Obesity and Eating DOs (3 questions) Flashcards
How is obesity Dxed?
Measure weight, height, waist circumference and calculate BMI
BMI: classes of obesity
- Class 1: Obese, BMI > 30.0
- Class II : Severe Obesity, BMI > 35.0
- Class III: Morbid/Extreme Obesity > or = 40
Obesity classification in Asians
Asians obesity classification is lower: BMI 23-24
What BMI ranges are eligible for bariatric surgery?
- Class II : Severe Obesity, BMI > 35.0
- Eligible for bariatric surgery if medical treatments have failed, and severe life-threatening complications are present
- Class III: Morbid/Extreme Obesity > or = 40
- Eligible for bariatric surgery if medical treatments have failed
“heatlhy weight” BMI
BMI 18-25
“Overweight” BMI
BMI 25-30
In what populations in BMI misleading?
thletes, children, geriatric
Waist circumference: high risk if….
- Waist circumference > 102cm or 40 inches for men
- Waist circumference > 88cm or 35 inches for women
- Lower values recommended for Asians
What can waist to hip ratio be used to assess?
- key indicator to cv risk.
- Females have more rounded contours so lower ratio, males more straight ratio, so higher ratio
Complications of obesity
- Insulin resistance
- Type II DM
- Hypertension
- Dyslipidemia
- PCOS
- Lower extremity joint disease
- Venous stasis
- OSA
- Cancers: Breast, endocrine, in women; prostate, colon in men.
- GI: GERD, gallstones, fatty liver, non-alcoholic steatohepatitis
What is the most efficient / effective means to lose weight?
- Reducing energy intake
- Creating a 500kcal/day deficit can allow loss of 1lb/week.
- Its much more difficult to increase energy expenditure by 500kcal/wk through exercise
Diet review: Ornish vs WWs vs Zone vs Atkins
- Ornish- Good. Teaches you to eat healthier w/ real food not processed (digested before food). Expensive to do. Least compliance, most weight loss.
- Weight Watchers- Good compliance. Support groups. Have products.
- Zone- Good compliance. Support Group. Have products.
- Atkins-bad!
Efficacy of pharm therapy for wt loss
seldom result in greater than 10% weight loss. This is sufficient to reduce medical complications of obesity, but patients may feel disappointed by such a modest amount of loss.
Criteria for medications to lose wt
- BMI>27kg/m2
- 1 or more conditions likely to improve with weight loss
- Failure of diet and exercise
- Agree to 2-4 wk. trial of making initial changes in diet and exercise before starting medication
- Agree to continued treatment of diet, exercise, behavior modification while on medication
- Agree to periodic follow up
- Premenopausal women able to have children must use contraception
- Consider pregnancy test prior to initiation
- No contraindication to medication
FDA approved wt loss meds
- Phentermine Hydrochloride (Adipex)
- Phendimetrazine (Bontril)
- Phentermine Hydrochloride/Topiramate (Qsymia)
- Orlista (Alli, Xenical)
- Lorcaserine (Belviq)
Off-label drugs used for wt loss
- DM: Metformin, Pramlintide (Symlin)
- Antiepileptic: Topomax
- Antidepressant: Wellbutrin
- Naltrexone Bupropion Hydrochloride (Contrave)
Gold standard bariatric surgery
Roux en Y gastric bypass-Gold Standard, but losing this since sleeve gastrectomy gaining ground.
Tx of anorexia nervosa
- For emaciated pts. medical monitoring and supervised nutrition rehabilitation
- If pts. refuse to eat, NG tube placed. Continuous feeding better than bolus. Initiate feeding slowly and monitor to avoid refeeding syndrome.
- Psychotherapy, when adequate nutrition restored
- Supplemental vitamin D and calcium
What is refeeding syndrome?
metabolic complication that occurs when nutritional support is given to severely malnourished patients Metabolism shifts from a catabolic to an anabolic state. Insulin is released on carbohydrate intake, triggering cellular uptake of potassium, phosphate, and magnesium. When the serum concentrations of these electrolytes are reduced, serious complications, such as arrhythmias, can occur.
What is the gender ratio for eating disorders?
Female to male ratio 3:1