and during weight loss
- Protein during Maintenance .7 – 1 mg/kg/d
* Weight loss 1.2-1.5 mg / kg lean body weight (have to get estiamte of body fat percentage), ~90-120 gm / d
Which gender and age group of pediatric patients has the highest rates of obesity
Girls 12-19
BMI naturally decreases in this age group before then trending up
Age 2-6
EKG changes with obesity
Increased QTc Non-specific T wave inversion/flattening Low QRS voltage LVH LAD Slightly elevated heart rate
What age group has been shown to have better weight loss success on average through weight loss treatment program
Older adults
Blood pressure criteria for metabolic syndrome
> = 130/85 or on meds
What body fat percentage in men and women roughly correlated with obesity
> 25% in men
>32% in women
What is the Acceptable Macronutrient Distribution Ranges (AMDR) for carbs in adults? Peds?
45-65
Similar in peds
What ethnicity has been shown to have better weight loss success on average through weight loss treatment program
White
Cholesterol criteria for metabolic syndrome
HDL <40 in men or <50 in women
“Bad fats”
Trans fats
Saturated fats
BMI for class III obesity
> 40
The excessive intake of calories after dinner that is voluntary and the patient recalls it is called
Night eating syndrome
The principal determinant of resting metabolic weight is
Lean body mass (not specifically just muscle mass)
This eating disorder is similar to bulimia but without the compensatory behavior
Binge eating syndrome
During rest, skeletal muscle mostly uses this macronutrient for respiration
90% fats
10% carbs
These 2 diets have been linked with decreased CV mortality and diabetes
Vegetarian
Mediterranean
Correlation between obesity and H1N1 influenza
Worse sevierity
Definition of a calorie
amount of energy required to raise the
temperature of 1 gram of H2O by 1°C
Highest correlation between adult obesity, and obesity in this pediatric age group
Teens 12-20. 60% chance of obese obese at age 35
Ages 3-5 only have 20% chance at age 35
Maternal HLD has what impact on the babies weight
None
DASH diet was primarily developed to change what health outcome
Blood pressure
Weight goal for patients age 2-5 with BMI of >99%
Acceptable to lose 1 lbs per month
The excessive intake of calories after dinner that is involuntary and the patient does not recall eating the next day is
Sleep related eating disorder
Eating inedible or bizarre items at night is seen in what eating disorder
Sleep Related Eating Disorder
Are very low calorie diets (VLCO) better than traditional diets at long term weight loss
No. Regain about half of what they lost
Recommended weight gain during pregnancy for BMI <18.5, 18.5-24.9, 25-29.9, and >30?
<18.5 = 30-40 lbs 18.5-24.9 = 25-35 lbs 25-29.9 = 15-25 lbs >30 = 10-20 lbs
Maternal HTN has what impact on the babies weight
None
What is the Acceptable Macronutrient Distribution Ranges (AMDR) for fat in adults? Peds?
20-35% of calories
A bit higher in peds (30-40% in ages 1-3)
The blood sugar criteria for metabolic syndrome
> = 100
Or on meds for diabetes/prediabetes
Weight goal for patients age 12-18 with BMI of 95%-99%
Up to 2 lbs weight loss
Are very low calorie diets (VLCO) better than traditional diets at short term weight loss
Yes have more rapid weight loss over the first couple months (~20%)
BMI criteria for VLCD?
At least a BMI of 30
The Atkins diet primarily limits this
Carbs
Pre-exercise routine clearance recommendations
USPSTF no stress test for asymptomatic low risk patient, and no stress test for slowly progressive exercise regimen unless symptomatic. Doesn’t make a rec regarding intermediate/high risk asymptomatic patients
ACC/AHA recommend stress test before VIGOROUS exercise regimen in intermediate risk patients (diabetics, men >45, and women >55)
ACSM recommends pre-exercise “medical clearance” before starting an exercise regimen if have a history of cardiac, metabolic, or renal disease.
VO2 max is used as a surrogate to measure this
Physical fitness
Is the rate of O2 consumption at maximal exertion
Per 2016 data, the prevalence of obesity in patients age 2-19 is
~18%
Brown fat is higher in these individual
More brown fat in women, younger, and leaner people.
Weight goal for patients age 6-11with BMI of 85-95%
Maintain weight
Binge eating episodes must occur this frequently to meet criteria for binge eating disorder
At least once a week for 3 months
What factor helps differentiate lipedema and lymphedema of the legs
Lymphedema includes the feet while lipedema (a genetic deposition of fat in the LE seen only in women) tends to mostly spare the feet
Lipedema also often has easy bruising and can be painful
The feeling that one needs to eat in order to fall asleep is consistent with
Night eating syndrome
Bed wetting can be a sign of this obesity related comorbidities
OSA
A low carb high fat diet will typically cause what changes in lipid panel
HDL increase
LDL May increase
Triglyceride decrease
Exercise recommendations per US Dep of Health
150 min/wk of moderate exercise or 75 min/wk of vigorous exercise
AND 2 or more days of resistance training
Need 150-300 min for weight loss or Maintenance of weight loss
What is NEAT?
Non-Exercise Activity Thermogenesis (NEAT) = Activities that are NOT sleeping, eating, or exercise (intentional physical activity). Includes common daily activities like fidgeting, walking, standing, change in posture, ADLs, and climbing stairs. Up to 2000 kcal of energy expenditure per day. Decreases CV mortality and improves metabolic parameters like lipid and insulin levels. Hypothalamus appears to regulate NEAT
According to the fetal programming hypothesis, the in utero environment during this trimester can lead to chronic disease later in life
2nd trimester
Changes in fertility in obesity
Lower fertility in obese in both sexes
Resting energy expenditure contributes about this % of total energy expenditure in the average person
60-75%
Change in weight after smoking cessation
Varies widely. Average of about 4kg of weight gain after 1 year. However, 16% lose weight and only 13% gain more than 10kg
What is the recommended amount of protein intake? In peds? During pregnancy/lactation? After Bariatric surgery? In the ICU? In elderly?
