Learning, Lifestyle, Obesity + Health Screening ** Flashcards
BMI ranges
Underweight: <18.5
Healthy: 18.5 - 24.9
Overweight: 25-29.9
Obese: >30
How to approach obesity
Make dx of obesity with clear definition + inform them of diagnosis
Assess for treatable comorbidities:
HTN
DM
CAD
OSA
OA
Enquire about effect of obesity on personal + social life
Establish readiness to change
Advise that treatment requires diet, exercise, support + facilitate access to these
Advise parents of healthy activity levels for kids
Challenge parents to make family wide changes in diet and exercise
Management of obesity
Readiness to change
Support
Multidisciplinary approach
Dietician
Personal Trainer
Psychology/Psychiatry (Cognitive behavioural therapy)
Obesity specialist/Endocrinologist
Lifestyle
Diet
May consider a weight los diet (reduction in dietary energy)
High protein - Low fat diet
Exercise
30 minutes daily of moderate intensity, increase to 60 minutes daily
Rx for BMI >30 if lifestyle measures have failed
Structured behavioural interventions (weight loss program)
Pharmacotherapy (not recommended by Canadian Taskforce)
Orlistat 120mg PO daily-TID
Stop medication if weight loss <5% at 3 months
No effect on mortality
Adverse effects: Bloating, steatorrhea, fecal incontinence
Lack of longterm safety data
Supplement with multivitamin 2h before or after medication
Consider GLP-1/SGLT2 for weight loss in diabetes (in addition to Metformin)
Rx for BMI >40 if lifestyle measures have failed
Consider Bariatric Surgery
Child BMI ranges based on percentile
Normal - BMI < 85th percentile
Overweight- BMI > 85th percentile
Obese > 97th percentile
Severe Obesity >99th percentile
Management of childhood obesity
Structured behavioural interventions
Family-wide changes in diet and activity (family-oriented behaviour therapy)
Avoid counterproductive interventions (e.g., berating or singling out the obese child)
Encourage positive reinforcement
Diet
Family meals
Healthy snacking
Decreased sugar consumption (juices, drinks)
Decrease portion size
Increase vegetables
Activity (WHO recommends 60 minutes moderate-vigorous daily)
Focus on fun/recreational activity
Limit screen time
Limit motorized transport
Limit time spent indoors
Limit sitting (eg. stroller)
Sleep
Recommendations for diet
low fat, high fibre, calcium + vit D (1000/d), low sodium, folic acid + B12 if wanting pregnancy
Recommendations for substance use
no smoking
no other substances
alcohol <2 drinks/d
<9/w women
<14/w men
Recommendations for wt, waist circ + waist to height (when are you at increased risk)?
Wt: Counsel on wt loss if BMI >30
Waist circumference: >80cm in women and >95cm in men = increased risk
Waist to height ratio: 0.5-0.6 = increased risk, >0.6 substantial risk
Recommendations for Exercise
150mins mod to vigorous activity weekly, bouts >10 min. Wt bearing 2-4 times weekly, stretching 4-7x weekly
Recommendations for Personal safety
seatbelts, avoid sun exposure, hearing protection, noise control programs
Recommendations for Oral hygiene
brushing teeth, flossing, fluoride, smoking cessation
Source, signs of deficiency + signs of too much Folate
Source: leafy greens, dried beans, legumes, citrus
Signs of deficiency: macrocytic anemia, diarrhea, lethargy
Signs of too much: seizures
Source, signs of deficiency + signs of too much Vit B12
Source: beef, pork, milk, cheese, fish
Signs of deficiency: megaloblastic anemia, leukopenia, weakness, peripheral neuropathy
Source, signs of deficiency + signs of too much Vit C
Source: citrus, tomatoes, potatoes, red berries, peppers
Signs of deficiency: scurvy, keratosis of hair, impaired wound healing, anemia, depression, lethargy, bleeding
Signs of too much: N/V, renal stones, osmotic diarrhea
Source, signs of deficiency + signs of too much Vit A
Source: fish, liver, egg yolk, dairy, leafy greens, orange/ yellow veg
Signs of deficiency: dermatitis, night blindness
Signs of too much: N/V, HA, dizziness, deep bone pain, gingivitis
Source, signs of deficiency + signs of too much Vit D
Source: fish, fortified milk, egg yolks, sunlight
Signs of deficiency: osteomalacia, muscle weakness, bone pain
Signs of too much: renal stones, anorexia, renal failure
Source, signs of deficiency + signs of too much Vit E
Source: polyunsaturated fats, milk, eggs, wheat, whole grains
Signs of deficiency: anemia, myopathy
Signs of too much: prolonged clotting time, impaired neutrophil function
Source, signs of deficiency + signs of too much Vit K
Source: leafy greens, liver ,veg oil
Signs of deficiency: bleeding, purpura, bruising
Signs of too much: jaundice
Source, signs of deficiency + signs of too much Ca
Source: leafy greens, fortified orange juice
Signs of deficiency: tetany, arrhythmias, CHF, osteomalacia
Signs of too much: weakness, renal failure, psychosis
Source, signs of deficiency + signs of too much Mg
Source: soy, clams, wheat, nuts, dairy, cereal
Signs of deficiency: weakness, convulsions, FTT
Signs of too much: hypotension, cardiac disturbance, resp failure
Source, signs of deficiency + signs of too much K+
Source: meat, milk, bananas, prunes, orange, grapefruit, legumes
Signs of deficiency: polyuria, ECG changes, dyspnea, paralysis
Signs of too much: mental confusion, hypotension, ECG changes
Source, signs of deficiency + signs of too much Iron
Source: meat, fish, eggs, peas, beans, lentils, soy
Signs of deficiency: microcytic hypochromic anemia, fatigue, tachycardia,
Signs of too much: organ damage
When to screen A1c
40-70 y/o overweight = screen as part of CV risk assessment
Moderate risk: q3-5yrs (CKD, PVD, HTN, lipids)
High risk: q1yr (WC >102cm, BMI >30, age >55, GDM, FDR w/ DM)
When to screen Lipids
yearly if other metabolic conditions (CKD, HTN, DM)
every 3 years if >50
When to screen Renal function
Annual if HTN or DM
When to screen for STIs
Sexual health
hep C + HIV if risky behaviour
<25 annually
When to screen for AAA
Men 65-80 Abdo US screening (once)
BMI calculation
kg/m2
Obesity rx
bupropion-naltrexone, orlistat (lipase inhibitor), GLP1 receptor agonist (semaglutide), gastric bypass, sleeve gastrectomy
When to screen for obesity
16 y/o
Limitations of using BMI
doesn’t count for weight extremes, doesn’t account for variance in body composition, doesn’t account for variance in ethnic groups
When do cervical cancer screening guidelines not apply?
Never sexually active, weakened immune system, sx of cervical cancer, prev abnormal screening results, those without cervix
Harms of screening
overdiagnosis, hospitalisation or medical intervention, false positives, anxiety, negative consequences of incidental findings, reduced QoL
