APK4120 Obesity and MET

How is overweight and obesity defined by WHO?

excessive fat accumulation that is a risk to health

Obesity is commonly rated using the _______

body mass index (BMI)

What is the equation for BMI?

kg/m²

_______ and ______ can be useful to determine risk for obesity

body composition; waist circumference

What is the body shape that carries excess adipose tissue in the mid section and has an increased risk for obesity, T2 diabetes, and chronic issued?

android (apple)

Men with a waist circumference of greater than or equal to ____ are at an increased risk of obesity

40 in (100 cm)

Women with a waist circumference of greater than or equal to ____ are at an increased risk of obesity

35 in (188 cm)

Obesity can occur in _______

childhood

____% of obesity occurrences begin in adulthood

70

What are the 5 multifactorial influences of obesity?

1. decreased physical activity

2. increased food intake

3. societal influences

4. individual psychology

5. biology

Obesity can be the result of a longstanding __________

energy imbalance (positive energy balance)

What are 3 conditions obesity increases the risk of?

1. diabetes

2. hypertension

3. dyslipidemia

What are the s/s of obesity?

fatigue, dyspnea, difficulty with PA

How should you review risks for obesity with a patient?

assess physical factors at each visit, assess exercise history

You should determine an obese pt’s readiness to change by asking “_____”

have you been trying to lose weight?

What are the general options for obesity treatment?

diet therapy, behavioral therapy, exercise therapy, pharmacotherapy, surgical therapy

What treatment option is typically reserved for severely obese?

surgical therapy

A BMI of ≤ ____ kg/m² is considered normal weight

25

For obesity treatment, you need to determine goals with respect to pt ______ and ______

expectations; timeline

patients commonly want to lose ____% of current weight

35

The beginning of more drastic measures for obesity begins at a BMI of ___

27

Calorie reduction for diet therapy should be based on measured or estimated _____ and _____

RMR; physical activity

_______ kcal deficit for 1 lb weight loss

~3,500

What are the 2 types of diet therapy?

1. hypocaloric

2. meal replacements

With a hypocaloric diet restrict to ___ to __ kcal/d

500; 750 (burn more than you take in)

What are the 2 types of meal replacements?

1. partial

2. complete (VLCD)

What does VLCD stand for?

very low calorie diet

What do you do for a partial meal replacement?

You replace one or two meals per day with a meal replacement product while maintaining a balanced diet for the remaining meals.

What do you do for a complete meal replacement?

You replace all meals with a meal replacement product, ensuring it meets all nutritional needs. (<1000 cal)

Meal replacements are more effective for pts with _______ because they take away having a _____

significant weight to lose; choice

What is behavioral therapy?

use of behavior change theories to promote adherence

What are the 5 stages of change according to the transtheroretical model?

1. precontemplation

2. contemplation

3. preparation

4. action

5. maintenance

What are the 4 behavior change theories?

1. stages of change (transtheoretical model)

2. cognitive restructuring

3. individual or group therapy

4. lapse/relapse planning

What behavior change theory is used to avoid all-or-nothing mindset?

cognitive restructuring

What behavior change theory is used for accountability, motivation, and skill-building?

individual or group therapy

What behavior change theory is used for problem-solving?

lapse/relapse planning

Behavioral therapy addresses ______, ______, _____, and _________

emotional; societal; familial; environmental issues

Weight loss does not occur in a ______

vacuum

There is an accelerated rate of weight loss when _______ combined with diet and behavior change

exercise therapy

________ are recommended for BMI ≥ 30

weight loss drugs

GLP-1 agonist slows ________ so that the food is in the GI tract longer, so you are full longer, and don’t want to eat

gastric emptying

What are the 2 types of GLP-1 agonist?

1. Ozempic/Wegovy (semaglutide)

2. Zepbound (tirzepatide)

Ozempic can have unfortunate side effects for people without ______ such as blindness, bowel obstruction

diabetes

The ______ effect that occurs with taking medications for weight loss can be more dangerous than ex rx

yo-yo

______ is the fastest-growing area of obesity treatment

surgical therapy

Surgical therapy can lead to a possible loss of >___% excess weight

50

10 yr loss due to surgical therapy ranges from ___% to ___%

15; 25

Surgical therapy has a ___% death risk and ___% morbidity risk

1; 15

What are the 2 most common effects of surgical therapy for obesity?

