Mid Term 1 Flashcards
What is screening?
process of identifying characteristics known to be associated with nutritional problems
What is the purpose of screening?
quickly identify individuals with nutrition risks
What is assessment?
process of assessment of body compartments and analysis of structure and function of organ systems and their effects on metabolism
What is the definition of AND on screening?
process of identifying patients, clients of groups who may have nutrition diagnosis and benefit from nutrition assessment and intervention
What are the goals of nutritional assessment?
identify monitor evaluate disease prevention specific deficiencies overall malnutrition
What is morbidity?
the condition of being diseased
malnutrition is associated with increased
morbidity
mortality
hospital length of stay
healthcare costs
Initial nutritional screening includes
pre-existing conditions causing nutrient loss
conditions that increase nutrient requirements
dietary intake
What are the components of assessment?
Anthropometrics Biochemical Clinical Dietary Functional
What are the stages of a nutrient depletion
diet inadequacy
tissue level - needs biopsy
bodily fluid level - urine, blood, etc.
function tissue
enzymatic activity - decreases ex. urea cycle enzymes
functional change - ex. vit A def, not able to see in dark
clinical symptoms - hair loss, dry skin, etc.
anatomical sign
What is anthropometrics composed of
body size
weight
proportions
What is body composition
the proportion of fat, muscle, and bone of an individual’s body, usu. expressed as percentage of body fat and percentage of lean body mass
Anthropometrics allow to assess body size and estimate composition using
height weight circumferences skinfolds ratios
What is the tool used to measure height standing?
stadiometer
What is frankfort plane?
line from eye to middle ear
What is the tool used to measure knee height?
caliper
What are the different ways of measuring height?
standing
knee height
arm span
why is arm span not recommended
not for asians, african americans. spinal deformities
How is frame size measured?
wrist circumference
r = height (cm)/wrist circumference (cm)
not used anymore, it was valid before BMI
What is weight?
sum of all components at each level of body composition - measure of body stores
How is weight measured?
scale
bed scale
chair scale
When should the weight be measured?
in the morning, fasting state, no clothes or shoes
How is BMI calculated?
weight (g)/ height ˆ2 (m)
What is the range of the normal BMI
18.9-24.9
What is the BMI of someone who is overweight
25-29.9
What BMI is considered obese?
more than 30
What is the healthy BMI for elderly
24-29
What are the limitations of BMI measurements?
does not measure body composition
differences in sex, age, ethnicity
limitations in athletes
must be accompanied with other measurements
How is % usual body weight calculated?
current weight/usual body weight x 100
What does it indicate if the %UBW is 85-95%
may indicate MILD malnutrition
What does it indicate if the %UBW is 74-84%
may indicate MODERATE malnutrition
What does it indicate if the %UBW is <74%
may indicate SEVERE malnutrition
How to calculate % weight change?
(UBW-current weight)/UBW x 100
What is considered a significant loss in % weight change?
%2 - 1 week %5 - 1 month %7.5 - 3 months %10 - 6 months %20 - unlimited
Unwanted weight loss can predict:
mortality
surgical outcomes/post op complications
risk of functional assessment
What are the measurements that can be done for body circumference and areas?
Mid-upper arm circ. (MAC) Mid-upper arm muscle circ. (MAMC) Mid-upper arm muscle area (MAMA) Corrected MAMA Mid-upper Arm Fat Area (MAFA) Waist circumference
What is the tool used to measure skinfold thickness?
caliper
skinfold thicknessis an indicative of _____
subcutaneous adipose tissue
Which body areas can we measure the skinfold thickness
triceps
subscapular
biceps
suprailiac
What is the princple behind skinfold thickness
assumes that each site is representative of total body stores
What does MAC indicate?
reflects muscle, bone, subcutaneous fat
– not sensitive to changes in muscle
What does MAMC indicate?
corrects for subcutaneous fat
– not sensitive to changes in muscle
What does MAMA indicate?
reflects muscle and bone
more sensitive to changes in muscle than MAMC
more adequately reflects total body muscle mass
What does cMAMA indicate?
reflects only muscle without bone
not valid in elderly or obese
– not sensitive to changes in muscle
What does MAFA indicate?
reflects the adipose tissue stores
better indicator of total body fat than a single skinfold measurement
What does waist circumference indicate?
reflective of visceral fat stores and abdominal obesity
How is waist circumference measured?
at level of iliac crest/navel
What are the ideal numbers of waist circumference in men and women?
