Overweight & Obesity

what occurs when energy intake is greater than energy expenditure.

Weight gain

what percentage of LA citizens are obese

38.6%

1 lb of adipose tissue = ~ ________ calories

3500

Environmental factors that can affect weight include

increased portion sizes, decreased exercise, sedentary working hours, & decreased sleep duration.

Genetic factors that can affect weight include

- genes that cause people to enjoy sugar & carbs

- imbalance of hormones & proteins (leptin, neuropeptide Y, ghrelin).

leptin

neuropeptide that helps burn fat; obese patients can develop resistance to it

BMI formula: (given kg or lbs)

weight (kg)/height (m2)

OR

weight (lb)/height squared [in^2] x 703

BMI may overestimate body fat in people with a _______ build.

muscular

BMI may underestimate the risk in ________ due to their different stature.

Asians

High BMI is a risk factor for diseases such as

CVD, HTN, T2D, gallstones, breathing problems, certain cancers, & sleep apnea.

what is an underweight BMI

<18.5

what is a normal BMI

between 18.5-24.9

what is an overweight BMI

between 25-29.9

what is an obesity class I BMI

between 30-34.9

what is an obesity class II BMI

between 35-39.9

what is an extreme obesity BMI (III)

> 40

BMI for pediatrics & adolescents is based on ________.

percentile

Pediatrics & adolescents with a BMI between the 85-95th percentile are _____

overweight

Pediatrics & adolescents with a BMI > 95th percentile are _____

obese

A waist circumference greater than ______ inches in men & ______ inches in women is associated with an increased risk of CVD & T2D.

40, 35

what are the waist circumferences in men and women, and what is this associated with

> 40 inch in men

> 35 inch in women

- associated with increased risk of type 2 DM and CVD

metabolic syndrome is characterized by

- the presence of certain metabolic risk factors & has been associated with increased risk of CVD & T2D

- low HDL levels (<40 men or <50 women), high BP (130/85), large waist circumference, high serum triglycerides (over 150), high fasting glucose (over 100)

Having 3 or more of these conditions classifies a patient with metabolic syndrome: (what are the parameters of each)

- HDL cholesterol < 40mg/dL in men & < 50 mg/dL in women

- BP of 130/85 mm Hg of higher

- waist circumference of > 40 inches in men or 35 inches in women

- serum triglycerides of 150 mg/dL or higher

- fasting blood glucose of 100 mg/dL or higher

what HDL cholesterol is a symptom of metabolic syndrome in men and women

< 40 mg/dL in men

< 50 mg/dL in women

what blood pressure is a symptom of metabolic syndrome

130/85 mmHg or higher

what waist circumference is a symptom of metabolic syndrome in men and women

> 40 inches in men

> 35 inches in women

what serum triglyceride levels are a symptom of metabolic syndrome

150 mg/dL or higher

what fasting serum glucose level is a symptom of metabolic syndrome

100 mg/dL or greater

Female reproductive disorders that arise due to obesity are often related to __________ that can result due to insulin resistance.

polycystic ovarian syndrome (POS)

T/F: Weight management is a lifelong challenge.

T

Lifestyle changes that can be used to manage weight include

- dietary modifications

- physical activity

- behavior therapy

weight loss surgeries:

gastric bypass

lap band

Weight loss surgeries reduce the size of the _______ to prevent over-eating.

stomach

T/F: Steroids can cause weight gain.

T

The initial weight loss goal is to lose how much body weight over what frame of time?

5-10% of body weight over 6 months

A ______% loss of body weight by overweight patients can increase their life expectancy. (benefit in this percent)

10

mainstay of weight loss therapy

dietary modification; caloric restriction, changes in macro intake, use of macronutrient substances, changes in timing/frequency of meals

Dietary modifications for weight loss can include

- caloric restriction

- changes in fat, protein, & carb intake

- use of macronutrient substances

- changes in the timing/frequency of meals.

The average 30 yo man should consume ________ kcal/day.

2400-3000

The average 30 yo female should consume ________ kcal/day.

1800-2400

basal energy expenditure (BEE)

the energy expended to maintain an awake resting body that is not digesting food

BEE formula for men:

66.5 + (6.23 x weight [lb]) + (12.7 x height [in]) - (6.8 x age [yrs])

BEE formula for women:

655.1 + (4.35 x weight [lb]) + (4.7 x height [in]) - (4.7 x age [yrs])

The BEE formula helps calculate a person's _________ need.

caloric

caloric need of sedentary person (little-no exercise) (what do you do to the BEE)

BEE x 1.2

caloric need of lightly active person (little exercise/sports 1-3 days/week) (what do you do to the BEE)

BEE x 1.375

caloric need of moderately active person (moderate exercise/sports 3-5 days/week) (what do you do to the BEE)

BEE x 1.55

caloric need of very active person (hard exercise/ sports 6-7 days/wk) (what do you do to the BEE)

BEE x 1.725

caloric need of extra active person (very hard exercise/ sports & physical job or 2x training) (what do you do to the BEE)

BEE x 1.9

what is the BEE of a 46 yo male weighing 240 lbs and 72 inch? what if he has a sedentary lifestyle

BEE: 2163.3 calories

sed: 1.2 x 2163.3 = 2595.96 cal/day

what is the calories per day in a low calorie diet, and what is the weight loss per week

800-1500 kcal/day

1-2 pounds/week

what is the calories per day in a very low calorie diet

800 or fewer calories

Patients on a low calorie diet (consumption of 800-1500 kcal/day) can lose _______ lb/wk.

