Obesity

Question 1

Obesity increases risk for

Answer 1

Colon cancer
Gb disease
Osteoarthritis

Question 2

Name BMI associated with classifications 
Underweight 
Normal
Overweight 
Obesity Class 1 
Obesity Class 2 
Extreme Obesity 3

Answer 2

HB

Question 3

Risk factors for metabolic syndrome

Answer 3

Waist over 102cm or 88cm (40 or 35 in)
TG over 150mg/dL
HDL less than 40 (men) less than 50 (women) 
BP equal or over 130/85
FBG equal or over 100

Question 4

What is the main concern with obesity?

Answer 4

The complications!!

Lung disease, NAFLD, Gb disease, PCOS, cancer, cataracts, phlebitis

Question 5

3 parts of obesity Tx pyramid.

Answer 5

Lifestyle changes, pharmacotherapy, and surgery

Question 6

What is step 1 of diet intervention?

Answer 6

Low calorie diet (LCD)
Women 1000-1200kcal
1200-1600 kcal for men

VLCD- 800 kcal- not used

Question 7

What is the most variable energy factor?

Answer 7

PA! (TEE=PA+TEF+REE)

Question 8

What is the best formula to use with obese patients?

Answer 8

Harris-Benedict with adj BW

Question 9

What is the goal of obesity treatment?

Answer 9

Decrease co-morbidities
Decrease mortality and morbidity
Increase QOL
Stop intergenerational cycle! (Team Barker)

Question 10

What risks can you modify? What risks can you not modify?

Answer 10

Can’t change genetics

Can change metabolic, biochemical, behavior, psych, environmental

Question 11

What is obesity?

Answer 11

Life long 
Progressive 
Life threatening 
Genetically related 
Costs money
Multifactorial disease with co-morbidities

Question 12

What are the US OW and OB statistics.

Answer 12

37.5% obese
68% overweight or obese

17% children are obese and 21-24% overweight

Question 13

Can obesity be cured?

Answer 13

No, it can be treated and controlled. Technically cure with bypass. Chronic condition controlled by treatment.

Question 14

Famous researcher from Colorado health sciences center?

Answer 14

James O Hill

Question 15

Where are obesity tx guidelines published?

Answer 15

NHLBI with AHA/ACC

Journal of Cardiology (ACC)
Obesity (TOS)

Question 16

AHA/ACC guidelines

Answer 16

Use BMI and waist circumference
Comp lifestyle approach with 6-12 months counseling.
Rec 1200-1500 or 1500-1800 kcals OR decrease by 500-750 kcals
Surgery if >40 or >35 BMI with co-morb

Question 17

What meds are used?

Answer 17

Appetite suppressants (anorectants)

Question 18

What is Orlistat and Alli?

Answer 18

Lipase inhibitor to cause less digestion and absorption of fat. Alli is lower strength
A D E K deficiencies may be present.

Question 19

What impact does Medicare D have on obesity drugs?

Answer 19

It does not cover FDA approved drugs.

Question 20

What is the national weight loss registry?

Answer 20

James Hill

People join if adult lost over 30# and kept off for at least 1 year

Shows breakfast importance, use scales, 90%exercise

Question 21

What are 2008 US adult PA guidelines?

Answer 21

At least 150 min/wk MPA
To decrease risk of chronic disease and increase health related fitness.
Strength at least 2x per week

Question 22

What are weight loss PA guidelines?

Answer 22

300min/wk of VPA to lose weight or maintain amount that you lost.

Question 23

What amount of daily steps count as active activity level?

Answer 23

At least 10000 steps.

7500-9999- somewhat active
> 12500 highly active

Question 24

What does MET stand for and what does number reflect?

Answer 24

Metabolic equivalent of task

Reflect oxygen consumption (describes aerobic capacity =VO2 max)

Question 25

What is the units label for MET?

Answer 25

mL/kg/min Kcal/kg/hour

Question 26

Absolute MET

Answer 26

Based on rate of energy expenditure Not related to speed Is sped/pace

Question 27

Relative MET

Answer 27

Uses personal fitness to find level of effort. Target HR, talk test, RPE, VO2 max

Question 28

How is volume of activity measured?

Answer 28

In MET minutes or MET hours. MET*time done=total MET min (Goal of 500-1000/wk)

Question 29

What is combined to kill less people than poor CRF?

Answer 29

Smoking, DM, and obesity

Question 30

Who found that low fitness was leading cause of death?

Answer 30

Steve Blair, lean unfit is worse than obese and fit.

Question 31

What is the main purpose of the Socio ecological model behavior theory?

Answer 31

Looks at the individuals relationship with the environment. For example, the gym, supporting people, fruit on the counter.

Question 32

Describe the topic of self-determination Theory.

Answer 32

Intrinsic and extrinsic motivation | Dr giving a money reward versus valuing a jog for mental health

Question 33

Describe the purpose of transtheoretical model?

Answer 33

Stages of change: pre, cont, prep, action, maintain | Self efficacy, balance, change

Question 34

Social cognitive theory

Answer 34

Foundation is self-efficacy Self-regulation Social support

Question 35

Who was Robert Sallis?

Answer 35

Exercise in Medicine campaign to get the topic talked about in Dr offices! ACSM

Question 36

What is the end result of a banded gastroplasty?

Answer 36

Restrict gastric volume Reversible Adjustable band

Question 37

What is the end result of roux-en- Y procedure?

Answer 37

Restricts volume eaten and decreases digestion/absorption (no stomach or duodenum)

Question 38

What improvements are made for bariatric surgery patients? This is from a 2004 JAMA study.

Answer 38

Diabetes remission, eliminated high blood pressure, reduced high cholesterol, eliminated sleep apnea, and improved fertility asthma and joint disease.

Question 39

What are two forms of banded gastroplasty?

Answer 39

Adjustable gastric banding and vertical sleeve gastrectomy

Question 40

What is the main side effect of Roo and why and what are the stages of it?

Answer 40

Dumping syndrome. There is no more pyloric sphincter so too much chyme draws water into SI.

Question 41

Early-stage dumping syndrome

Answer 41

10-20 min after eating, high refined CHO meal, too much blood into intestine, decreased body blood flow, diarrhea and cramping from fluid. Faint, dizzy, sweat.

Question 42

Intermediate dumping syndrome.

Answer 42

20-30 min after eating. Malabsorption of Complex CHO in colon. Bloat, cramp, gas, diarrhea

Question 43

Late stage dumping syndrome

Answer 43

1-3 hours after eating. Reactive hypoglycemia, sweat, anxiety, shaky, hungry, confused, week.

Question 44

MNT for dumping syndrome

Answer 44

No liquids with meals, decrease refined carbs and increase complex, 20% protein, 30 to 40% fat, small frequent meals, to 20 times, decreased lactose. Lying down after meals.

Question 45

Long term deficiencies of gastric surgery.

Answer 45

B12, folic acid, and Fe deficiencies. Decreased lipase and bile amounts.

Question 46

What should patient do before gastric surgery?

Answer 46

Stop smoking, start exercising, join social group, start multivitamin supplement, quit caffeine and Pop, start protein supplement, lose 10% of weight.

Question 47

What are the main nutritional focuses of surgery Tx?

Answer 47

Protein Fluid Multivitamin

Question 48

Post operation food schedule.

Answer 48

Clear liquids 24 hours Full liquids 24hoir-2weeks Purée/blender- after 2 weeks Soft foods at 6 Weeks

Question 49

What are the common Roux en y deficiencies?

Answer 49

Dehydration, protein (60-80g per day), iron, calcium, Vitamin B12, folate,