obesity and management pt 1 Flashcards
how is excess adipose tissue determined?
BMI
waist circumference
visual inspection of pt
3 risk factors for obesity
- gender - female
- ethnicity - black, native american, mexican american
- financial - lower income
BMI may ___ weight in pts with high muscle mass while it can ____ weight in pts with low muscle mass
overestimate
underestimate
BMI categories
- underweight = <18.5
- normal = 18.5-24.5
- overweight = 25 - 29.9
- obese = >30
- Class I = 30 - 34.9
- class II = 35 - 39.9
- class III = >40
what type of fat is more concerning than subcutaneous fat
visceral fat
what type of fat is more concerning than glutofemoral fat distribution
truncoabdominal
what are the most important factors of the etiology of obesity
- lifestyle
- diet
genetics also thought to pkay a role in 40-70% of obesity cases
7 conditions linked to onset of obesity
- Hypothalamic obesity
- Cushing’s Syndrome
- Hypothyroidism
- Polycystic Ovarian Syndrome
- Growth Hormone Deficiency
- Altered Gut Flora
- Psychiatric Disease
3 psychiatric meds linked to onset of obesity
- Antipsychotics - clozapine, olanzapine, risperidone
- Mood stabilizers - lithium, valproate, carbamazepine
- Antidepressants - TCAs, SSRIs
2 diabetic meds linked to onset of obesity
- Insulins - especially intensive insulin therapy
- Oral - sulfonylureas, thiazolidinediones (TZDs)
3 other meds linked to onset of obesity
- Glucocorticoids
- beta-blockers
- hormonal agents
3 females factors that influence onset of obesity
- Pregnancy - mild weight gain effect
- Excess weight gain = increased postpartum retention - Oral Contraceptives - minimal
- Menopause - consistent weight gain, even if taking HRT
2 male factors that influence onset of obesity
- Lifestyle - typically become more sedentary over time
- Testosterone - declines with age → more fat, less muscle
2 ethnicities that influence onset of obesity
- Hispanic - increased propensity to be obese
- Blacks - increased obesity in females, less obesity in males
Onset - younger age of obesity onset in Hispanic and black women as compared to white women
3 socioeconomic status factors that influence onset of obesity
- Literacy/Education - regarding food choices and activity
- Financial - affordability of healthy food choices, gyms
- Environment - availability of fresh foods, sidewalks, parks
5 behavioral factors that influence onset of obesity
- Physical Activity - sedentary lifestyle promotes wt gain
- Sleep Deprivation - negative metabolic consequences
- Smoking Cessation - average 4-5 kg weight gain
- Diet - diet high in fats and sugars associated with obesity
- Eating Habits - overeating, night-eating, binge-eating
what hormone increases hunger and appetite
ghrelin
what hormone suppresses hunger
leptin
3 metabolic/homeostatic factors that influence onset of obesity
- Adaptation - losing 10-20% of body weight slows BMR
- Gut hormones - leptin, ghrelin, orexin, GLP-1, np-Y, etc.
- Gut flora - abnormal microbiome is correlated with obesity
7 factors that influence adult-onset obesity
- meds
- gender
- ethnicity
- socioeconomic status
- behavioral
- genetics
- metabolic/homeostatis
metabolic syndrome must meet criteria of at least 3 out of 5
- Central (abdominal) obesity
- Low HDL
- Hypertension
- Hyperglycemia
- Hypertriglyceridemia
BMI of 25-29.9 with no CVD, no obesity-related comorbidities, what is the intervention
counseling on avoiding wt gain, diet advice, physical activity recommendations
BMI of 25-29.9 with 1+ CVD risk factors, or BMI of 30-34.9 get what intervention
Specific tools and strategies for dietary changes, increased physical activity from baseline (even if already active), behavioral intervention, pharmacotherapy
BMI of 35+ get what intervention?
specific diet and exercise plans, multicomponent behavioral intervention, pharmacotherapy, bariatric surgery
