Obesity Flashcards
Underweight BMI
Less than 18.5
Define obesity
A complex disorder involving excess body weight beyond the body’s physical requirements
Normal BMI
18.5-24.9
Overweight BMI
25.0-29.9
Class 1 Obese BMI
30-34.9
Class II Obese BMI
35.0-39.9
Morbidly obese BMI
more than 40
Name 5 methods to assess obesity
BMI
Waist circumference
Waist-to-hip ratio
Body shape
Determination of fitness level
How do we measure waist circumference?
We measure on top of the hip
How does body shape correlate with obesity?
We are more concerned for someone with an apple shape than a pear shape because central obesity (apple shape) is more dangerous because visceral fat increases the risk of metabolic diseases, while subcutaneous fat (pear shape) is less harmful.
How is moderate intensity of fitness defined by the talk test?
You can talk but cannot sing during the activity
How is vigorous intensity of fitness defined by the talk test?
You cannot say more than a few words
Describe primary obesity
We traditionally understand it as Calories in > Calories out; but there are so many more factors that influence primary obesity!!
Describe secondary obesity
Other issues or other metabolic problems (congenital or chromosomal abnormalities)
Describe modifiable and non-modifiable causes of primary obesity
Genetics
Prenatal & early life
Physiologic regulation
Lifestyle & environment
Mental Health
How do genetics affect obesity?
BMI has a strong genetic component (Chromosome 16). Several genes have expression in the hypothalamus and fulfill roles in appetite regulation.
What is the strongest genetic link associated with obesity?
FTO gene (Fat mass and Obesity-associated gene) on chromosome 16 is one of the strongest genetic links to obesity
What are the 3 modifiable prenatal factors for obesity?
Smoking habits (more obese children)
Weight gain (children prone to obesity)
Blood sugar levels esp gestational diabetes (children prone to obesity)
What are the 3 modifiable postnatal factors during infancy that influence weight in later life?
How rapidly they gain weight, how long they’re breastfed (the longer, the less likely), and how much they sleep (less sleep = incr obesity risk)
Food dessert
An area where residents have limited access to affordable and nutritious food, particularly fresh fruits, vegetables, and other whole foods
How does sleep correlate with obesity?
Sleep 5hrs or less = 15% risk of obesity compared to 7 hrs
How does stress correlate with obesity?
Increased cortisol causes the same signals initiated by starvation and food in a reward
Formula for energy balance
Energy intake > Energy expenditure = Energy balance
Storage of energy is primarily stored as..
fat!
What are the common functions of the hormones that influence obesity?
Appetite suppressant, appetite stimulant, or delay gastric emptying
What are the location of origin for the hormones that influence obesity?
Hypothalamus, adipose tissue, and gut
Leptin
Suppress hunger and decrease food consumption
Ghrelin
Stimulates appetite
Incretins
Slow gastric emptying, decreases appetite (satiation)
Insulin
Decreases appetite
In obese individuals, leptin levels (increase or decrease)…
increase! there is a leptin insensitivity
Explain ghrelin in obese individuals (increase or decrease)
In obesity, post prandial ghrelin decline does not occur (overeating)
In obese individuals, what kind of free fatty acid concentration do they have?
Increased concentrations of free fatty acids which inhibits insulin secretion
Complications Associated with Obesity
Metabolic syndrome, Diabetes, Dyslipidemia, HTN, Non-alcoholic liver disease, Polycystic ovary syndrome, Obstructive sleep apnea, Osteoarthritis, Urinary stress incontinence, Gastroesophageal reflux disease, Immobility, Psychological disorder due to stigma
Android obesity
occurs when excess body weight collects on the torso (apple shape)
What are the 3 factors that influence dyslipidemia?
Hypertriglyceridemia
Low HDL
Hypercholesterolemia
Where is Ghrelin produced?
In the stomach
What are the cardiovascular issues related to android obesiry
Dyslipidemia, Hypertension, and Atherosclerosis
How is insulin resistance promoted in type 2 diabetes?
The release of free fatty acids and inflammatory factors such as cytokines and microphages
Does it get easier or more difficult when managing obesity with T2DM?
Difficult
What is metabolic syndrome?
A collection of risk factors that increase for developing diabetes, stroke, or cardiovascular disease.
In order to “qualify” for metabolic syndrome, how many of the symptoms must you endorse?
3 of the 5 symtpoms
What is the waist circumference value that increases the risk for metabolic syndrome?
men ≥ 40 in
women ≥ 35 in
What is the triglyceride value that increases the risk for metabolic syndrome?
> 150 mg/dL or on meds
What is the HDL level that increases the risk for metabolic syndrome?
men < 40 mg/dL
women < 50 or on meds
What are the SBP and DBP values that increase the risk for metabolic syndrome?
≥ 130 SP or ≥ 85 DBP or on meds for HTN
What is the fasting blood glucose value that increases the risk for metabolic syndrome?
≥ 110 mg/dL or on meds
Is obesity a preventable cause of cancer?
