Obesity Flashcards
What % of adults are obese?
35.7%
How many states met the “Healthy People 2010” Target?
None - goal was 15% of the population or less as obese
How do the healthcare costs of normal weight individuals compare to obese individuals?
Significantly higher for the obese - $1,429 more per anum
True or false, obesity is a disease of adults
False, 17% of children are obese - this is 3x higher than in 1980
Describe the racial and ethnic disparities in childhood obesity
Hispanic boys more likely to be obese than non-
Hispanic white boys
Non-Hispanic black girls more likely to be obese than non-Hispanic white girls
True or false, obesity and disability are correlated
True
Name the functions of adipocytes
Energy storage, endocrine fxn, immune fxn
Describe the basic immune response created by obesity
Immune cells are stimulated by adipokines and
become over-active, creating a state of CHRONIC
INFLAMMATION
True or false, an obese person will have few macrophages in their adipose tissue compared to a normal weight person
False, will have more
What is leptin?
An adipokine that suppresses appetite while increase energy consumption
Deficiency causes severe obesity
In obese people, receptors can become leptin resistant
What is adiponectin?
An anti-inflammatory adipokine
Levels reduced by obesity, insulin resistance
Weight loss increases levels
Low levels predict DM, CVD, weight gain
What do the adipokines Resistin, Retinol Binding Protein 4, and Tumor Necrosis Factor Alpha share in common?
They induce insulin resistance
How does the food system support obesity?
Increased cheap, energy-dense food
Improved food accessibility
Persuasive marketing
What can TV watching habits tell us about obesity?
TV viewing and low “leisure time physical activity”
independently PREDICTED metabolic syndrome in mid-adulthood.
How do standard portion sizes compare to government standards?
Executive chefs - 2-4x greater
Fast food chains - 2-8x greater
What is the BMI range for underweight?
< 18.5
What is the BMI range for normal weight?
18.5 to 24.9
What is the BMI range for overweight?
25 to 29.9
What is the BMI range for obese class I?
30 to 34.9
What is the BMI range for obese class II?
35 to 39.9
What is the BMI range for extreme obesity or obese class III?
Above 40
What do waist circumference and BMI tell us about disease risk?
Disease risk increased with being overweight regardless of waist size, but a waist size over 40 in men and 35 in women increases disease risk even more
What is the Waist-to-Hip Ratio (WHR)?
Measurement:
Hip circumference at widest of buttocks
Waist circumference over abdomen at narrowest diameter
> 0.90 for men = obese
0.85 for women = obese
Smaller waist, larger hips = good
What are some of the health conditions that one is at risk for when one is obese?
CAD HTN Stroke Type 2 DM Cancer Premature death
How do obesity and knee OA relate?
Increased knee OA with increased BMI in varus knees (not valgus)
How do obesity and carpal tunnel relate?
Risk doubles with obesity, AND Diabetes is an independent risk factor
How do obesity and rotator cuff tendinitis relate?
80-120% higher for patients with “moderate” obesity (BMI <35)
How do obesity and LBP relate?
Strong associations between LBP and obesity in large studies, but no definite causal relationships
How does the gait pattern change with obesity?
Increased hind foot motion
Increased forefoot abduction
What are the possible effects of minor trauma in overweight people?
Can cause injuries typically only seen in high-speed traumatic accidents – knee dislocation most notably
Weight and joint replacement surgery do not appear to be correlated
False, in a recent study in the UK, 27% of hip replacements and 69% of knee replacements were attributable to the patient being overweight
When are medications indicated for weight loss
When BMI exceeds 27, when temporary and moderate (~5 kg over 1 year) loss is desired, and when diet and exercise are also prescribed
What current weight loss medications are on the market?
Anorexiants (sympathomimetic amines, sibutramine) – FDA-approved for adults
Lipase inhibitors (orlistat) – FDA-approved for adults and children
What are the side effects of sibutramine?
Dry mouth Constipation Insomnia Slight blood pressure increase Slight heart rate increase
What are the side effects of orlistat?
Loose stools
Fecal incontinence
Vitamin D deficiency (may need supplementation)
When is surgical intervention for weight loss indicated?
BMI ~35 or 40 with significant obesity related comorbidities
Age 16 to 65 years
Documented failure to achieve long-term weight loss with nonsurgical approaches
Psychological stability and realistic expectations
Well-informed and motivated
Supportive family/social environment
Commitment to long-term follow-up
Resolution of alcohol/substance abuse
Name the types of bariatric surgery
Malabsorptive, restrictive, and Roux-en-Y Gastric Bypass
Describe malabsorptive bariatric surgery
Decreases the length of small intestine
Examples: ejunoileal bypass (rare), Biliopancreatic diversion
Describe restrictive bariatric surgery
Reduce storage capacity of stomach
Examples: Laparoscopic adjustable gastric band (LAP-BAND), Laparascopic Sleeve Gastrectomy
Describe Roux-en-Y Gastric Bypass bariatric surgery
Uses both malabsorptive and restrictive methods
Most common type of bariatric surgery
What are some of the benefits associated with Roux-en-Y Gastric Bypass bariatric surgery?
