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Nutrition > Lecture 3 > Flashcards

Lecture 3 Flashcards

1
Q

What is obesity?

A

Excess of adipose tissue

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2
Q

How do we determine obesity?

A

BMI
Waist circumference
Visual inspection of patient

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3
Q

How much of US adults are obese?

A

42%

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4
Q

What are risk factors for obesity?

A

Female
Black, Native American, Mexican American
Lower income

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5
Q

How do we calculate BMI?

A

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

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6
Q

What factor can wrongly diagnose a BMI?

A

Amount of muscle mass

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7
Q

What is considered morbid obesity?

A

100 lbs over IBW(ideal body weight)
BMI >40
BMI >35 with 1+ obesity-related condition present

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8
Q

How do we classify class I obesity? class II? class III?

A

Class I: 30-34.9
Class II: 35-39.9
Class III: ≥ 40

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9
Q

What type of fat is more concerning?

A

Visceral fat over subcutaneous fat
Truncoabdominal fat over gluteofemoral fat distribution

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10
Q

What is the circumference and waist-hip ratio for obesity?

A

Men: >102cm(40in) ratio>1.0
Women: >88cm(35in) ratio>0.88

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11
Q

When should BMI be obtained and obesity be screened?

A

Every visit
Every routine physical(for obesity)

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12
Q

What factors can contribute to obesity?

A

Genetics (40-70% of obesity case)
Behavioral
Medical
Psychological
Socioeconomics
Lifestyle
Diet

Dont Let My Grandma Play Bad Songs

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13
Q

What medical conditions are linked to obesity?

A

Hypothalamic obesity (Damage to hypothalamus → hyperphagia)
Cushing’s Syndrome
Hypothyroidism
Polycystic Ovarian Syndrome
Growth Hormone Deficiency
Altered Gut Flora
Psychiatric Disease

HPGAPHC

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14
Q

What psychiatric medications can contribute to obesity?

A

Antipsychotics (clozapine, olanzapine, risperidone)
Mood stabilizers (lithium, valproate, carbamazepine)
Antidepressants (TCAs, SSRIs)

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15
Q

What diabetic medications can contribute to obesity?

A

Insulins
Oral(sulfonylureas, thiazolidinediones (TZDs))

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16
Q

What other medications can contribute to obesity?

A

Glucocorticoids
Beta-blockers
Hormonal agents

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17
Q

What factors in women can contribute to obesity?

A

Pregnancy, as well an postpartum retention
Oral contraceptives
Menopause

18
Q

What factors in men can contribute to obesity?

A

Lifestyle
Testosterone decrease (more fat, less muscle)

19
Q

How does ethnicity affect obesity?

A

Hispanic: increase likely to be obese
Blacks: more likely in women
Young hispanic and black women become obese younger compared to white women

20
Q

How does socioeconomic status affect obesity?

A

Literacy/education: food choices and activity
Financial: affordability of food choices, gym
Environment: availability of food and activity

21
Q

How does behavioral factors influence obesity?

A

Physical activity
Sleep deprivation(negative metabolic consequences)
Smoking cessation
Diet
Eating habits

22
Q

How does sleep deprivation affect weight gain?

A

Decreases leptin(anorexigenic)
Increases gherlin(orexigenic)
Increased hunger and appetite

23
Q

How does genetics play a role in obesity?

A

Twin studies: 60-90% heritability of obesity
Adoptee studies: BMI of children generally corresponds to biological parents

24
Q

How do metabolic/homestatic factors influence obesity?

A

Adaption: losing 10-20% body weight slows BMR
Gut hormones: leptin, gherlin, orexin, GLP-1,np-Y
Gut flora: abnormal microbiome correlated with obesity

25
Q

How many symptoms do you need to be considered to have a metabolic syndrome? How many obese patients meet the criteria?

A

At least 3 of the following…
Central(abdominal) obesity
Low HDL
HTN
Hyperglycemia
Hypertriglyceridemia

3/5 obese patients meet it

26
Q

What do people with metabolic syndrome have an increase risk of?

A

Heart disease
Stroke
Type II DM

27
Q

What cardiovascular effects result from obesity?

A

HTN
Coronary artery disease
Heart failure
Stroke

28
Q

What endocrine effects result from obesity?

A

Type 2 Diabetes Mellitus
Hyperlipidemia
Metabolic Syndrome

29
Q

What MSK effects result from obesity?

A

Degenerative joint disease
Increased body pain
Limited movement/function

30
Q

What psychological effects result from obesity?

A

Psychosocial disability
Lower quality of life
Mood and anxiety disorders
Social discrimination

31
Q

What gastrointestinal effects result from obesity?

A

Cholecystitis/Cholelithiasis
GERD/Reflux
Fatty liver disease
Gallbladder cancer
Liver cancer
Colon cancer

32
Q

What pulmonary effects result from obesity/

A

Sleep apnea
Dyspnea on exertion
Pulmonary embolism

33
Q

What OB/GYN effects result from obesity?

A

Pregnancy complications
Breast cancer
Endometrial cancer

34
Q

What are other effects that results from obesity?

A

Increased surgical risk
Multiple skin conditions
Increased all-cause mortality (decreased with age)

35
Q

What factors to we evaluate on obese patients?

A

Weight-related history
Substance use
Medical history
Psych history
Lifestyle
Physical exam
Labs

36
Q

What are possible secondary causes of obesity?

A

Thyroid goiter
Moon facies/buffalo hump
Hirsutism

37
Q

What labs do we order for obese patients?

A

Fasting glucose
Lipid profile (HDL, LDL, VLDL, triglycerides)
Thyroid function testing
+/- HbA1c

38
Q

When we evaluate for weight and health status what should we include?

A

BMI
Abdominal obesity
Obesity-related comorbidities
Cardiovascular risk factors

39
Q

What is considered a low risk assessment, what should we do?

A

BMI 25-29.9
No CVD or obesity-related comorbidities
Intervention
Counsel to avoid weight gain, diet advice, and physical activity recommendation

40
Q

For those that are at a minimal risk what exception should we take caution with?

A

High weight circumference or weight gain of >10kg since 18yo

41
Q

How should we intervene for those with moderate risk?

A

Increase physical activity
Tools and strategies for dietary changes
Behavioral intervention
Pharmacotherapy

42
Q

How should we intervene for those with high risk?

A

Specific diet and exercise plans
Multicomponent behavioral intervention
Pharmacotherapy
Bariatric surgery

Nutrition (7 decks)

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