Obesity & Undernutrition

Question 1

What is primary obesity ?

Answer 1

most prevalent
- excess calorie intake over expenditure for the body’s metabolic demand

Question 2

What is secondary obesity ?

Answer 2

due to a medical problem
- Ex.) endocrine disorders, CNS lesions/disorders/meds, chromosomal/congenital anomalies

Question 3

What is Leptin ?

Answer 3

our appetite suppressant
- increases fat metabolism
- a deficiency or resistance to this can cause obesity

Question 4

What is the Hypothalamus linked to obesity ?

Answer 4

our appetite stimulant
- if there is an imbalance (Neuropeptide Y) then it can cause overeating

Question 5

What is Ghrelin ?

Answer 5

inhibits leptin
- found in the gut
- gastric bypass surgery decreases ghrelin

Question 6

What can obesity cause ?

Answer 6

• increases fat mass (adipocytes) which increases adipokines
• increases adipokines contribute to insulin resistance and atherosclerosis, disrupts immune factors and predispose to certain cancers

Question 7

What are the values for BMI ?

Answer 7

• > 25: overweight
• > 30: obese
• > 40: extreme obesity

Question 8

What are the values for waist circumference for obesity ?

Answer 8

> 35 inches in women and >40 in men
- bigger adverse outcomes for heart attacks and other cardiac events

Question 9

What is the waist-to-hip ratio for determining obesity ?

Answer 9

waist measurement/hip measurement
- < 0.8 is optimal and >0.8 indicates truncal fat

Question 10

What types of diseases can an apple body shape cause ?

Answer 10

carries fat more above waist
- heart disease
- DM
- breast cancer
- endometrial cancer
- HTN
- hyperlipidemia

Question 11

What types of conditions can a pear body shape cause ?

Answer 11

carries fat more below waist
- osteoporosis
- varicose veins
- cellulitis

Question 12

What are some health risks associated with obesity ?

Answer 12

• sleep deprivation from obstructive sleep apnea can lead to overeating (cause of decrease in leptin)
• reduced chest wall compliance
• increase work of breathing
• cancers due to increase estrogen
• colorectal cancer due to hyperinsulin
• insulin and adipolines can stimulate cancer call proliferation

Question 13

What conditions must be met to have medication intervention for weight loss ?

Answer 13

• adults with a BMI 27 or greater with at least 1 weight-related condition
• BMI of 30 of greater

Question 14

What are some considerations for a nutrient absorption-blocking med ?

Answer 14

Orlistat: Xenical: Alli
- blocks fat breakdown and absorption in the GI tract
- can cause: diarrhea, bloating, flatulence, liver damage, and fatty stools

Question 15

What are some consideration for use of Bupropion/Naltrexone (Contrave) ?

Answer 15

an antidepressant/opioid antagonist
- works on the brain to decrease cravings
- can cause: dry mouth, HA, and constipation

Question 16

How does Plenity aid in weight loss ?

Answer 16

increases volume of stomach and small intestine contents
- gel pieces taken with meals

Question 17

What are some consideration for use of Qysmia ?

Answer 17

Phenermine (sympathomimetic) & Topiramate (anti-seizure/migraine med)
- (phenermine) increases metabolism and (topiramate) decreases appetite
- addictive
- can cause: restlessness, tachycardia, palpations and insomnia

Question 18

What is Semaglutide used for in weight loss ?

Answer 18

Wegovy
- induces satiety by slowing gastric motility
- same as Ozempic but a higher dose
- weekly injection
- can cause: hypoglycemia if used with other diabetic meds, gastroparesis and GI distress
- can slow food down so much it can cause paralytic ileus

Question 19

What is the criteria for Bariatric surgery ?

Answer 19

• BMI 40 or greater
• BMI 35 with 1 or more severe obesity-related medical condition
• psychological screening to ensure patient can commit to lifelong behavior change and screen for depression and addiction and ability to cope with new body image
• no advanced cancers, liver and kidney disease and cardiopulmonary disease

Question 20

What is the lap band technique ?

