Surgerical & Medical Management Of Obesity Flashcards
Obesity
- complex medical condition
- weight higher than consdered healthy
Limits for defining obesity
- > 100 lbs above ideal body weight
- BMI > 40kg/m2
- BMI >35kg/m2 + 1 or more co-morbid conditions
Class I obesity BMI
30-34.9
Class II obesity BMI
35-39.9
With co-morbid condition
Considered clinically severe/morbid
Class III obesity BMI
40+
Clinically severe/morbid
Complications of obesity
- pulmonary diseases
- liver diseases
- gall bladder disease
- osteoarthritis
- cataracts
- stroke
- cancer
- heart disease
- diabetes
- pancreatitis
- gout
- death
Factors influencing obesity
Genetic
Behavioral
Environmental
Other influences of obesity
- increased portion sizes
- obseogenic environment (readily available foods, high sugar)
- sedentary lifestyle
- emotions/mental health
- socioeconomic status
- smoking cessation
Nutrition therapy for obesity
- very individualized
- emphasize healthy food choices
- low carb, high protein, moderate fat
- very low calorie diets
Behavioral therapy for obesity
- helps with making life-long sustainable changes
- help with binge eating, food addiction, disordered eating
Pharmacotherapy for obesity
Reduces appetite/cravings
Physical activity for obesity
- increase metabolism
- energy balance
Bariatric/weight loss surgery for obesity
- for patients when all other options have failed
- must be well-informed and motivated
What is key to successful weight loss & maintenance?
Lifestyle modifications
What is the calorie deficiency to lose 1lb/week?
500 calories
What is the calorie deficiency to los 2lb/week?
1000
Medical nutrition therapy in obesity
- 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
What is the non-surgical weight loss goal?
1-2 lbs lost/week
What must you remember when coming up with a plan for making lifestyle modifications in obesity?
Must be willing to meet patients where they are at
Where should you try and stay on the hunger scale?
Between 3-7 (hunger pangs - completely satisfied)
Very low calorie diets
- considered safe when medically supervised
- programs typically have requirements for BMI
When would you use a very low calorie diet? (VLCD)
- more than 40 pounds to lose
- rapid weight loss 3-5lb/week
- T2D, obesity related co-morbidites: HTN, high cholesterol, high triglyercies
VLCD guidelines
- support through weekly group sessions
- meal replacements as sole source of nutrition during weight loss
- 800-900 calories/day
- monitored by medical professionals
When would you use a low calorie diet? (LCD)
- less than 40 lbs to lose
- steady gradual weight loss 2-3 lb/week
- T1D, T2D, obesity related co-morbidities
Low calorie diet guidelines
- support through weekly group sessions
- meal replacements and protein supplements incorporated with grocery foods
- 1100-1200 calories/day
- monitored by medical professionals
Common pharmacotherapy drugs for obesity
- lorcaserin Hcl
- phentermine/topiramate
- orlistat
- naltrexone/bupropion
- liraglutide
What are the two categories of bariatric surgery?
- Malabsorptive & restrictive
2. Restrictive
Examples of malabsorptive & restrictive bariatric surgeries
- Gastric bypass
- SIPS
- BPD/DS
Examples of restrictive bariatric surgery
- sleeve gastroectomy
- intragastric balloon
- LAGB (band)
How can you qualify for bariatric surgery?
- BMI >35 + 1 co-morbid condition
- BMI >40 without any co-morbid conditions
T/F as the sleeve bariatric surgery increases there is a decrease in number of readmission
False!
Increase in readmission
T/f Gastric bypass is reversible
True
T/F ulcers are not a concern with gastric bypass
False!
They are a concern. No NSAIDs, nicotine, caffeine or alcohol
Average weight loss of gastric bypass
60-70% of excess BW in 1-1.5 years
T/W at 10 years most patients regain 10-15% of BW with gastric bypass
True!
With gastric bypass which nutrients are you at risk to malabsorb?
Ca Fe B12 D Folate Thiamine
What are some potential complications of gastric bypass?
- leak
- ileus
- intractable vomiting/diarrhea
- dehydration
How long is duodenum in gastric bypass?
70cm
What do you bypass in gastric bypass?
Common channel
Why is the common channel important?
> 250cm for absorption of nutrients
How long is the roux limb in gastric bypass?
150cm
- increase malabsorption
- increase weight loss
Dumping syndrome
- 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
Sleeve gastroectomy
- newer procedure for 2 step procedure
- restrictive effect from stomach
How much of the stomach is removed in sleeve gastrectomy?
80-85%
T/F sleeve gastrectomy is reversible
False!
Irreversible
T/F malabsorption is a concern in sleeve gastrectomy
False!
Not a concern
Benefit of sleeve gastrectomy
- reduced ghrelin production (don’t feel hungry)
What is the average weight loss in sleeve gastrectomy?
50% of excess BW in 1-1.5 years
What nutrients are you concerned with in sleeve gastrectomy?
- B12
- Iron
- Thiamine
- Ca
Complications of sleeve gastrectomy
- similar to RyGB (but rare)
