Test 3 Considerations in Obesity and Exercise Flashcards
epidemiological impact and importance of overweight and obesity in the United States
- 2/3 adults are overweight or obese
- 1/3 adults are obese
- factors that affect obesity: ↑ in age, being male, ↓ income, certain race
Discuss the long-term health consequences associated with obesity.
- coronary heart disease
- stroke
- HTN
- DM
- cancer
- thromboembolic disease
- degenerative joint disease
- obstructive sleep apnea
- OA
- metabolic syndrome
- ↑ morbidity and mortality
Identify medications commonly associated with weight gain.
- Atypical antipsychotics (e.g. risperidone)
- Antiepileptics (e.g. gabapentin)
- Appetite stimulants (e.g. megestrol acetate, dronabinol)
- Beta blockers (e.g. metoprolol)
- Birth control injectables/devices (e.g. Depo-Provera®)
- Chronic corticosteroid use (e.g. prednisone)
- Insulin (e.g. insulin lispro)
- Mirtazapine
- Opioids (e.g. oxycodone)
- Oral hypoglycemics (e.g. glipizide)
- Tricyclic antidepressants (e.g. amitriptyline)
- Selective serotonin reuptake inhibitors (e.g. citalopram
pathophysiology of obesity
Appetite → Energy storage → Energy expenditure
Calculate a patient’s body mass index (BMI)
- BMI = weight (kg) / height^2 (m^2)
- BMI = [weight (lb.) / height^2 (inches^2)] x 703
categorize a patient’s BMI
- <18.5: Underweight
- 18.5-24.9: Normal weight
- 25-29.9: Overweight
- 30-34.9: Class I obesity
- 35-39.9: Class II obesity
- ≥40: Class III (extreme) obesity
diagnostic criteria for metabolic syndrome
must have 3 of the following:
- WC >40 inches in men, >35 inches in women
- HDL <40 mg/dL in men, <50 mg/dL in women
- Triglycerides >150 mg/dL
- Systolic blood pressure > 130 mmHg or diastolic blood pressure >85 mmHg
- Fasting blood sugar >100 mg/dL
estimate the health benefits associated with weight loss
- 3kg weight loss → triglycerides reduce 15mg/dL
- 5-8kg weight loss → LDL reduced by 5mg/dL, HDL increase by 2-3 mg/dL
- 5% weight loss → systolic BP reduced by 3mmHg, diastolic BP reduced by 2mmHg
mechanisms in which medications cause weight gain
- appetite stimulant (ex. 5HT1A agonist, beta blocker, D1/D2 antagonist, opioid antagonist)
mechanisms in which medications cause weight loss
- fat absorption inhibitor: gastrointestinal lipase inhibitor
- appetite suppression
Disease-induced or “organic causes” of obesity
- hypothyroidism
- Cushing’s syndrome
- growth hormone deficiency
- psychiatric disorders (depression, schizophrenia, binge-eating disorder)
- genetic disorders
pathophysiology of obesity: appetite
- central and peripheral networks
- central, increased appetite: 5HT1A agonist (SSRI), α1/β2 antagonist (Beta blockers), D1/D2 antagonist (Atypical antipsychotics), μ-opioid agonist
- central, decreased appetite: 5HT2C agonist, α1/β2 agonist, NE/DA reuptake inhibitor, μ-opioid antagonist
- peripheral, increased appetite: Ghrelin
- peripheral, decreased appetite: Leptin, GLP1
pathophysiology of obesity: energy storage
adipose tissue
- white: responsible for manufacturing, storage, and release of lipids
- brown: more common in lean individuals, promotes energy expenditure
pathophysiology of obesity: energy expenditure
o energy balance = energy ingested - energy expended
o energy ingested: based on appetite and storage
o energy expenditure: combination of BMR and physical activity
weight loss goals
- weight reduction
- improve health
- must be realistic and meaningful
- individualized
- initial goal: 5-10% within first 6 months
