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MC II Exam 3 > Obesity > Flashcards

Obesity Flashcards

(64 cards)

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1
Q

What % of adults are obese?

A

35.7%

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2
Q

How many states met the “Healthy People 2010” Target?

A

None - goal was 15% of the population or less as obese

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3
Q

How do the healthcare costs of normal weight individuals compare to obese individuals?

A

Significantly higher for the obese - $1,429 more per anum

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4
Q

True or false, obesity is a disease of adults

A

False, 17% of children are obese - this is 3x higher than in 1980

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5
Q

Describe the racial and ethnic disparities in childhood obesity

A

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

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6
Q

True or false, obesity and disability are correlated

A

True

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7
Q

Name the functions of adipocytes

A

Energy storage, endocrine fxn, immune fxn

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8
Q

Describe the basic immune response created by obesity

A

Immune cells are stimulated by adipokines and
become over-active, creating a state of CHRONIC
INFLAMMATION

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9
Q

True or false, an obese person will have few macrophages in their adipose tissue compared to a normal weight person

A

False, will have more

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10
Q

What is leptin?

A

An adipokine that suppresses appetite while increase energy consumption
Deficiency causes severe obesity
In obese people, receptors can become leptin resistant

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11
Q

What is adiponectin?

A

An anti-inflammatory adipokine
Levels reduced by obesity, insulin resistance
Weight loss increases levels
Low levels predict DM, CVD, weight gain

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12
Q

What do the adipokines Resistin, Retinol Binding Protein 4, and Tumor Necrosis Factor Alpha share in common?

A

They induce insulin resistance

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13
Q

How does the food system support obesity?

A

Increased cheap, energy-dense food
Improved food accessibility
Persuasive marketing

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14
Q

What can TV watching habits tell us about obesity?

A

TV viewing and low “leisure time physical activity”

independently PREDICTED metabolic syndrome in mid-adulthood.

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15
Q

How do standard portion sizes compare to government standards?

A

Executive chefs - 2-4x greater

Fast food chains - 2-8x greater

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16
Q

What is the BMI range for underweight?

A

< 18.5

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17
Q

What is the BMI range for normal weight?

A

18.5 to 24.9

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18
Q

What is the BMI range for overweight?

A

25 to 29.9

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19
Q

What is the BMI range for obese class I?

A

30 to 34.9

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20
Q

What is the BMI range for obese class II?

A

35 to 39.9

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21
Q

What is the BMI range for extreme obesity or obese class III?

A

Above 40

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22
Q

What do waist circumference and BMI tell us about disease risk?

A

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

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23
Q

What is the Waist-to-Hip Ratio (WHR)?

A

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

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24
Q

What are some of the health conditions that one is at risk for when one is obese?

A 
CAD
HTN
Stroke
Type 2 DM
Cancer
Premature death
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25
How do obesity and knee OA relate?
Increased knee OA with increased BMI in varus knees (not valgus)
26
How do obesity and carpal tunnel relate?
Risk doubles with obesity, AND Diabetes is an independent risk factor
27
How do obesity and rotator cuff tendinitis relate?
80-120% higher for patients with “moderate” obesity (BMI <35)
28
How do obesity and LBP relate?
Strong associations between LBP and obesity in large studies, but no definite causal relationships
29
How does the gait pattern change with obesity?
Increased hind foot motion | Increased forefoot abduction
30
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
31
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
32
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
33
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
34
What are the side effects of sibutramine?
``` Dry mouth Constipation Insomnia Slight blood pressure increase Slight heart rate increase ```
35
What are the side effects of orlistat?
Loose stools Fecal incontinence Vitamin D deficiency (may need supplementation)
36
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
37
Name the types of bariatric surgery
Malabsorptive, restrictive, and Roux-en-Y Gastric Bypass
38
Describe malabsorptive bariatric surgery
Decreases the length of small intestine Examples: ejunoileal bypass (rare), Biliopancreatic diversion
39
Describe restrictive bariatric surgery
Reduce storage capacity of stomach Examples: Laparoscopic adjustable gastric band (LAP-BAND), Laparascopic Sleeve Gastrectomy
40
Describe Roux-en-Y Gastric Bypass bariatric surgery
Uses both malabsorptive and restrictive methods | Most common type of bariatric surgery
41
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
42
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
43
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
44
What is a good initial goal for someone trying to lose weight?
10% reduction in baseline body weight
45
What is a healthy weekly rate for weight loss?
Overweight: ½ -1 lb./week Obese: 1-2 lbs./week
46
What is a healthy daily calorie reduction for weight loss?
Overweight: 300-500 kcal/day Obese: 500-700 kcal/day
47
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
48
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)
49
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)
50
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
51
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 ```
52
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 ```
53
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
54
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.
55
What can Dionne's Egress Test tell you?
If the pt is safe to mobilize w/out mechanical lift
56
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!
57
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
58
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)
59
True or false, Borg RPE is equivalent to attained MET levels?
False
60
What demographic factors seem to lead individuals to report a higher RPE?
Females, patients with lower ed. levels and patients on diuretics
61
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
62
What factors may increase compliance with a walking program?
HR < 70% RPE 11 Slower gait speed Use of pedometer
63
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
64
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.

MC II Exam 3 (8 decks)

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