<102cm in men
<88cm in women
What does waist:hip ratio indicate?
estimates distribution of subcutaneous and intraabdominal adipose and muscle tissue
– not used anymore
What are other technological techniques to measure body compositions?
BIA DXA BOD POD Underwater weighing MRI
What is the gold standard in measuring body composition?
MRI
How does Bioelectrical Impedance work?
measures impedance to a low frequency electrical current (mainly from fat)
estimates fat mass, fat free mass, total body water
What are the limitations of BIA?
influenced by hydration status
less precise in atypical bodies (obese)
reference data is limited
How does Dual X-ray Absorptiometry work?
imaging technique, based on attenuation of radiation from different tissue densities
measures bone, soft lean and fat tissues, whole-body and segments
sufficient precision to assess short and long term changes
– recognized as a reference method
What are the limitations of DXA?
expensive
radiation
assumes normal hydration status
How does Air displacement (BOD POD) work?
total body volume measured by air displacement in a chamber
based on fat and lean tissue density
What are the limitations of BOD POD?
access to instruments
residual lung volume must be measured
What is biochemical assessment?
measurement of nutritional markers in blood, urine, etc.
detects subclinical nutrient deficiencies
What are the components that can be assessed by biochemical assessment?
visceral and somatic proteins hematological assessment lipid profile micronutrient assessment immunocompetence assessment
Biochemical assessment can be affected by:
nutritional status
medications
illness
physiological state
What is the ideal level of albumin
40-60g/L or 4.0-6.0g/dL
What is the ideal level of glucose
3.9-6.1 mmol/L
What is the ideal level of iron
11-32 umol/L
Visceral protein status is assessed by the measurement of
serum proteins
RBC
WBC
What is the composition of serum proteins
albumin
fibronectin
transferrin
Transferrin is composed of:
prealbumin
retinol binding protein
In what condition does biochemical assessment has low sensitivity and specificity for nutritional status?
poor protein intake altered metabolism and synthesis hydration inflammation pregnancy madications exercise
What is the half life of albumin
17-21 days
What is the function of albumin
maintain osmotic pressure
transport of large insoluble molecules, drugs, calcium, zinc
What is the function of transferrin
iron transport
What is the function of TTR
transports T3-T4
carrier for RBP
What is the function of RBP
retinol transport from liver to periphery
circulates with TTR
In what condition is albumin high and low?
high during dehydration
low during low protein intake, poor synthesis, overhydration, edema, acute illness, aging
In what condition is Transferrin high and low?
high during Fe deficiency, pregnancy, chronic loss
low during acute illness, chronic infection, PEM, systemic disease
In what condition is TTR high and low?
high during renal disease, Hodgkins disease
low during liver disease, PEM, chronic loss, malabsorption, hyperthyroidism
In what condition is RBP high and low?
high during renal disease
low during vitamin A def., zinc def, hyperthyroidism, liver disease
What are acute phase proteins?
are a class of proteins whose plasma concentrations increase (positive acute-phase proteins) or decrease (negative acute-phase proteins) in response to inflammation.
Give examples of + acute phase proteins
C-reactive protein (CRP)
Ferritin
Give examples of - acute phase proteins
albumin, transferrin, TTR, and RBP
How is somatic protein status assessed?
nitrogen balance
creatinine excretion
immune function
How is positive N balance expressed in terms of anabolism and catabolism?
anabolism>catabolism
How is 0 N balance expressed in terms of anabolism and catabolism?
anabolism=catabolism
How is negative N balance expressed in terms of anabolism and catabolism?
anabolism
How is N balance calculated?