1-2

Very low calorie diets (800 or less kcal/day) should be used only by patients with which BMI

> 30

which BMI can do a very low calorie diet, and what is the VLCD? what amount must come from which food group

- pts with BMI > 30

- 800 or fewer calories

- at least 1 g/kg of IBW of protein a day

No more than 30% of our total daily calories should come from ______.

fat

what percentage of out total daily calories should come from fat? what about saturated fat?

no more than 30% for fat

no more than 8-10% from saturated fat

8-10% of our daily total caloric intake should be obtained from __________.

saturated fat

55% of our total daily caloric intake should be obtained from _______.

carbs

what percentage of our daily calories should come from carbs

55%

is something that is sugar free not going to spike insulin/glucose levels

no; can spike insulin

Meal replacement therapy involves

replacement of 2 meals daily with liquid drink, a snack bar, or a measured frozen meal. third meal was a "reasonable" third meal

Initial weight loss associated with meal replacement therapy is due to

low sodium

The main advantage of meal replacement therapy is ________.

portion control

T/F: Commercial weight loss programs are expensive, have sub-optimal data supporting their efficacy, & provide social support to patients.

T

what to eat during the fasting period and during the non-fasting periods

fasting: water and zero-calorie beverages such as black coffee and tea

non-fasting: "eating normally"; does not mean going crazy

what are the different time frames of fasting

16:8

18:6

20:4

ADF (alternative day fasting)

Children & adolescents should have how much vigorous activity a day and how many per week

>/= 60 minutes of moderate or vigorous aerobic activity every day, including vigorous activity at least 3 days a week

Adults should have how many minutes of moderate aerobic activity and how many minutes of vigorous physical activity

150 minutes of moderate aerobic activity or 75 minutes of vigorous physical activity a week

- initially performed in >/= 10 minute episodes

The #1 outcome of ________ is improved health.

behavior therapy

nondrug treatment guidelines for obesity

- small, gradual changes in eating/exercise patterns

- maintain realistic goals for weight loss and increased exercise

- eat meals at a table and do nothing else while eating

- set a regular schedule and avoid skipping meals

- eat slowly and enjoy the food

- put fork/spoon down between bites

- leave some food on the plate each time you eat

- wait 5 minutes before going back for seconds

- use smaller plate

- keep healthy snacks on hand

- use a list when shopping and shop after eating

- drink 8 glasses of noncaloric beverages a day

- increase your lifestyle activity; walk and stand more, climb stairs, and park farther from destination

After eating, you should wait ______ minutes before going back for seconds.

5

Dietary products include ________ & other products to supplement diet, & they are distinct from OTC medications for weight loss.

herbals

what are the distinct entities from OTC meds

dietary products; herbals and other products to supplement diet; regulated under DSHEA and recognized as safe unless the FDA proves otherwise

only FDA approved OTC weight loss product

orlistat (Alli)

orlistat (Alli) is what; what does it work

OTC product that decreases fat absorption by inhibiting gastric/pancreatic lipase & inhibits hydrolysis of triglycerides

OTC dosing for orlistat

60 mg TID before meals containing fat

how does orlistat decrease fat absorption

- inhibiting gastric and pancreatic lipases

- inhibits hydrolysis of triglycerides

Rx dosing for orlistat

120 mg TID before meals

T/F: Anything that binds something in the gut or intestines will have bad side effects.

T

Most patients on orlistat lose ______ lbs over 6 months.

5-10

Orlistat may decrease the absorption of what? what is recommended for this?

fat soluble vitamins, so it is recommended that patients take a multi-vitamin at bedtime or separate the products by at least 2 hours from orlistat.

systemic effects of orlistat

minimally absorbed, so little systemic effects

Patients with a history of _________ should be cautious when using orlistat due to its increased levels in urinary oxalate

kidney stones

patients with history of kidneys stones and orlistat

caution due to increased levels of urinary oxalate

GI side effects of orlistat include:

- flatulence with oily spotting

- loose & frequent stools

- fatty stools

- fecal urgency/incontinence.

Orlistat has drug interactions with:

warfarin

cyclosporine (causes reduced concentrations)

Orlistat and patients with malabsorption disorders

should be avoided

T/F: Patients who have a history of thyroid disease, cholelithiasis, nephrolithiasis, or pancreatitis should consult their doctor before using orlistat.

T

which patients should consult MD before initiating orlistat

history of thyroid disease, cholelithiasis, nephrolithiasis, or pancreatitis

Patients should stop use of orlistat & contact their healthcare professional if they develop signs & symptoms of ______ injury, including itching, yellow eyes or skin, dark ______, light-colored _______, or loss of appetite.

liver, urine, stools

when should patients stop use of orlistat/contact healthcare prof

develop signs and symptoms of liver injury:

- itching

- yellow eyes or skin

- dark urine

- light colored stools

- loss of appetite

what should not be used as weight loss products.

Laxatives or diuretics

what percentage of adults are reported trying to lose weight using a dietary supplement

34%; women 25-34 years old

herbal weight loss supplement that is a stimulant, energy booster, & thermogenic aid; claims to increase basal metabolism, increase energy, & counteract fatigue

bitter orange

bitter orange claim to fame

increases basal metabolism, increases energy, and counteract fatigue

synephrine and octopamine in bitter orange are structurally similar to what? what are the potential health risks

synephrine: ephedrine

octopamine: norepinephrine

- same potential health risks as ephedra (HTN, CV toxicity, MI)

Bitter Orange is often combined with sources of ________.

caffeine (cola nut, guarana, mate)

Green tea, Chromium, & Garcinia are __________.

fat & carbohydrate modulators

chromium; what kind of supplement is it/what does it do

Fat & carbohydrate modulator that has limited evidence of increasing lean body mass & decreasing fat mass; it increases insulin sensitivity & can cause rhabdomyolysis & renal failure with mega doses