1
Q
Obesity occurs..
A
when excess calories are stored as fat
2
Q
Obesity
A
- most prevalent preventable health problem in US
- increase risk of morbidity and mortality
- Nearly 70% of Americans are overweight or obese
3
Q
Pathophysiology of Obesity
A
- all body function requires energy
- excess energy (kcals)/nutrients are stored as triglycerides in fat cells
- Nutrients provide energy
- 70% of energy expended goes to maintain BMR
- Physical activity accounts for 5-10% of energy expended
4
Q
Etiology of Obesity
A
- excess energy and/or decreased energy expenditure
- appetite
- GI filling
- Hormonal factors
- emotions
5
Q
Hormonal factors and Obesity
A
- Leptin
- Insulin
- Thyroid Hormone
6
Q
Risk Factors
A
- heredity (25-40% of obesity)
- physical inactivity
- cultural factors
- environmental factors
- socioeconomic factors
- psychological factors
- addiction
- coping mechanism
7
Q
Adipose Tissue
A
- mature adipose cells do not multiply
- however, immature adipose cells multiply in presence of estrogen during puberty and late adolescents, during breastfeeding, overweight middle aged adults
8
Q
Clinical Manifestations: Upper body obesity
A
- waist hip ratio >1 in men, >0.8 in women
- increased levels of circulating free fatty acids
- increased risk of HTN, dyslipidemia, heart disease, stroke, hyperinsulinemia
APPLE
9
Q
Complications of Obesity
A
-HTN
-Coronary heart disease
-Heart failure
-Stroke
-Metabolic syndrome
-Insulin Resistance
-DM2
-Sleep apnea
-Reproductive impairment
-Gallstones
-Cancer
Joint Pain/OA
10
Q
Reproductive Impairment
A
Men: decreased androgen
Women: menstrual irregularity, polycystic ovary syndrome
11
Q
Cancer
A
- colon
- breast
- endometrial
12
Q
Obesity Management
A
- Diet
- Exercise
- Behavior modification
- Pharmacotherapy
- Surgery
13
Q
Apple vs. Pear
A
Pear is healthier, lower body weight
Apple: upper body weight
14
Q
Diagnostic Tests: Anthropometry
A
- BMI (kg divided by meters)
- Skin folds
- Hydrodensitrometry (water displacement)
- Bioelectrical impulse (low energy electrical impulse)
- Waist circumference (> or = 40 in men, 35 in women)
15
Q
Diagnostic Tests: Labs
A
- Thyroid panel
- Serum glucose
- Lipid profile
- Electrocardiography
16
Q
Pharmacologic Interventions
A
- Amphetamine and non-amphetamine appetite suppressants
- Appetite suppressant
- Fat absorption inhibitor
- OTC
17
Q
Amphetamine and non-amphetamine appetite suppressants
A
- Phentermine
- Stimulate CNS
18
Q
Appetite suppressant
A
- Meridia (Sibutramine)
- Appetite suppressant: lowers cholesterol and triglycerides, increase metabolic rate
- removed from the market in 2010 due to increased risk of heart attacks and strokes
19
Q
Fat absorption inhibitor
A
Orlistat (Xenical)
20
Q
Qysmia
A
- phentermine (stimulant) and topiramate (anti-seizure)
- avoid in pregnancy
21
Q
Belviq
A
- locaserin HCl
- seratonin 2C receptor agonist/stimulator
22
Q
Methycellulose
A
bulk-forming product
-creates sensation of fullness
23
Q
Nutrition
A
- regular, small servings
- create 500-1,000 calories deficit
- “yo-yo” dieting may result in metabolic deficiencies that make subsequent weight loss more difficult
24
Q
women calorie recommendation
A
1,000-1,200 kcal
25
less than 1,200 cals
may result in lean tissue loss and nutritional deficits
26
Aerobic Exercise
30-40 minutes five or more days per week
increases BMR
increases energy consumption
preserve lean muscle mass
27
Behavioral modifications
- food diary
- replace eating with other habits
- identify triggers
28
Surgery
morbidity obese and unable to lose weight through dieting or exercising
or
have serious obesity-related complications
29
Contrave
naltrexone, an opioid antagonist, and bupropion, an antidepressent
30
Post-Operative Interventions
- monitor vitals
- monitor I&O
- Assess bowel sounds
- monitor NG tube as ordered
- NPO for 3 days or until peristalsis returns
31
Complications of Post-op Bariatric Surgery
1. infection and/or hemorrhage
2. dumping syndrome
3. Diarrhea
4. hypoglycemia
5. dehydration
6. gastric leak leading to infection/sepsis or ulceration
32
Deficiencies caused by Bariatric Surgery
1. Vitamin B12 (most significant)
2. Calcium
3. Iron
4. fat-soluble vitamins (A,D,E,K???)
33
Saxenda
liraglutide
- glucagon-like peptide-1 receptor agonist
- daily SQ injection
- not recommended as first line therapy
34
Vitamin B12
-decreased absorption of Vit B12 from intestinal tract
signs and symptoms:
- pallor,
- fatigue,
- weight loss,
- smooth,
- beefy tongue,
- slight jaundice,
- paresthesia of hands and feet
- disturbances of gait and balance
35
3 types of surgeries
1. Restrictive
2. Malabsorptive - not doing anymore
3. Restrictive/Malabsorptive
36
Restrictive/Malabsorptive Surgeries
- Gastric bypass
| - duodenal switch
37
Restrictive Surgeries
- Gastric banding
- Gastric sleeve
- Gastric stapling
38
Treatment for Vitamin B12 deficiency
1. Increasing dietary B12, may not be effective
| 2. IV replacement (severe), not oral due to malabsorption and gastric issues
39
Dumping Syndrome
rapid emptying of gastric contents into small intestines following gastric resection
-water drawn into intestines through osmosis
- typically happens 30 min post prandial
- N/V
- Abdominal fullness/cramping
- Diarrhea
- Palpitations
- Tachycardia
- Perspiration
- Weakness
- Dizziness
- Borborgyums - noises of gas and fluids through bowels
40
Patient Education for Dumping Syndrome
- avoid sugar, salt, and milk
- eat a high protein, high good fat, and low carb diet
- eat small meals
- avoid consuming fluids with meals
- avoid very hot or very cold foods/drinks
- lie down after meals
- take antispasmodic medications as prescribed
41
Patient Education: Bariatric Syndrome
- avoid alcohol and carbonated beverages
- Avoid foods high protein, saturated fat (fried foods), and sugar foods/drinks (fruit juice) and avoid simple carbs
- eat slowly and chew well
- take nutritional supplements
- progress diet as ordered
- monitor for s/s complications
42
men calorie recommendation
1,200-1,600 kcal
MS1 Exam Three
flashcards
Decks in class (9)
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