N balance (g/day) = (protein intake g/6.25) - (UUN + 4)
1 mmol of UUN equals to
0.028g of UUN
What are the limitations of N balance
time consuming
prone to errors
missed or incomplete urine collections
does not account for losses due to diarrhea, vomiting, wound leaks
– tend to overestimate
Why is creatinine excretion measured?
excretion is proportional to skeletal muscle
creatinine excretion increases with —-
exercise, meat intake, menstruation, infection, fever, trauma
creatinine excretion decreases with —-
renal failure and age
How is creatinine height index measured?
observed 24h creatinine (mg) excreted/expected 24h creatinine excretion
Hematological assessment is done with
complete blood count
complete blood count includes
erythrocytes (shape, size, color, number) to diagnose anemia
What is anemia?
reduction in the quantity of hemoglobin or in the number of RBC in the blood
leads to decreased oxygen carrying capacity
How are RBC classified in terms of their color?
hypochromic (pale color)
normochromic
hyperchromic (darker color)
How are RBC classified in terms of their shape?
microcytic (small cells)
normocytic
macrocytic (large cells)
Anemia maybe due to deficiencies of
iron folate vitamin B12 other nutrients (vitamin C, E) chronic diseases
What is the shape and the color of the RBC in case of iron deficiency anemia
microcytic and hypochromic
What is the shape and the color of the RBC in case of folate deficiency anemia
macrocytic and megaloblastic
What is the shape and the color of the RBC in case of vitamin B12 deficiency anemia
macrocytic and megaloblastic
What are the general test that can be done to diagnose anemia and its type?
hemoglobin hematocrit rbc count mean corpuscular volume mean corpuscular hemoglobin mean corpuscular hemoglobin concentration
What are the ideal level for hemoglobin
Higher than
Men: 14 g/dL
Women: 12 g/dL
What are the ideal level for hematocrit
Men: 40%
Women: 37%
In what conditions does hemoglobin decrease
during PEM, hemorrhage, and other anemias
What is hematocrit
% of RBC in total blood volume
hematocrit increases during ___
dehydration
hematocrit decreases during ___
hemorrhage and water overload
What is the order of depletion during iron deficiency?
decrease in:
storage iron - liver, bone marrow, spleen
transport iron - transferrin saturation
essential iron - rbc, hemoglobin, enzymes
What are some specific test that can be done to for anemia diagnosis?
serum ferritin serum iron TIBC (Transferrin and Iron-binding Capacity) Transferrin saturation Erythrocyte Protoporphyrin
What are the lab tests that can be done to diagnose folate deficiency anemia?
serum folate
rbc folate
The indicators of folate deficiency anemia are
low serum and rbc folate
megaloblastic and macrocytic rbc
normal B12 levels
What are the lab tests that can be done to diagnose vitamin B12 deficiency anemia?
serum B12
Schilling test
What does it mean when the serum b12 levels are low in case of normal intake
malabsorption
What are the iron requirements for men, women, pregnant, and elderly
men 8mg/day
women 18mg/day
pregnant 27mg/day
elderly 8mg/day
What are excellent sources of heme iron
clams
oysters
liver
What are good sources of heme iron
beef cooked
turkey
What are sources of heme iron
chicken ham lamb pork veal salmon
What are excellent sources of non-heme iron
cooked legumes
seeds
fortified cereals
tofu
What are good sources of non-heme iron
canned legumes
enriched egg noodles
dried apricot
What are sources of non-heme iron
nuts sunflower seeds cooked pasta bread cooked oatmeal wheat germ
What are the risk factors for poor iron status
diet low in animal products diet low in vitamin c diet low in fortified foods consumption of coffee and tea with meals consumption of phytates and oxalates with meals excessive menstrual losses 3+ annual blood donations pregnancy >3
How is iron supplementation done and what are the important things that the patients should be informed about?
ferrous sulfate (200mg TID X 6 months)
3 x better absorption
liquid tablet form
expect a rise in Hb of 1g/L per week
– side effects such as darker poop
To maximize iron absoprtion
take on an empty stomach with liquid (food decreases absorption 1/3)
What is clinical assessment
includes pt’s medical, social, and psychological history
physical examination for clinical signs and symptoms of malnutrition
sign vs. symptom
sign is something that you can visually see and symptom is subjective from patients eyes
Patient history includes
1st, 2nd diagnosis past medical history weight history factors affecting nutrient intake social history (religion, socioeconomic, shopping, cooking, family)
How is dietary assessment done?
