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PT: Nutrition Exam 1 > Surgerical & Medical Management Of Obesity > Flashcards

Surgerical & Medical Management Of Obesity Flashcards

1
Q

Obesity

A
  • complex medical condition

- weight higher than consdered healthy

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2
Q

Limits for defining obesity

A
  • > 100 lbs above ideal body weight
  • BMI > 40kg/m2
  • BMI >35kg/m2 + 1 or more co-morbid conditions
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3
Q

Class I obesity BMI

A

30-34.9

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4
Q

Class II obesity BMI

A

35-39.9
With co-morbid condition
Considered clinically severe/morbid

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5
Q

Class III obesity BMI

A

40+

Clinically severe/morbid

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6
Q

Complications of obesity

A
  • pulmonary diseases
  • liver diseases
  • gall bladder disease
  • osteoarthritis
  • cataracts
  • stroke
  • cancer
  • heart disease
  • diabetes
  • pancreatitis
  • gout
  • death
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7
Q

Factors influencing obesity

A

Genetic
Behavioral
Environmental

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8
Q

Other influences of obesity

A
  • increased portion sizes
  • obseogenic environment (readily available foods, high sugar)
  • sedentary lifestyle
  • emotions/mental health
  • socioeconomic status
  • smoking cessation
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9
Q

Nutrition therapy for obesity

A
  • very individualized
  • emphasize healthy food choices
  • low carb, high protein, moderate fat
  • very low calorie diets
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10
Q

Behavioral therapy for obesity

A
  • helps with making life-long sustainable changes

- help with binge eating, food addiction, disordered eating

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11
Q

Pharmacotherapy for obesity

A

Reduces appetite/cravings

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12
Q

Physical activity for obesity

A
  • increase metabolism

- energy balance

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13
Q

Bariatric/weight loss surgery for obesity

A
  • for patients when all other options have failed

- must be well-informed and motivated

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14
Q

What is key to successful weight loss & maintenance?

A

Lifestyle modifications

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15
Q

What is the calorie deficiency to lose 1lb/week?

A

500 calories

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16
Q

What is the calorie deficiency to los 2lb/week?

A

1000

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17
Q

Medical nutrition therapy in obesity

A
  • regular structured eating
  • high protein, low carb
  • lean protein, veggies, fruits, low fat dairy, whole grains
  • limit sweets, processed food, fast food
  • decrease portion sizes
  • mindful and intuitive eating
  • self-monitoring
  • regular physical activity
  • possibility to be combined with medications
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18
Q

What is the non-surgical weight loss goal?

A

1-2 lbs lost/week

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19
Q

What must you remember when coming up with a plan for making lifestyle modifications in obesity?

A

Must be willing to meet patients where they are at

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20
Q

Where should you try and stay on the hunger scale?

A

Between 3-7 (hunger pangs - completely satisfied)

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21
Q

Very low calorie diets

A
  • considered safe when medically supervised

- programs typically have requirements for BMI

22
Q

When would you use a very low calorie diet? (VLCD)

A
  • more than 40 pounds to lose
  • rapid weight loss 3-5lb/week
  • T2D, obesity related co-morbidites: HTN, high cholesterol, high triglyercies
23
Q

VLCD guidelines

A
  • support through weekly group sessions
  • meal replacements as sole source of nutrition during weight loss
  • 800-900 calories/day
  • monitored by medical professionals
24
Q

When would you use a low calorie diet? (LCD)

A
  • less than 40 lbs to lose
  • steady gradual weight loss 2-3 lb/week
  • T1D, T2D, obesity related co-morbidities
25
Q

Low calorie diet guidelines

A
  • support through weekly group sessions
  • meal replacements and protein supplements incorporated with grocery foods
  • 1100-1200 calories/day
  • monitored by medical professionals
26
Q

Common pharmacotherapy drugs for obesity

A
  • lorcaserin Hcl
  • phentermine/topiramate
  • orlistat
  • naltrexone/bupropion
  • liraglutide
27
Q

What are the two categories of bariatric surgery?

A
  1. Malabsorptive & restrictive

2. Restrictive

28
Q

Examples of malabsorptive & restrictive bariatric surgeries

A
  • Gastric bypass
  • SIPS
  • BPD/DS
29
Q

Examples of restrictive bariatric surgery

A
  • sleeve gastroectomy
  • intragastric balloon
  • LAGB (band)
30
Q

How can you qualify for bariatric surgery?

A
  • BMI >35 + 1 co-morbid condition

- BMI >40 without any co-morbid conditions

31
Q

T/F as the sleeve bariatric surgery increases there is a decrease in number of readmission

A

False!

Increase in readmission

32
Q

T/f Gastric bypass is reversible

A

True

33
Q

T/F ulcers are not a concern with gastric bypass

A

False!

They are a concern. No NSAIDs, nicotine, caffeine or alcohol

34
Q

Average weight loss of gastric bypass

A

60-70% of excess BW in 1-1.5 years

35
Q

T/W at 10 years most patients regain 10-15% of BW with gastric bypass

A

True!

36
Q

With gastric bypass which nutrients are you at risk to malabsorb?

A 
Ca
Fe
B12
D
Folate 
Thiamine
37
Q

What are some potential complications of gastric bypass?

A
  • leak
  • ileus
  • intractable vomiting/diarrhea
  • dehydration
38
Q

How long is duodenum in gastric bypass?

A

70cm

39
Q

What do you bypass in gastric bypass?

A

Common channel

40
Q

Why is the common channel important?

A

> 250cm for absorption of nutrients

41
Q

How long is the roux limb in gastric bypass?

A

150cm

  • increase malabsorption
  • increase weight loss
42
Q

Dumping syndrome

A
  • bypass pyloric sphincter so this can occur
  • eat too large of portion of food (high in sugar or fat) and food dumps into new part of SI
  • NVD, shaking
43
Q

Sleeve gastroectomy

A
  • newer procedure for 2 step procedure

- restrictive effect from stomach

44
Q

How much of the stomach is removed in sleeve gastrectomy?

A

80-85%

45
Q

T/F sleeve gastrectomy is reversible

A

False!

Irreversible

46
Q

T/F malabsorption is a concern in sleeve gastrectomy

A

False!

Not a concern

47
Q

Benefit of sleeve gastrectomy

A
  • reduced ghrelin production (don’t feel hungry)
48
Q

What is the average weight loss in sleeve gastrectomy?

A

50% of excess BW in 1-1.5 years

49
Q

What nutrients are you concerned with in sleeve gastrectomy?

A
  • B12
  • Iron
  • Thiamine
  • Ca
50
Q

Complications of sleeve gastrectomy

A
  • similar to RyGB (but rare)

PT: Nutrition Exam 1 (12 decks)

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