Obesity Flashcards
Obesity increases risk for
Colon cancer
Gb disease
Osteoarthritis
Name BMI associated with classifications Underweight Normal Overweight Obesity Class 1 Obesity Class 2 Extreme Obesity 3
HB
Risk factors for metabolic syndrome
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
What is the main concern with obesity?
The complications!!
Lung disease, NAFLD, Gb disease, PCOS, cancer, cataracts, phlebitis
3 parts of obesity Tx pyramid.
Lifestyle changes, pharmacotherapy, and surgery
What is step 1 of diet intervention?
Low calorie diet (LCD)
Women 1000-1200kcal
1200-1600 kcal for men
VLCD- 800 kcal- not used
What is the most variable energy factor?
PA! (TEE=PA+TEF+REE)
What is the best formula to use with obese patients?
Harris-Benedict with adj BW
What is the goal of obesity treatment?
Decrease co-morbidities
Decrease mortality and morbidity
Increase QOL
Stop intergenerational cycle! (Team Barker)
What risks can you modify? What risks can you not modify?
Can’t change genetics
Can change metabolic, biochemical, behavior, psych, environmental
What is obesity?
Life long Progressive Life threatening Genetically related Costs money Multifactorial disease with co-morbidities
What are the US OW and OB statistics.
37.5% obese
68% overweight or obese
17% children are obese and 21-24% overweight
Can obesity be cured?
No, it can be treated and controlled. Technically cure with bypass. Chronic condition controlled by treatment.
Famous researcher from Colorado health sciences center?
James O Hill
Where are obesity tx guidelines published?
NHLBI with AHA/ACC
Journal of Cardiology (ACC)
Obesity (TOS)
AHA/ACC guidelines
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
What meds are used?
Appetite suppressants (anorectants)
What is Orlistat and Alli?
Lipase inhibitor to cause less digestion and absorption of fat. Alli is lower strength
A D E K deficiencies may be present.
What impact does Medicare D have on obesity drugs?
It does not cover FDA approved drugs.
What is the national weight loss registry?
James Hill
People join if adult lost over 30# and kept off for at least 1 year
Shows breakfast importance, use scales, 90%exercise
What are 2008 US adult PA guidelines?
At least 150 min/wk MPA
To decrease risk of chronic disease and increase health related fitness.
Strength at least 2x per week
What are weight loss PA guidelines?
300min/wk of VPA to lose weight or maintain amount that you lost.
What amount of daily steps count as active activity level?
At least 10000 steps.
7500-9999- somewhat active
> 12500 highly active
What does MET stand for and what does number reflect?
Metabolic equivalent of task
Reflect oxygen consumption (describes aerobic capacity =VO2 max)
What is the units label for MET?
mL/kg/min
Kcal/kg/hour
Absolute MET
Based on rate of energy expenditure
Not related to speed
Is sped/pace
Relative MET
Uses personal fitness to find level of effort.
Target HR, talk test, RPE, VO2 max
How is volume of activity measured?
In MET minutes or MET hours.
MET*time done=total MET min
(Goal of 500-1000/wk)
What is combined to kill less people than poor CRF?
Smoking, DM, and obesity
Who found that low fitness was leading cause of death?
Steve Blair, lean unfit is worse than obese and fit.
What is the main purpose of the Socio ecological model behavior theory?
Looks at the individuals relationship with the environment. For example, the gym, supporting people, fruit on the counter.
Describe the topic of self-determination Theory.
Intrinsic and extrinsic motivation
Dr giving a money reward versus valuing a jog for mental health
Describe the purpose of transtheoretical model?
Stages of change: pre, cont, prep, action, maintain
Self efficacy, balance, change
Social cognitive theory
Foundation is self-efficacy
Self-regulation
Social support
Who was Robert Sallis?
Exercise in Medicine campaign to get the topic talked about in Dr offices!
ACSM
What is the end result of a banded gastroplasty?
Restrict gastric volume
Reversible
Adjustable band
What is the end result of roux-en- Y procedure?
Restricts volume eaten and decreases digestion/absorption (no stomach or duodenum)
What improvements are made for bariatric surgery patients? This is from a 2004 JAMA study.
Diabetes remission, eliminated high blood pressure, reduced high cholesterol, eliminated sleep apnea, and improved fertility asthma and joint disease.
What are two forms of banded gastroplasty?
Adjustable gastric banding and vertical sleeve gastrectomy
What is the main side effect of Roo and why and what are the stages of it?
Dumping syndrome. There is no more pyloric sphincter so too much chyme draws water into SI.
Early-stage dumping syndrome
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.
Intermediate dumping syndrome.
20-30 min after eating. Malabsorption of Complex CHO in colon. Bloat, cramp, gas, diarrhea
Late stage dumping syndrome
1-3 hours after eating. Reactive hypoglycemia, sweat, anxiety, shaky, hungry, confused, week.
MNT for dumping syndrome
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.
Long term deficiencies of gastric surgery.
B12, folic acid, and Fe deficiencies. Decreased lipase and bile amounts.
What should patient do before gastric surgery?
Stop smoking, start exercising, join social group, start multivitamin supplement, quit caffeine and Pop, start protein supplement, lose 10% of weight.
What are the main nutritional focuses of surgery Tx?
Protein
Fluid
Multivitamin
Post operation food schedule.
Clear liquids 24 hours
Full liquids 24hoir-2weeks
Purée/blender- after 2 weeks
Soft foods at 6 Weeks
What are the common Roux en y deficiencies?
Dehydration, protein (60-80g per day), iron, calcium, Vitamin B12, folate,