24-hour recall
Food records
Food frequency questionnaire
Direct observation
What is 24h recall and what are the advantages and disadvantages?
ask about intake during the previous 24h (must be done >3 times) AD: - quick and inexpensive - element of surprise - low patient burden - literacy independent DISAD: - memory dep. - overestimation/underestimation - higher inter-interviewer variability
What is food records and what are the advantages and disadvantages?
recorded or weighted for given period of time asses actual or usual intake AD: - greater precision than 24h recall - not memory dependent - considered actual intake DISAD: - time consuming - may not reflect "normal" eating patterns - pt must be literate and motivated
What is food frequency questionnaire and what are the advantages and disadvantages?
survey of intake over specified time includes food lists, consumption frequency AD: - quick, inexpensive - can examine specific nutrients - can be used in large studies - considered usual intake DISAD: - qualitative info and less accurate - memory dependent - difficult since not meal based - pt must be literate and motivated
What is direct observation and what are the advantages and disadvantages?
used in controlled setting AD: - not memory dependent - pt unaware of assessment DISAD: - does not represent usual intake - high staff burden - may be intrusive - difficult to attain and interpret
What are the components of Total Energy Expenditure?
- Resting energy expenditure/Basal Metabolic rate
- Physical Activity
- Thermic effect of food
- injury/stress
What does indirect calorimetry measure?
measure the quantity of O2 consumed and CO2 produed by energy processes.
from this, heat production is calculated
this method is used to measure basal energy expenditure or resting energy expenditure
Basal energy expenditure vs resting energy expenditure
BEE is the energy needed to carry out fundamental metabolic functions, such as breathing, ion transport, normal turnover of enzymes and other body components, etc.
REE is metabolism during a time period of strict and steady resting conditions that are defined by a combination of assumptions of physiological homeostasis and biological equilibrium.
REE differs from basal metabolic rate (BEE) because BEE measurements must meet total physiological equilibrium whereas REE conditions of measurement can be altered and defined by the contextual limitations.
Therefore, BEE is measured in the elusive “perfect” steady state, whereas REE measurement is more accessible and thus, represents most, if not all measurements or estimates of daily energy expenditure.
What are the equations that can be used to calculate REE
harris-benedict fao/who mifflin st jeor owen rule of thumb
How is TEE calculated?
TEE = REE x Activity factor x Stress factor
What are the limitations of Harris-Benedict
tends to overestimate REE by 5-15% except in males >65 where it underestimates REE
DO NOT USE WITH OBESE
Which equation is most commonly used and most accurate in everyone?
Mifflin St Jeor
better predicts REE in non-obese and obese subjects
What is the simple calculation of REE in non-obese?
25kcal/kg –> low activity or overweight
30kcal/kg –> moderate activity, non-obese
35kcal/kg –> for higher active or higher needs
Which weight do we use in calculating the REE? “Ideal” or current?
If patients BMI = 16-29.9 use current weight
If BMI >30 use the ideal or healthy body weight
What is the PA level for sedentary
1.3
What is the PA level for moderate
1.5
What is the PA level for active
1.8
What are the protein requirements?
for healthy adults - 1.0g/kg/d
elderly - 1.0-1.2g/kg/d
What are the fluid requirements?
