Obesity and Metabolic Syndrome Flashcards
Define metabolic syndrome
- a collection of risk factors that increases an individual’s chance of developing cardiovascular disease, stroke, and diabetes mellitus.
- most are overweight/obese
- genetics/environment
Requirements for diagnosis
3 or more of the following:
- Waist Circumference >40 (men), >35 (women)
- Triglycerides > 150 or on drug treatment
- HDL <40 (men), <50 (women) or on drug treatment
- SBP >130 or DBP >85 or on drug treatment
- FBG > 100 or Drug Tx
Drug Therapy for the following count as criteria:
- Hyperlipidemia
- HTN
- Hyperglycemia
Risk Factors for Metabolic Syndrome
- Age: 20-39 18% , > 60 46.7%
- Gender Women > than Men
- Racial and ethnic groups
- Family history: Parental history ASCVD/ DM
- Lifestyle- diet, exercise, sleep, smoking
- Medical risk factors: Obesity
- Low Economic Status
- Medications: Antipsychotics/ Antidepressants
Management of Metabolic Syndrome
- Lifestyle Modification: diet, exercise, stop Smoking
- Medications
BMI Ranges
- Underweight = <18.5
- Normal = 18.5-24.9
- Overweight: 25.0-29.9
- Obese Class 1: 30.0-34.9
- Obese Class 2: 35.0-39.9
- Morbid Obesity (Class 3): ≥40
Normal Proportions
Visceral fat
Cardiovascular Disease
Metabolic Syndrome
Waist Circumference: Ideal
<40 inches in men
<35 inches in women.
Waist-to-hip ratio (WHR)
Waist measurement/hip measurement=
<0.8 optimal
Genetic Factors
Genetics + Environment
Food
Physical Activity
Socioeconomic
Psychosocial
Eating Behavior
Energy Metabolism
Body Fat metabolism
Appetite
Many factors
Hypothalamus
Gerontologic Considerations
- Number of older obese persons has risen
- More common in women than men
- Decreased energy expenditure and loss of muscle mass are important contributors
- Exacerbates age-related problems
- Individuals who are obese live 6 to 7 fewer years than people of normal weight.
- Examples of age-related problems include arthritis, urinary incontinence, hypoventilation, and sleep apnea.
Nursing Assessment
- May withhold info out of embarrassment
- Provide acceptable reasons for personally intrusive questions
Health history:
- Time of obesity onset
- Diseases related to metabolism and obesity
- Medications
- Objective
- Height, weight, BMI, skinfold thickness, waist circumference
- History of weight gain/weight loss
- Interested in losing weight
- Contributors to weight gain
- What impedes weight loss
- Eating patterns
Nursing Assessment
- May withhold info out of embarrassment
- Provide acceptable reasons for personally intrusive questions
Health history:
- Time of obesity onset
- Diseases related to metabolism and obesity
- Medications
- Objective
- Height, weight, BMI, skinfold thickness, waist circumference
- History of weight gain/weight loss
- Interested in losing weight
- Contributors to weight gain
- What impedes weight loss
- Eating patterns
Planning
- Modify eating patterns
- Participate in regular physical activity
- Achieve weight loss
- Maintain weight loss
- Minimize/prevent health problems
Nutritional Therapy
- Motivation is Key!
- Success depends partly on amount of weight to be lost
- Eating behaviors need examination
- Goals need to be realistic and healthy
- The ability to adhere to a diet and degree of weight loss strongly depends on the patient’s motivation.
- A moderately obese person will obviously attain his or her goal more easily than a person with extreme obesity.
- The obese patient must recognize the advantages of weight loss and weight control. You can assist by helping the patient track eating patterns with a diet diary.
- Trying to lose too much too fast usually results in a sense of frustration and failure for the patient. You can help patients understand that losing large amounts of weight in a short period causes skin and underlying tissue to lose elasticity and tone. Slower weight loss offers better cosmetic results.
- Remind the patient that plateaus are normal occurrences during weight reduction.
- A weekly check of body weight is a good method of monitoring progress. Daily weighing is not recommended.
- There is no clear consensus on the number of meals to be eaten when a person is on a diet.
- No Magic diets
- Restricting dietary intake so that it is below energy requirements.
- What is a good goal for weight loss each week?: 1-2lb/week
- Portion Sizes
- Balanced Diet
- Supervision
- Multidisciplinary
- Don’t Forget Water
Diet - Weight Reduction
- High fiber, low saturated fats, low in simple sugars, increased intake of fruits and vegetables and whole grains.
- Mediterranean Diet
- DASH (Dietary approaches to stop hypertension)
- Low Glycemic Index
- High Fiber Diet 30 grams/day
Weight Reduction Methods
- Exercise-Daily for 30 minutes to an hour
- Behavior Modification:
- Assumptions:
- Learned behavior
- Cues that regulate eating
- Self monitoring
- Stimulus control
- Rewards
- Assumptions:
- Support Groups
- Encourage person to join a support group of other obese persons who are receiving help to modify eating habits
Drug Therapy
- Never used alone
-Used only in conjunction with calorie reduction diet, exercise, and behavior modification- Appetite-Suppressing Drugs
- Sibutramine (Meridia): monitor BP and HR, don’t use with CAD, HF, Stroke history - Nutrient Absorption-Blocking Drugs
- Orlistat (Xenical)-blocks enzyme that breaks down fat so undigested fat passes through body in stool)
- Appetite-Suppressing Drugs
- Reserved for BMI>30
- Drugs that increase energy expenditure are not approved (ephedrine)
- Avoid over the counter diet aids/supplements
- Do not cure obesity and without substantial changes in food intake and increased physical activity, weight gain will occur when drugs stopped.
