Obesity Flashcards
Obesity occurs..
when excess calories are stored as fat
Obesity
- most prevalent preventable health problem in US
- increase risk of morbidity and mortality
- Nearly 70% of Americans are overweight or obese
Pathophysiology of Obesity
- 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
Etiology of Obesity
- excess energy and/or decreased energy expenditure
- appetite
- GI filling
- Hormonal factors
- emotions
Hormonal factors and Obesity
- Leptin
- Insulin
- Thyroid Hormone
Risk Factors
- heredity (25-40% of obesity)
- physical inactivity
- cultural factors
- environmental factors
- socioeconomic factors
- psychological factors
- addiction
- coping mechanism
Adipose Tissue
- 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
Clinical Manifestations: Upper body obesity
- 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
Complications of Obesity
-HTN
-Coronary heart disease
-Heart failure
-Stroke
-Metabolic syndrome
-Insulin Resistance
-DM2
-Sleep apnea
-Reproductive impairment
-Gallstones
-Cancer
Joint Pain/OA
Reproductive Impairment
Men: decreased androgen
Women: menstrual irregularity, polycystic ovary syndrome
Cancer
- colon
- breast
- endometrial
Obesity Management
- Diet
- Exercise
- Behavior modification
- Pharmacotherapy
- Surgery
Apple vs. Pear
Pear is healthier, lower body weight
Apple: upper body weight
Diagnostic Tests: Anthropometry
- 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)
Diagnostic Tests: Labs
- Thyroid panel
- Serum glucose
- Lipid profile
- Electrocardiography
Pharmacologic Interventions
- Amphetamine and non-amphetamine appetite suppressants
- Appetite suppressant
- Fat absorption inhibitor
- OTC
Amphetamine and non-amphetamine appetite suppressants
- Phentermine
- Stimulate CNS
Appetite suppressant
- 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
Fat absorption inhibitor
Orlistat (Xenical)
Qysmia
- phentermine (stimulant) and topiramate (anti-seizure)
- avoid in pregnancy
Belviq
- locaserin HCl
- seratonin 2C receptor agonist/stimulator
Methycellulose
bulk-forming product
-creates sensation of fullness
Nutrition
- regular, small servings
- create 500-1,000 calories deficit
- “yo-yo” dieting may result in metabolic deficiencies that make subsequent weight loss more difficult
women calorie recommendation
1,000-1,200 kcal
less than 1,200 cals
may result in lean tissue loss and nutritional deficits
Aerobic Exercise
30-40 minutes five or more days per week
increases BMR
increases energy consumption
preserve lean muscle mass
Behavioral modifications
- food diary
- replace eating with other habits
- identify triggers
Surgery
morbidity obese and unable to lose weight through dieting or exercising
or
have serious obesity-related complications
Contrave
naltrexone, an opioid antagonist, and bupropion, an antidepressent
Post-Operative Interventions
- monitor vitals
- monitor I&O
- Assess bowel sounds
- monitor NG tube as ordered
- NPO for 3 days or until peristalsis returns
Complications of Post-op Bariatric Surgery
- infection and/or hemorrhage
- dumping syndrome
- Diarrhea
- hypoglycemia
- dehydration
- gastric leak leading to infection/sepsis or ulceration
Deficiencies caused by Bariatric Surgery
- Vitamin B12 (most significant)
- Calcium
- Iron
- fat-soluble vitamins (A,D,E,K???)
Saxenda
liraglutide
- glucagon-like peptide-1 receptor agonist
- daily SQ injection
- not recommended as first line therapy
Vitamin B12
-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
3 types of surgeries
- Restrictive
- Malabsorptive - not doing anymore
- Restrictive/Malabsorptive
Restrictive/Malabsorptive Surgeries
- Gastric bypass
- duodenal switch
Restrictive Surgeries
- Gastric banding
- Gastric sleeve
- Gastric stapling
Treatment for Vitamin B12 deficiency
- Increasing dietary B12, may not be effective
2. IV replacement (severe), not oral due to malabsorption and gastric issues
Dumping Syndrome
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
Patient Education for Dumping Syndrome
- 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
Patient Education: Bariatric Syndrome
- 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
men calorie recommendation
1,200-1,600 kcal