1ml/kcal
What are dehydration symptoms?
thirst dry mouth headache tachycardia rapid weight loss increased Na, albumin, BUN, creatinine, Hb, Hct
What are overhydration symptoms?
increased BP decreased pulse rate edema decreased Na, K, Albumin, BUN, creatinine, Hb, Hct rapid weight gain
What is the requirement for calcium
1200mg
What is functional assessment
muscle strength correlates with muscle mass
handgrip strength measured with a dynamometer
repeated 3x on dominant hand
>23kg women, >35kg men
overweight vs adiposity
overweight = excess body fat (fat, muscle, bone, water-includes all components) obesity = excess adiposity
Pear body shape is called
gynoid - related with women
Apple body shape is called
android - related with men
What is the ideal BMI and waist circumference of asian population
BMI >23 in women >27 in men
waist >90 in men >80 in women
What are health consequences of obesity
CVD HTN Diabetes Cancer Breathing problems arthritis gallbladder diseases reproductive problems surgical risks emotional consequences healthcare cost
Cardiometric risks include
CVD
HTN
Diabetes
What kind of relationship does BMI and all-cause mortality have
J-shaped relationship meaning lower risk and low mortality when you have a BMI between 20-25
Lower end of the bmi is also at risk and as you go over, the risk increases.
- not a linear but exponential relationship
What is Intra-abdominal fat and what is its significance in terms of mortality
it is visceral fat and it is more dangerous than subcut. fat
waist circumference = subcut. fat + visceral fat
What are the type of cancers in women where the risk is increased by increased obesity
endometrium
ovary
cervix
breast (post-menopausal)
What are the type of cancers in men where the risk is increased by increased obesity
prostate
What are the type of cancers in both men and women where the risk is increased by increased obesity
colon, gallbladder, kidney, liver
What is the other name of gallstones
cholelithiasis
What are the hepatobiliary disorders that obesity causes
increases the risk of gallstones
increases the risk of non alcoholic fatty liver disease (NAFLD)
How is the progression of liver failure in terms of NAFLD
steatosis –> steatohepatitis –> cirrhosis (irreversible) –> liver failure
What are the repsroductive disorders that obesity causes
men:
- reduced testosterone, increased estrogen levels
- gymnecomastia (breast enlargement)
women:
- PCOS
- gestational diabetes
- preclampsia
What is the etiology of obesity
energy balance appetite and body weight regulation genes environmental conditions medical conditions and medications other factors
What is obesogenic environement?
environments that encourage people to eat unhealthily and not do enough exercise.
Why is the Physical activity energy is higher in sedentary obese people than active individuals?
in obese, it is not just excess fat, but here is also more lean mass to support the body but doesn’t actually come from physical exercise
Define hunger
physical sensation indicating need or intense desire for food
define satiety
feeling of fullness after eating
define satiation
state of being satisfactory full associated with length of time between meals
define appetite
desire to eat
it is not the amount of food you eat, it is the desire to eat
what are the types of control in appetite
homeostatic
hedonic
what is hedonic control of appetite
influence of environmental factors, emotional, social
hedonic = pleasure
Where is the location of the homeostatic regulation of food intake
central: cerebral cortex, arcuate nucleus, paraventricular nucleus, lateral nucleus, brainstem
peripheral: stomach, gut, fat, pancreas, vagus
what are the two pathways of regulation of food intake
orexigenic - involves peptides
anorexigenic - less food intake
what are the hormones that are secreted from hypothalamus
Oxytocin - inhibits CRH - inhibits MCH - increases Orexin - increases AgRP - increases seretonin - inhibits histamine - inhibits
what are the hormones that are secreted from stomach
ghrelin - increases appetite
what are the hormones that are secreted from the gut
CCK - inhibits
Oxyntomodulin - inhibits
GLP-1
PPY
what are the hormones that are secreted from fat tissue
leptin - decreases appetite
what are the hormones that are secreted from pancreas
insulin
glucagon
PP
Medical conditions and pharmacological agents that cause obesity
congenital causes (down syndrome, prader-willi)
neuroendocrine disorders (cushings, pcos, gh)
pharmacological agents (psychiatric meds)
steroid hormones
antidiabetic agents
Dietary assessment for obesity includes
weight history, previous diets food intake (24h recall) patterns of meals ability to cook, budget, access to food allergies, intolerance use of vitamins and minerals medications
Physical activity assessment for obesity includes
interviews, questionnaires, log sheets does not capture fidgeting pedometers accelometers apps on phones
Define physical activity
all leisure and non leisure body improvements resulting in a substantial increase in EE
define exercise
a form of leisure time PA that is planned, structured and repetitive. its main objective is to improve or maintain physical fitness
define physical fitness
a set of attributes that are either health or performance related. the ability to carry out doily tasks with vigor and alertness, without fatigue, and with ample energy to energy leisure time pursuits and to meet unforeseen
