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MS1 Exam Three > Obesity > Flashcards

Obesity Flashcards

1
Q

Obesity occurs..

A

when excess calories are stored as fat

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2
Q

Obesity

A
  • most prevalent preventable health problem in US
  • increase risk of morbidity and mortality
  • Nearly 70% of Americans are overweight or obese
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3
Q

Pathophysiology of Obesity

A
  • all body function requires energy
  • excess energy (kcals)/nutrients are stored as triglycerides in fat cells
  • Nutrients provide energy
  • 70% of energy expended goes to maintain BMR
  • Physical activity accounts for 5-10% of energy expended
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4
Q

Etiology of Obesity

A
  • excess energy and/or decreased energy expenditure
  • appetite
  • GI filling
  • Hormonal factors
  • emotions
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5
Q

Hormonal factors and Obesity

A
  • Leptin
  • Insulin
  • Thyroid Hormone
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6
Q

Risk Factors

A
  • heredity (25-40% of obesity)
  • physical inactivity
  • cultural factors
  • environmental factors
  • socioeconomic factors
  • psychological factors
  • addiction
  • coping mechanism
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7
Q

Adipose Tissue

A
  • mature adipose cells do not multiply
  • however, immature adipose cells multiply in presence of estrogen during puberty and late adolescents, during breastfeeding, overweight middle aged adults
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8
Q

Clinical Manifestations: Upper body obesity

A
  • waist hip ratio >1 in men, >0.8 in women
  • increased levels of circulating free fatty acids
  • increased risk of HTN, dyslipidemia, heart disease, stroke, hyperinsulinemia

APPLE

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9
Q

Complications of Obesity

A

-HTN
-Coronary heart disease
-Heart failure
-Stroke
-Metabolic syndrome
-Insulin Resistance
-DM2
-Sleep apnea
-Reproductive impairment
-Gallstones
-Cancer
Joint Pain/OA

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10
Q

Reproductive Impairment

A

Men: decreased androgen

Women: menstrual irregularity, polycystic ovary syndrome

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11
Q

Cancer

A
  1. colon
  2. breast
  3. endometrial
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12
Q

Obesity Management

A
  • Diet
  • Exercise
  • Behavior modification
  • Pharmacotherapy
  • Surgery
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13
Q

Apple vs. Pear

A

Pear is healthier, lower body weight

Apple: upper body weight

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14
Q

Diagnostic Tests: Anthropometry

A
  • BMI (kg divided by meters)
  • Skin folds
  • Hydrodensitrometry (water displacement)
  • Bioelectrical impulse (low energy electrical impulse)
  • Waist circumference (> or = 40 in men, 35 in women)
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15
Q

Diagnostic Tests: Labs

A
  • Thyroid panel
  • Serum glucose
  • Lipid profile
  • Electrocardiography
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16
Q

Pharmacologic Interventions

A
  • Amphetamine and non-amphetamine appetite suppressants
  • Appetite suppressant
  • Fat absorption inhibitor
  • OTC
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17
Q

Amphetamine and non-amphetamine appetite suppressants

A
  • Phentermine

- Stimulate CNS

18
Q

Appetite suppressant

A
  • Meridia (Sibutramine)
  • Appetite suppressant: lowers cholesterol and triglycerides, increase metabolic rate
  • removed from the market in 2010 due to increased risk of heart attacks and strokes
19
Q

Fat absorption inhibitor

A

Orlistat (Xenical)

20
Q

Qysmia

A
  • phentermine (stimulant) and topiramate (anti-seizure)

- avoid in pregnancy

21
Q

Belviq

A
  • locaserin HCl

- seratonin 2C receptor agonist/stimulator

22
Q

Methycellulose

A

bulk-forming product

-creates sensation of fullness

23
Q

Nutrition

A
  • regular, small servings
  • create 500-1,000 calories deficit
  • “yo-yo” dieting may result in metabolic deficiencies that make subsequent weight loss more difficult
24
Q

women calorie recommendation

A

1,000-1,200 kcal

25
Q

less than 1,200 cals

A

may result in lean tissue loss and nutritional deficits

26
Q

Aerobic Exercise

A

30-40 minutes five or more days per week

increases BMR

increases energy consumption

preserve lean muscle mass

27
Q

Behavioral modifications

A
  • food diary
  • replace eating with other habits
  • identify triggers
28
Q

Surgery

A

morbidity obese and unable to lose weight through dieting or exercising

or

have serious obesity-related complications

29
Q

Contrave

A

naltrexone, an opioid antagonist, and bupropion, an antidepressent

30
Q

Post-Operative Interventions

A
  • monitor vitals
  • monitor I&O
  • Assess bowel sounds
  • monitor NG tube as ordered
  • NPO for 3 days or until peristalsis returns
31
Q

Complications of Post-op Bariatric Surgery

A
  1. infection and/or hemorrhage
  2. dumping syndrome
  3. Diarrhea
  4. hypoglycemia
  5. dehydration
  6. gastric leak leading to infection/sepsis or ulceration
32
Q

Deficiencies caused by Bariatric Surgery

A
  1. Vitamin B12 (most significant)
  2. Calcium
  3. Iron
  4. fat-soluble vitamins (A,D,E,K???)
33
Q

Saxenda

A

liraglutide

  • glucagon-like peptide-1 receptor agonist
  • daily SQ injection
  • not recommended as first line therapy
34
Q

Vitamin B12

A

-decreased absorption of Vit B12 from intestinal tract

signs and symptoms:

  • pallor,
  • fatigue,
  • weight loss,
  • smooth,
  • beefy tongue,
  • slight jaundice,
  • paresthesia of hands and feet
  • disturbances of gait and balance
35
Q

3 types of surgeries

A
  1. Restrictive
  2. Malabsorptive - not doing anymore
  3. Restrictive/Malabsorptive
36
Q

Restrictive/Malabsorptive Surgeries

A
  • Gastric bypass

- duodenal switch

37
Q

Restrictive Surgeries

A
  • Gastric banding
  • Gastric sleeve
  • Gastric stapling
38
Q

Treatment for Vitamin B12 deficiency

A
  1. Increasing dietary B12, may not be effective

2. IV replacement (severe), not oral due to malabsorption and gastric issues

39
Q

Dumping Syndrome

A

rapid emptying of gastric contents into small intestines following gastric resection

-water drawn into intestines through osmosis

  • typically happens 30 min post prandial
  • N/V
  • Abdominal fullness/cramping
  • Diarrhea
  • Palpitations
  • Tachycardia
  • Perspiration
  • Weakness
  • Dizziness
  • Borborgyums - noises of gas and fluids through bowels
40
Q

Patient Education for Dumping Syndrome

A
  • avoid sugar, salt, and milk
  • eat a high protein, high good fat, and low carb diet
  • eat small meals
  • avoid consuming fluids with meals
  • avoid very hot or very cold foods/drinks
  • lie down after meals
  • take antispasmodic medications as prescribed
41
Q

Patient Education: Bariatric Syndrome

A
  • avoid alcohol and carbonated beverages
  • Avoid foods high protein, saturated fat (fried foods), and sugar foods/drinks (fruit juice) and avoid simple carbs
  • eat slowly and chew well
  • take nutritional supplements
  • progress diet as ordered
  • monitor for s/s complications
42
Q

men calorie recommendation

A

1,200-1,600 kcal

MS1 Exam Three (9 decks)

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