Yes
What are active lifestyle changes a person with obesity can take?
At least 150 minutes per week of moderate activity (consult with provider)
What are diety lifestyle changes a person with obesity can take?
Consult with nutritionalist
What are behavioral lifestyle changes a person with obesity can take?
Attend behavioral therapy, support groups
If lifestyle changes alone, do not work, what are the next steps?
Pharmacotherapy
What do stimulant pharmacotherapy drugs do for obesity? Side effects?
Stimulate your metabolic rate and allow you to burn calories.
Side effects: jittery
What are T2DM drugs meant to do?
Meant to make the patient feel satiated after eating.
Pharmacotherapy is reserved fro those who have a BMI of …
BMI of 30 or BMI of 27 in the presence of weight-related conditions (HTN, T2DM, or dyslipidemia)
What is the last resort to tx obesity?
Surgery
What are the criteria for bariatric surgery?
Extreme obesity (BMI of 40+).
BMI of 35 - 29.9 with the presence of serious weight-related health issues.
Exhibited commitment to making lifestyle changes for surgery to work.
What are the 3 surgical option for obesity?
Gastric banding
Sleeve gastrectomy
Gastric bypass (Roux en Y)
What does gastric banding do for the patient?
It is a band around the stomach to make the patient feel full much quicker. It comes with a port which inflated and adjusts band size.
What does a gastric sleeve do for the patient?
80% of the stomach is removed where ghrelin is secreted. Therefore, you are less interested in eating. And you have a small pouch.
What does Roux en Y
Rerouting of the GI system. The stomach is minimized and the small intestine is re-routed. 90% excision of the stomach.
Advantages for gastric banding
Reversible, absence of dumping syndrome and malabsorption
Advantages for vertical sleeve gastectomy
No bypass of the intestine. Preserves the function of the stomach. No anemia, vitamin deficiency
Advantages for Roux en Y Gastric bypass
Better weight loss
Disadvantages for gastric banding
Weight loss limited
Disadvantages for vertical sleeve gastectomy
Weight loss limited
Disadvantages for Roux en Y Gastric bypass
Dumping syndrome, iron deficiency, folic acid deficiency, anemia, calcium deficiency, cobalmin deficiency
Dumping syndrome
30 to 60 minutes after a meal you experience N/V, diarrhea, abdominal cramping, sweating, lightheadedness, tachycardia
What action(s) can onset dumping syndrome?
Eating simple sugars (candy).
What action(s) can prevent dumping syndrome?
Eat 5-6 small meals/snacks a day.
Keep portions small.
Cut food into small pieces.
Chew well prior to swallowing.
Combine proteins or fats along with fruits or starches.
Stop eating when you first feel full.
Drink liquids 30-45 minutes after meals.
Stop eating when you feel ligghtheaded.
Post surgery you run the risk of…
Infection
Dehydration
Malnutrition
To prevent post-op malnutrition you must…
Know what small, nutrient-dense meals look like.
Pay attention to vitamins/supplements.
Avoid foods that stretch the stomach.
T/F those with a Roux en Y can have carbonated drinks
False, carbonation can stretch the stomach.
What are dietary restrictions post surgery?
Drink 3-4 oz every 30 min.
No carbonation.
No sugar.
Sip liquids SLOWLY.
Room temp liquids.
Diet progression as ordered.
What is the method of action for Incretin Mimetics – or GLP -1 Agonist?
Activate the GLP-1, GIP receptors causing same effects as the incretin hormones
What is the therapeutic use for Incretin Mimetics – or GLP -1 Agonist?
Type 2 DM adjunctive therapy
What are Incretins
group of metabolic hormones that stimulate a decrease in blood glucose levels. Incretins are released after eating and augment the secretion of insulin released from pancreatic beta cells of the islets of Langerhans by a blood glucose-dependent mechanism. Incretins slow the rate of absorption of nutrients into the bloodstream by reducing gastric emptying and may directly reduce food intake.
What is the method of action of Amylin Mimetics?
Amylin is a hormone co-secreted with insulin from beta cells that suppress postprandial glucagon secretion which decreases hepatic glucose production.
What is the therapeutic use for Amylin Mimetics?
Adjunctive for Type 1 DM & Type 2 DM
What is Amylin?
a peptide hormone that is co-secreted with insulin from the pancreatic β-cell and is deficient in diabetic people. It inhibits glucagon secretion, delays gastric emptying, and acts as a satiety agent
What is the therapeutic use for SGLT2 Inhibitor?
Type 2 Diabetes; being studied off label for Type 1 diabetes
What is the method of action for SGLT2 Inhibitor?
inhibits SGLT-2 in kidney reduces reabsorption of glucose (thus increasing the excretion of glucose in the urine)
Exenatide is the prototype for
Incretin Mimetics – or GLP -1 Agonist
Pramlintide is the prototype for
Amylin Mimetics
Canagliflozin (Invokana) is the prototype for
SGLT2 Inhibitor