define active living
when physical activities are an integral part of daily living
What are METs
Metabolic Equivalent Tasks
energy cost of physical activities
1 MET = ?
3.5 ml O2 uptake/kg BW/min
1kcal/kg BW/hour (sitting or lying quitely)
What are behavioural aspects in treating obesity
readiness to change long-term commitment family, friend or social support right timing identification of barriers stages of change theory
What are the stages of change theory
pre-contamplation contemplation preparation action maintenance/relapse
What is the distribution of percentage of energy expenditure at rest
liver is the most active organ
brain also takes up huge amount of energy
How many grams of water are lost when 1g of glycogen or protein tissue is being lost
4g of water
Explain the fed signal
when the meal is ingested, there is going to be a rise in glucose level in blood
insulin response is the main driver of the metabolism adaptation
muscle and adipose tissue require insulin for glucose uptake they are said to be insulin sensitive
liver + CNS + RBC –> dont require insulin for glucose uptake
What happens to FFA levels in response to a meal
FFA decrease even if the meal contains FFA bc in the fasting state FFA increase and once the meal is ingested, the insulin levels rise and the FFA concentration will go down
What do fad diets claim about CHO and insulin
carbs have the most profound effect on insulin release, therefore are the most likely to favour energy storage and weight gain
Why is insulin important?
besides blood glu regulation and fat storage, it also inhibits protein breakdown and promotes protein synthesis
Give examples of high GI food
beer, glucose, cooked carrots, white rice
give examples of low gi food
wheat bread spaghetti (al dente) raw carrots dairy beans veggies
What are the 3 goals of adapting to fasting
- meet energy needs
- meet glucose requirements
- spare protein (lean mass)
What are the 3 facts of energy paradox
- the brain needs 500kcal of water soluble fuels (glu)
- almost all energy is stored as FA and not as glycogen
- FA cannot be converted to glucose
What are the periods of glucose consumption
exogenous
glycogen stores
gluconeogenesis
ketogenesis
What are the types of ketoacids
acetoacetate
b-hydroxybutyrate ***
Why are ketoacids produced
produced as a result f overwhelming FA oxidation
used as fuel for brain; reduces needs for gluconeogenesis
How are ketoacids excreted in the urine
they must be “salted out” which involves loss of either Na, K, H, or NH4
ideally NH4 is excreted bc it is a waste product but K is the preferred ion to be excreted
What is the condition called when too much K is excreted with ketoacids
hypokalemia
What is ketoacidosis
the concentration of B-OH needs to be higher than 10mM. It starts to become a problem at 6mM
Renal consequences of starvation
need normal kidney function
ammonia is toxic so need for more water
acid/base balance changes in response to starvation needs to be controlled by kidney
What is the recommended value of protein intake in case of weight reduction diets in order to have a positive N balance
1.5g/kg/d
What is Forbes predictions
Prediction1:
during fast, obese individuals will lose less N (LBM) than thin ppl
Prediction2:
the fatter the subject the less the less the contribution of LBM to total weight loss on energy restricted diets
What are the cardiovascular and renal changes to severe weight loss
decrease in CV output, heart rate and BP
increase in tachycardia
increase in stress on kidneys (acid-base balance)
What are the immune function changes to severe weight loss
decrease in T-cell function/lymphocytes
decrease in cytokines
What are the GI function changes to severe weight loss
decrease in lipid absorption
decrease in gastric and pancreatic bile secretion
decrease in villous surface area
What is a ketogenic diet?
