Weight Control Exam 4 - Thearupretic Approaches

Purpose of metabolic/bariatric surgery

• multiple comorbidities

• unsuccessful attempts with diet and exercise

• morbidly obese successful maintenance post surgery

• biological chances

• alternations in hormone signaling (hunger hormones)

• reduction in healthcare costs (less medications)

candidates for metabolic/bariatric surgery

• BMI of greater than of equal to 35 kg/m²

• BMI of 30-34.9 kg/m² with metabolic disease

• children and adolescents if appropriate

• risk to beneift (does the benefit outweigh the risk)

• compliance (life long commitment)

BMI criteria for metabolic/bariatric surgery

• BMI of greater than of equal to 35 kg/m²

• BMI of 30-34.9 kg/m² with metabolic disease

BMI criteria for Asian population

• greater than or equal to 25 kg/m² suggests clinical obesity

• greater than or equal to 27.5 kg/m² be offered MBS

role of obesity-related comorbitidies

• increase early mordity

• result of weight

lifestyle changes before and after surgery

• before you must build the healthy habits so you can sustain them after surgery

• if the diet is not followed after surgery the client can develop an infection which can lead to sepsis and death

two types of surgery

• roux-en y gastric bypass (RYGB)

• sleeve gastrectomy

roux-en Y gastric bypass (RYGB)

• most common metabolic and bariatric sugical procedure in the U.S.

• both restrictive and malabsorptive

• few risk, great benefits

• food path from sotamch to intestine altered

  • small puch about the size of an egg

• can be reversed

sleeve gastrectomy

• restritive procedure

• hormonal componenet

• small stomach

  • about 2/3 - ¾ removed

  • 100 - 150 mL remaining

• decreased appetite - ghrelin

• not reversible

restrictive procedures

• sleeve gastrectomy

• Roux-en- Y Gastric Bypass

malabsorptive procedures

• Roux-en Y Gastric Bypass

combination procedures

• only one

• Rouz-en Y Gastric Bypass

infection

around the incisional area

blood clots

• depe vein thrombosis

• most serious

• shortly after surgery

• get patient walking as soon as possible

ulcers

• acid production

nutrient deficiencies

• ongoing attention needed

• iron

• calcium

• B12

• folate

• vitamin D

nutrition after surgery

gradual increase of food

diet phases

1. clear liquid diet

2. full liquid diet

3. pureed diet

4. soft diet

5. maintenance diet

clear liquid diet

• first phase

• to be followed: 2 days

• purpose: hydration with minimal stress on surgical site

• water, sf Jell-O, clear broth, sf electrolyte drinks

full liquid diet

• second phase

• to be followed: begin day 3 and follow for 1 week until 1st post op visit

• purpose: promote recovery

• protein shakes, nutrient drinks, skim milk, pureed yogurt, cream soups with nothing in them

pureed diet

• third phase

• to be followed: 10 days

• purpose: eat slow and time how the individual eats

• high quality protein:

  • greek yogurt, chicken, eggs, cottage cheese

• can’t eat and drink at the same time

soft diet

• fourth phase

• to be followerd for 2 weeks

• purpose: portion control

• soft veggies/fruits, ground meats (no tough meats), soft fish

• NO SKINS

• avoid raw veggies

maintenance diet

• fifth phase

• to be follow for life

• high protein

• low sugar

• no carbonation

• no caffeine

• hydration is key

• minimal alcohol if any

• avoid high fat and high sugar foods

dumping syndrome after gastric bypass

• nausea

• dizziness

• cold sweats

• weakness

• increased pulse

• very common

• due to rapid movement of digestion

• foods in high simple sugars, refined carbs, large meals, and eating too quickly trigger this

physical activity after surgery

• low PA levels pre and post surgery

  • despite health benefits

  • help cardiovascular fitness and promote muscle mass

• would benefit from increased PA levels

  • short, but frequent walks to avoid blood clots

  • structure aerobic exercise and resistance training

• more research needed

vitamin/mineral supplementation after surgery

• supplementation for rest of life

• directed by registered dietitian

• blood tests to assess and make changes when necessary

• must be vigilant about taking prescribed vitamin and mineral supplements

long-term follow-up

• regular visists

  • assess progress

  • discover complications or nutritional deficiencies

• avoid behaviors that will result in weight gain

  • lifestyle

  • habits should be in place

pregnancy after surgery

• avoid for 1-2 years post surgery

• usually put on birth control

• can be high risk due to the weight loss and deficiencies

weight maintenance

• lifestyle habits

• follow the diet needed

purpose of weight-loss medications

• management not cure obesity

• help with comorbidities

candidate criteria for weight-loss medications

• BMI > 30 kg.m² OR > 27 kg/m² with obesity related comorbidities

• diet and exericse - lifestyle changes

• consultation with physician

• not for pregnant or nursing moms

  • risk for fetal and infant development

importance of combining medication with lifestyle modification

• offer best results

• will not solve the problem on it’s own

orlistat

Brand names: Xenical and Alli

mechanism of action for orlistat

• fat blocker

• works directly in GI tract

• blocks pancrease

general side effects of orlistat

• gas

• oily stools

• abdominal cramping

• difficulty holding bowerls

• affects absorption of fat soluable vitamins (A, D, E, K)

Liraglutide

Brand name: Saxenda

mechanism of action for liraglutide

• signals brain to telll stomach full

• work with hunger regulation

• injection

general side effects of liraglutide

• nausea

• vomitting

• diarrhea

• constipation

• decrease in blood pressure

• increase in appetite

when to stop taking liraglutide

• discontinue after 16 weeks if < 4 % BW not lost

Naltrexone/Bupropion

Brand name: Contrave

mechanism of action for naltrexone/bupropion

• appertite supressant and reduce cravings

• combination of medications

general side effects of naltrexone/buproprione

• nausea

• constipation

• headache

• vomitting

• dizziness

• insomnia

• dry mouth

• increase risk of suicidal thoughts and behaviors

• increase neuropsychiatric behaviors (bupropion)

• increase blood pressure and heart rate (monitor)

• avoid if history of seizures

• discontinue after 12 weeks if < 5 % of BW not lost

who shouldn’t take naltrexone/buproprione

• avoid if history of seizures

When should you stop taking naltrexone/buproprione

• discontinue after 12 weeks if < 5 % of BW not lost

Phentermine

Brand name: Adipex

mechanism of action of phentermine

• appetite suppressant (anorectic)

• stimulate CNS

• increases epinephrine

• increases energy, decreases hunger

general side effects of phentermine

• dry mouth

• diarrhea

• constipation

• vomitting

• increase in heart rate

• papiltations

• SOB

• chest pain

• insomnia

• risk of addiction or abuse - can cause withdrawal

who should avoid taking phentermine

• heart disease

• congestive heart failure

• pregnant or nursing

Phetermine/Topiramate

Brand name: Qsymia

mechanism of action of phentermine/topiramate

• appetite suppressant, feel full, increase metabolism

general side effects of phentermine/topiramate

• tingling of hands and feet

• dizziness

• alterated sense of taste

• insomnia

• constipation

• dry mouth

• birth defects

• increase in heart rate

• suicidal thoughts or actions

• eye problems

who should avoid taking phentermine/topiramate

• history of:

  • glaucoma

  • hyperthyroidism

  • CAD

  • stroke

when to stop taking phentermine/topiramate

• after 12 weeks if <5% BW not los, increase does thne if still no gradually wean