0.8 g/kg for adult Higher in peds (1.5 for infants, 0.95 children, 0.85 teenagers) Higher in ages 65 and older, 1-1.2 Higher in ICU 2+ Higher after Bariatric surgery 1.5 Higher in pregnancy/lactation 1.1
In the National Weight control Registry, this habit was most commonly reported among patients who lost weight and kept it off for 2+ years
Exercising at least 1 hour daily
What is the preferred way to assess growth between the ages of birth and 2 years old
WHO normative growth chart
Weight for length percentage
Criteria for Metabolic syndrome
Waist >40 inch men or >35 women (waist cut off varies by race in some definitions but there is no consensus)
Triglycerides >= 150
HDL <40 men or <50 women
BP > 130/85
Fasting sugar >=100 (other guidelines say 110)
3 of the above
If being treated for a condition still counts
Relationship between bone marrow fat and obesity
None
Use of skin fold testing in peds patients?
Don’t. Hasn’t been studied
Use of waist circumference in peds patients
Don’t. Don’t have good data on what ranges are normal/abnormal etc
Electrolyte abnormalities seems in bulimia
hypokalemia and metabolic alkalosis
What is the Acceptable Macronutrient Distribution Ranges (AMDR) for protein in adults? Peds?
10-35%
Similar in peds
Changes in testosterone levels in obesity? After weight loss?
Obese men have low total testosterone, low sex hormone binding globulin, and slightly low to normalish free testosterone.
Weight loss increases testosterone
Does the speed of weight loss determine long term success?
No. Weight regain after slow and rapid weight loss is very similar
Weight goal for patients age 6-11 with BMI of >99%
Up to 2 lbs per week
What does a Very low calorie diet include?
<800 calories per day and 1.5g/kg of protein
Weight goal for patients age 12-18 with BMI of >99%
Up to 2 lbs weight loss per week
Changes in thyroid labs with obesity
mild changes in thyroid labs, that reverse with weight loss.
Elevated TSH, Elevated free T3, lower/normal free T4. T4 (levothyroxine) is the prohormone that is converted
The thermic effect of food contributes about this % of total energy expenditure in the average person
10%
Weight goal for patients age 2-5 with BMI of 85-95%
Maintain weight
BMI for class 1 obesity
30-35
“Good fats”
Monounsaturated fats like olive oil
Polyunsaturated fats
The DASH diet primarily limits this
Fat
Dash diet increases low fat dairy and monounsaturated fats
Waist circumference criteria for metabolic syndrome
White women >= 88cm
White men >= 102 cm
Asian, middle eastern, African, South American women >= 80cm
Japanese women >= 90cm
Asian men >= 85cm
African and Middle East me >= 94 cm
variance among many different definitions
Exercise recommendation from the American College of Sports Medicine to prevent weight gain or to lose weight
150-250 min moderate exercise
Pediatric BMI categories
Underweight = <5% BMI
Normal weight = 5-85% BMI
Overweight = 85-95% BMI (not weight) for sex and age
Obesity = greater than or equal to 95% BMI
Class 2 obesity = 120-140% of the 95% of BMI or BMI 35-40
Class 3 obesity = >140% of the 95% of BMI or BMI >40
Weight goal for patients age 12-18 with BMI of 85-95%
Maintain or gradual weight loss
Triglyceride criteria for metabolic syndrome
> = 150 or on medications
In pediatric patients, how long should you wait to assess the effects of counseling on lifestyle interventions before increasing intensity of intervention
3-6 months
Among pediatric patients this ethnic group has the highest rate of obesity
Hispanics
Most common eating disorder
Binge Eating Disorder
Presents in 30% + of obese patients
Does acanthosis nigricans improve with treatment of insulin resistance/obesity
Yes
This condition is more common in obese children and includes progressive bowing of the legs due to disturbance in the medial proximal tibial growth plate
Blount’s Disease
Most accurate way to assess diet
24 hour recall
Are carbohydrates an essential nutrient?
No. Body can synthesize them
Weight goal for patients age 6-11 with BMI of 95-99%
Gradual 1 lbs per month
BMI for class 2 obesity
35-40
Visceral adiposity trend in adults as age
Progressively increases
Progressive impairment in the ability of subcutaneous tissue to hold fat with aging
Maternal smoking has what impact on the babies weight
Correlated with obesity
Among adults, what ethnicity has the highest prevalence of obesity in the US
Non-hispanic blacks
BMI formula
Kg / m ^2
Physical activity contributes about this % of total energy expenditure in the average person
15-30%
In elderly Caucasian’s this is the change in total adipose, body weight, and weight circumference
Weight decreases but adipose tissue and waist continue to increase
Body weight in adults tends to increase until it peaks at about this age
60, then starts to drop
Per 2016 data, the prevalence of obesity in adults is
~40%
Headaches are commonly seen during the first few days of this type of diet
Low carb
Has deplete glycogen, loss of water leads to lower blood pressure
Weight goal for patients age 2-5 with BMI of 95-99%
Maintain weight
What is the preferred way to assess growth between the ages 2 and up
CDC normative growth chart
BMI percentage
Strongest predictor of future obesity in a peds patient
Before age 6, biologic paterents weight is the strongest predictor of future obesity. After age 6 patients one weight strongest predictor