1. restrictive

2. malabsorptive

Most surgical therapy for obesity occurs ________

laparoscopically (only requires small incisions)

What is the restrictive effect in regard to surgical therapy?

synch stomach to ensure small food intake (golfball)

What is the malabsorptive effect in regard to surgical therapy?

a reduction in nutrient absorption through the intestines, leading to weight loss

Roux-en-Y Gastric Bypass (RNY)

• stomach stapled to size of an egg

  • reduces the amount of food you can eat

• reduced portion stapled directly to jejunum (bypassing duodenum; reduces food absorption)

• restrictive and malabsorptive

Laproscopic Adjustable Gastric Band

• silicone band placed around stomach to reduce amount of food you can eat at one time

  • adjustable band placed around stomach

  • port placed below skin to adjust band

• fast recovery bc no manipulation of tissues

• pts must inhibit their food intake

  • eat many small meals throughout the day

  • adequate nutrition requires supplements

• restrictive

Vertical Sleeve Gastrectomy

• ¾ of stomach is removed with remaining portion shaped into a sleeve

• reduces ghrelin levels

  • removes hormonal affects from impacting diet

• pt can eat more food than with bypass/lap band

What is a collection of interrelated cardiometabolic risk factors that are present in a given individual more frequently than may be expected with a change of combination?

metabolic syndrome

MET Syndrome is a collection of ________ cardiometabolic risk factors

interrelated

MET Syndrome usually occurs in the presence of ____ or ______

overweight; obesity

Nearly ____% of adults 20+ years old have MET Syndrome

35

MET Syndrome is likely a combination of ________, ______, and ________

obesity/abdominal adiposity; insulin resistance; mitochondrial dysfunctoin

What are the 6 contributors to MET syndrome that increase the likelihood of interrelated cardiometabolic risk factors?

1. age

2. physical inactivity

3. obesity

4. insulin resistance

5. oxidative stress

6. chronic inflammation

For a diagnosis of MET Syndrome you must have ___/5 interrelated cardiometabolic risk factors

3

What are the 5 interrelated cardiometabolic risk factors for MET Syndrome?

1. abdominal obesity

2. high fasting blood sugar

3. low HDL cholesterol

4. high blood pressure

5. high triglycerides

MET Syndrome can lead to what 2 conditions?

1. Type 2 diabetes

2. Atherosclerotic Cardiovascular Disease (ASCVD)

What are the 5 measures that contribute to MET Syndrome?

1. elevated waist circumference

2. elevated triglycerides (or drug tx for elevated triglycerides)

3. reduced HDLc (or drug tx for reduced HDLc)

4. High blood pressure (or drug tx for hypertension)

5. elevated fasting glucose (or drug tx for elevated glucose)

The presence of ___+ abnormal findings reflects the presences of MET syndrome

3

MET Syndrome treatment is similar to the treatment for _____

obesity

When treating MET Syndrome you should promote ______ and ________

weight loss; physical activity

_____ quality is important when treating MET Syndrome

diet

Similar to the treatment for obesity, you can use __________ and for more severe cases ________

pharmacological agents; surgical procedures

For both obesity and MET Syndrome, routine ______ is not necessary but is helpful

exercise testing

For both obesity and MET Syndrome, alternative modes of exercise testing should be available for those with difficulty ______

walking

For both obesity and MET Syndrome, IF testing occurs, it should follow standardized _______ protocols and procedures

treadmill

For both obesity and MET Syndrome, with exercise testing it is important to have specialized what?

equipment (suitable for those with a larger physique)

For both obesity and MET Syndrome, individuals should aim for at least ______+ kcal expended per week

2,000

For both obesity and MET Syndrome, a combination of ____ and ______ exercise is necessary to preserve lean mass during weight loss

aerobic; resistance

For both obesity and MET Syndrome, when approaching ex rx you may need a greater focus on _____ in case of extreme weight loss where you may see a shift in the individual’s ______

balance; center of gravity

For both obesity and MET Syndrome, when beginning ex rx you should start with ________ exercises such as sitting on the ground and standing up

body weight (use initial weight as an advantage)

A ____________ is vitally important for successful weight management in obese individuals as well as those with __________

multifactoral approach

Development as a competent CEP should include knowledge and understanding of _______ used to develop programming and educate patients

behavior theory