Answer 20

band goes around top part of stomach which causes food to go through the stomach but slower
- will feel full longer
- port is under skin

Question 21

What is the gastric sleeve technique ?

Answer 21

• portion of stomach is cut out so causes decreased absorption of food

Question 22

What is the gastric plication ?

Answer 22

similar to gastric sleeve
- but stomach is folded and not cut
- reversible

Question 23

What is the intragastric ballon ?

Answer 23

ballon is inserted into the stomach that is filled with about 400-700 mL saline
- leads to feeling of fullness

Question 24

What is the Gastric Bypass 1 (with duodenum) ?

Answer 24

majority of stomach is cut out and left with a tiny stomach
- food passes through duodenum as usually but smaller stomach leads to feeling full faster

Question 25

What is a Gastric Bypass 2 (bypass duodenum) ?

Answer 25

smaller gastric pouch is where food goes and this pouch is surgically connected to the jejunum
- bypass portion of the stomach
- we bypass the duodenum and go straight into the jejunum which reduces absorption
- only the digestive juices go through the duodenum while food though the jejunum

Question 26

What is dumping syndrome ?

Answer 26

gastric contents empty too rapidly into the small intestine which decreases absorption
- can cause pt’s to never eat normally again
- not every pt will experience this but some can
- pt’s will follow everything we tell them but they may still get this
- can cause: N/V, weakness, diarrhea

Question 27

What can be done Post-Op to prevent Dumping Syndrome ?

Answer 27

• low sugar, and low carb
• small meals (6 per day)
• chew well
• rest after eating (moving causes foods to move along the GI tract faster and digest faster)
• drink beverages between meals, not with meals (drinks can cause the food to flush along the GI tract faster and not digest/absorb)

Question 28

How long does a patient need to be NPO after a gastric bypass surgery ?

Answer 28

until bowel sounds return

Question 29

How long will a pt remain on a liquid diet after a gastric bypass ?

Answer 29

7-10 days

Question 30

When can a pt return to a regular diet after gastric bypass ?

Answer 30

4-6 weeks

Question 31

What is Metabolic Syndrome ?

Answer 31

collection of risk factors that increase an individual’s chance of developing cardiovascular disease, stroke and diabetes

Question 32

What medications are used to Tx Metabolic Syndrome ?

Answer 32

will focus on treating BP, cholesterol, and glucose
- “statin” to decrease cholesterol
- “Metoprolol, or Lisinopril” to decrease BP
- Metformin to increase sensitivity to insulin

Question 33

What is primary/starvation related Protein-Calorie Malnutrition (PCM) ?

Answer 33

• chronic starvation
• no inflammation (anorexia nervosa)

Question 34

What is secondary/chronic disease-related PCM ?

Answer 34

calorie intake should be enough but tissues aren’t met due to disease process
- cancers, RA

Question 35

What is acute disease/injury-related malnutrition ?

Answer 35

• burns
• trauma
• major infections

Question 36

What are clinical manifestations of malnutrition ?

Answer 36

• dry, scaly skin rashes
• crusting/ulceration around the mouth
• thin hair/loss
• brittle nails
• sunken eyes
• decreased body temp
• decreased muscle mass
• mental status changes (difficulty concentrating, irritable, confused)
• delayed wound healing
• susceptible to infection

Question 37

What are some expected lab values in malnutrition ?

Answer 37

• low Iron, RBC, Albumin vitamins and WBC
• BUN will be high at 1st due to dehydration then both will go low
• in prolonged starvation the Na-K pump stop working so K will increase and Na is low
• short term malnutrition the K will be low

Question 38

What is Nasogastric (NG) tube used for ?

Answer 38

• temporary
• good suction/decompress the abdomen
• good absorption of medications and tube feedings

Question 39

What is a Naso-Jejunal/Duodenal tube used for ?

Answer 39

• temporary
• goes past the stomach
• less risk of aspiration
• cannot be used for suction

Question 40

What is a gastrostomy tube used for ?

Answer 40

long term nutritional support

Question 41

What is a Jejunostomy tube used for ?

Answer 41

long term nutritional support