BMI reduced by 10-15 kg/m2
Mean weight loss of 20-40 kg
Decreased mortality rate –
-Diabetes: 9% mortality rate (vs. 28% among those
who chose not to do surgery)
-Non-diabetes: 89% reduction in mort. rate
Resolution of HTN in 62% of patients
Resolution of OSA: 86% of patients
Type 2 diabetes reduction: 77% of patients
What are some of the side effects associated with Roux-en-Y Gastric Bypass bariatric surgery?
Vitamin Deficiencies (B12, D)
Gallstones
Surgical risks: PE, sepsis, anastomotic leaks
How can patients prepare for bariatric surgery?
Increase physical activity - 20 min/day, 3-4 days/week
Improved cardiorespiratory fitness
Reduced surgical complications
Improved healing capacity
Enhanced postoperative recovery
What is a good initial goal for someone trying to lose weight?
10% reduction in baseline body weight
What is a healthy weekly rate for weight loss?
Overweight: ½ -1 lb./week
Obese: 1-2 lbs./week
What is a healthy daily calorie reduction for weight loss?
Overweight: 300-500 kcal/day
Obese: 500-700 kcal/day
What are some general principles around calories and macronutrients that one should follow when trying to lose weight?
Low calorie diet
Reduce carbohydrates
Reduce saturated fat intake
Total fat intake </= 30% of total kcals
How might someone who is starting an exercise program start and progress?
Begin with 30-45 minutes CV activity 3-5 days/week
Progress up to 60 minutes, 5-7 days/week
LOW to MODERATE Intensities (40-70% of max)
What are the ACSM recommendations for weekly CV activity?
> = 30 minutes cardiovascular activity on all or most days/week (>/= 250 minutes/week moderate intensity activity)
What are the health benefits of a 5-10% weight reduction in an overweight person?
Decreased total cholesterol, LDL-C, and serum
trigylceride levels
Improved glycemic control in patients who have T2DM
Reduced risk factors for DM and CVD
Increased HDL levels
Decreased wear on the joints
What are some good CV tests for the outpatient setting?
Half mile walk 6 minute walk test 2 minute walk test 10- meter walk Heart Rate Recovery
What are some good CV tests for the inpatient setting?
6 minute walk test 2 minute walk test 10- meter walk Dionne’s Egress Test Heart Rate Recovery
Why is it important to take into consideration your patient’s body type?
Not everyone will move the same way
e.g. “Pears” don’t always roll over to their side to get up - always understand how pt typically sits up
Explain how to execute Dionne’s Egress Test
Test 1: 3 reps of sit/stand transfer (can use walker, must clear seat by an inch or more)
Test 2: 3 steps of marching in place
Test 3: Advance step and return each foot
*If at any point, the patient requires manual assistance, mechanical lift transfer is indicated.
What can Dionne’s Egress Test tell you?
If the pt is safe to mobilize w/out mechanical lift
What are Dionne’s Tips for Safe Mobilization?
Reduce skin shear and friction; use Gortex overlays,inflatable mats
Assist the patient to flat spin rather than sidelying –
easy to crush mattress and roll off bed
Deflate air mattresses or overlays prior to mobilization
Try to maintain physical contact with patient’s knee
during supine>sit postures – can note sliding
Avoid penetration of gait belts into skin folds
USE PROPER EQUIPMENT!
What factors can account for the majority of 6MWT results?
A study of 200+ women showed that 75% of variance in walking distance could be explained by BMI, peak VO2, quad muscle strength, age, and hours of TV watching or sports participation
How does the CV response of obese individuals compare to normal weight individuals?
Walking at a self-selected pace, obese individuals had a higher HR and VO2 (working harder at same intensity as normal weight individuals)
True or false, Borg RPE is equivalent to attained MET levels?
False
What demographic factors seem to lead individuals to report a higher RPE?
Females, patients with lower ed. levels and patients on diuretics
How does RPE compare for intermittent vs. continuous exercise?
RPE significantly lower for intermittent exercise
Intermittent exercise prescription demonstrated
beneficial effects on BMI, HR, walking distance, and
T2DM
What factors may increase compliance with a walking program?
HR < 70%
RPE 11
Slower gait speed
Use of pedometer
What are the recommendations given by the UCH weight loss center to help patients lose weight
Meet patients where they are at
Identify psychological and physical barriers to exercise
Tailor programs to be done at home
Identify modes of activity in all areas of life
Identify support; more success with a workout buddy
Be professional – talk about aerobic activity in particular as you would with any other population
Focus on Short Term Goals
What are some good ways to practice sensitivity when dealing with an overweight patient?
Recall we never have an individual’s whole story
Let the patient do the talking
Observe level of connection between diet and health
conditions
Observe level of expectation around change – even
small changes will make big differences in health
Help patients tap into personal goals/things
that have worked in the past.
