VP4-Emotional Well-Being, Obesity Flashcards
Tricia is a 38 year old woman with three children. She is 5’4” and weighs 190 pounds, with a BMI of 32.6. She describes herself as “always being a bigger girl” but with each pregnancy she had trouble losing the birth weight and is now at her highest weight.
She presents to your office feeling fatigued with bilateral knee pain.
She appears discouraged and makes several statements about how she should be thinner and be able to lose the weight like her step-sister did.
Besides screening for depression and stress, what option(s) could help assess her positive emotions?
A. Behavioral health assessment
B. PHQ4
C. Online quiz for Positivity Ratio
D. Online quiz for character virtues and strengths
E. Asking about her social support system
C. Online quiz for Positivity Ratio
Assessing her positive emotions could be done with an online quiz testing her positivity ratio. The ratio compares positive emotions to negative emotions. If a person has 3 to 1 ratio positive to negative emotions they are more resilient and more likely to overcome the current situation.
A behavioral health assessment is not necessary to illicit a patient’s positive emotions (Answer A).
A PHQ4 questionnaire screens for anxiety and depression (Answer B).
Character virtues and strengths do not reveal positive emotions, but may be important in helping a person build more positive emotions (Answer D).
Social support system (family and friends) may either build into or detract from emotional wellness, but don’t specifically identify positive emotions (Answer E).
What could be helpful about positive emotions in Tricia’s care?
A. Positive emotions will be helpful as they broaden and expand thinking which could help Tricia as she attempts to lose weight.
B. Negative emotions would be more helpful in driving lasting behavior change.
C. Positive emotions are protective against suicidal thoughts but not in pts with chronic medical conditions.
D. Life satisfaction and well-being cannot be increased while she is still obese.
E. Assessing positive emotions would not be helpful.
A.
Positive emotions will be helpful as they broaden and expand thinking which could help Tricia as she attempts to lose weight.
Assessing positive emotions is helpful (Answer E). Positive emotions broaden and expand thinking. This helps people be more creative and adapt at dealing with obstacles that are before them.
Negative emotions can drive behavior change, but will decrease resiliency and life satisfaction and not encourage lasting change (Answer B).
Positive emotions are protective against suicidal thoughts in patients with chronic medical conditions (Answer C).
Positive emotions can increase life satisfaction and well-being even when chronic medical condition is unchanged (Answer D).
Which statement is consistent with the USPSTF Guidelines for a person like Tricia, with a BMI of 32.6?
A. The guidelines recommend only screening adults over the age of 35 years old for obesity.
B. Adults with a BMI ≥ 30, or BMI ≥25 with CVD risk factors, should be referred to lifestyle intervention.
C. All adults should be screened for obesity and if BMI is above 30kg/m2, should be offered intensive, multicomponent behavioral interventions.
D. There is insufficient evidence to offer obesity counseling.
C.
All adults over the age of 18 (not 35 years of age) should be screened for obesity and if obese be offered intensive intervention.
This a Grade B recommendation (Answer D).
The ACA/AHA guidelines recommend that adults with a BMI of 27 with comorbidities or a BMI greater than 30 is when pharmacotherapy may be combined with intensive lifestyle therapies (Answer B).
Tricia’s work up for underlying causes of fatigue has been normal. She returns to your office to discuss ways she can lose weight. She is very interested in bariatric surgery. Currently, all her vital signs are normal. She has not been diagnosed with any other medical condition besides Obesity Class 1. Is she a candidate for bariatric surgery?
A. Yes. She has a BMI over 27
B. Yes. She has a BMI over 27, and is fatigued
C. Yes. She has a BMI over 30
D. Yes. She has a BMI over 30, and is fatigued
E. No. She is not a candidate at this time.
E.
Tricia is not a candidate at this time. The ACA/AHA recommends any patient with a BMI ≥ 40 or BMI ≥35 with one obesity-associated comorbid condition should be referred to bariatric surgery. Fatigue is a symptom. It is not considered an obesity related illness
As Tricia continues to follow up for intensive counseling for obesity management, you find out that her mother and sister are also ”heavy.” Her father is Native American. Her parents are divorced, but she denies any abuse or trauma as a child. She graduated from high school, but never pursued higher education. Currently, her family qualifies for low-income housing. Which health factor most likely has had the strongest influence over her obesity?
A. Public policy and the lack of a soda tax in her area
B. Genetics, as obesity is more prevalent among Native American’s
C. Community structure and lack of safe walking and biking trails near the low income housing
D. The lifestyle she inherited and is now living out
E. Lack of healthy coping from stressful events, like her parents divorce and pregnancy
D.
The lifestyle she inherited and is now living has likely had the greatest impact on her obesity (through epigenetics) and is the controlling factor for 70-90% of chronic disease.
Our genes are estimated to be responsible for only about 10% of the variance in chronic disease.
Public policy, lack of healthy coping skills, and lack of safe areas to walk play a part in a healthy lifestyle and weight control, but can be mostly be addressed through improving personal choices.
Tricia is ready to set an action plan for exercise for weight loss. She has already started to make significant dietary changes. Her action plan includes a SMART goal, her level of confidence and importance, identifying of her support system, and identifying barriers to change and solutions to these. What would be the additional benefits of including a Contract for Health Behavior Change?
A. Assurance patient will complete the goal
B. a legal protection in case of a lawsuit
C. a way of establishing accountability and eliciting engagement from the patient
D. reducing the amount of necessary follow up.
C.
A way of establishing accountability and eliciting engagement from the patient
Patient health behavior change contracts are not essential to action plans, but can be helpful
The data on contracts is inconclusive; they are not true contracts, but merely a means of creating commitment and accountability
A way to follow-up should also be included
In order to help Tricia be more aware of what behaviors she is changing and the thoughts and emotions surrounding them, it would be best for Tricia to:
A. Self-monitor her diet and exercise as monitoring is the most helpful skill in long-term lifestyle change.
B. Normalize eating a healthy diet.
C. Assess obstacles when she has not met her goal of changing.
D. Modify SMART goals to a level where she is consistently meeting her goals
A
She should self-monitor her diet and exercise.
Monitoring is the most helpful skill in long-term lifestyle change. The other choices could be helpful in behavior change, but will not help like monitoring could in long term behavioral change.
What is true about social support and weight loss?
A. Less weight loss is achieved when there’s family involvement.
B. Social support does not lead to better long term success while coaching for weight loss.
C. Social support can provide incentives for weight loss beyond what individuals do on their own, potentially through accountability, friendly competition and encouragement.
D. Social support is not an important part of weight loss and long-term success.
C:
Social support can provide incentives for weight loss beyond what individuals do on their own, potentially through accountability, friendly competition and encouragement. (Answer C).
More weight loss is achieved and better long-term success is seen with increased social support.