very low CHO(6-12%), high FAT (60-70%) less than 50g of CHO to induce ketosis diet should not include: grains fruits starchy vegetables added sugars
weight loss is due to water loss
Side effects of ketogenic diets
hyperuricemia hypocalcemia irritability lethargy appetite suppressant carnitine deficiency elevated serum lipids (when isocaloric) constipation water soluble vitamin def. renal stones growth inhibition
What is refeeding syndrome
shift back to glucose as the main fuel
what happens in refeeding syndrome
rapid shift of electrolytes and intracellular anions and cations to intracellular space
sodium and water retension
rapid refluxes of insulin due to CHO load
symptoms of refeeding syndrome
fatigue lethargy dizziness muscle weakness edema arhythmia hemolysis
physiological changes during repletion (refeeding syndrome)
ECF expnasion (edema from increased Na intake)
Glycogen Synthesis (may lower PO4, K concentration)
Increased BEE (reversal of starvtion and LBM building)
Increased insulin secretion (fed signal, glu uptake)
stimulates N retention
stimulate cell synthesis, growth and rehydration
What are the steps in refeeding
- normalize fluid and electrolytes imbalances
(PO4, K and Mg by supplementation and limit Na and water in the first few days) - provide a mixed diet at maintenance energy level
(to establish intolerence and avoid refeeding syndrome. aim for 100-500g glucose to stop LMB breakdown but start with 25% of dose) - provide PRO at 1.5-2g/kg/d
(start with 20g/day due to adaptation in urea cycle enzymes) - monitor serum electrolytes, weight, intake, output
What are the 5As of obesity management
ASK - permission to discuss weight, explore readiness
ASSESS - risks and root causes
ADVISE - health risks and treatment options
AGREE - health outcomes and behavioural goals
ASSIST - access to resources and providers
What are 5As guiding pronciples
obesity a chronic condition
improving health and well-being, not just reducing weight
early intervention
success is different for everyone
a patients best weight may never be an ideal weight
What are therapeutic objectives in treating obesity
individually tailored changes in eating behaviour weight loss/weight stabilization prevention of weight regain reduction in risk factors eligibility for surgey psychosocial adjustment
Cardiovascular benefits of weight loss
normalizes TG levels raises HDL lowers LDL improves CHD risk profile reduces need for antihyperlipidemic medication
Diabetic benefits of weight loss
increased glucose tolerance
increased insulin sensitivity
decreased for glucose lowering medications
Benefits of weight loss in HTN
decrease in:
- systolic BP
- blood volume
- cardiac output
- sympathetic activity
- need for hypertension medication
What is the plateau phase?
hypocaloric diet becomes isocaloric as the body adjusts
What are the priorities in a weight loss diet?
create energy deficit
avoid nutritional deficiencies
preserve lean mass
promote long-term adherence (avoid hunger 3h)
What are endurance activities
large muscle group physical activities of a continuous nature
What does the international physical activity guidelines recommend?
approx. 1000kcal/week or 400-500kcal/day
Recommendations for fitness are
FITT
F frequency –> 3-5 times
I intensity
T time –> 20-60 minutes >10000 steps everyday
T type –> aerobic, resistance, flexibility
physical activity need to prevent weight gain
150-250 min/week
1200-2000 kcal/week
physical activity need for weight loss
<150 min/wk for minimal wl
>250-400 min/wk results in 5-7kg wl
physical activity need for maintenance after weight loss
200-300 min/wk
What are the two main types of pharmacological treatment therapy adjunct to diet exercise and behavior
lipase inhibitors
appetite suppressant
Give an example of lipase inhibitor and its mechanism
ORALISTAT
malabsorption of fat
50% efficacy
side effects include fatty stools, incontinence, fecal urgencies, losses in Vit ADEK
Give an example of appetite suppressant and its mechanism
SIBUTRAMINE
prescribed short term - may cause addiction
- seratonin agonists
- amphetamine derivatives
side effects include nausea, dizziness, headaches, difficulty sleeping, constipation
How to change eating habits
enhance self-awareness
minimize exposure to food
interrupt behaviour chains (cookie story)
