Weight Control Exam 2

Three steps of the clinical process

1) Assessment

2) Classification

3) Treatment

Assessment

• gathering information

• lab values, measurements, family history

Classification

• interpret findings

• classifications

• disease risk

Treatment

• individualized plan of care

• nutrtition, ongoing monitorting, medical needs, exercise

BMI Classifications

• underweight

• overweight

• mildly obese (class I)

• moderately obese (class II)

• morbidly obese (class III)

underweight classification value

• BMI: < 18.5

• % over ideal weight: NA

• % of fat: < 20

normal classification values

• BMI: 18.5 - 24

• % over ideal body weight: 0-10%

• % of fat: 20-25%

overweight classification values

• BMI: 25 - 29

• % over ideal body weight: 10-20%

• % of fat: 26-31%

• disease risk relative to normal weight and waist circumference in inches men less than or equal to 40 inches and women less than or equal to 35 inches: increased

• disease risk relative to normal weight and waist circumference in inches men greater than 40 inches and women greater than 35 inches: high

mildly obese (class I) values

• BMI: 30-34

• % over ideal body weight: 20-40%

• % of fat: 32-37%

• disease risk relative to normal weight and waist circumference in inches men less than or equal to 40 inches and women less than or equal to 35 inches: high

• disease risk relative to normal weight and waist circumference in inches men greater than 40 inches and women greater than 35 inches: very high

moderatelu obese (class II)

• BMI: 35-39

• % over ideal body weight: 140-100%

• % of fat: 38-45%

• disease risk relative to normal weight and waist circumference in inches men less than or equal to 40 inches and women less than or equal to 35 inches: very high

• disease risk relative to normal weight and waist circumference in inches men greater than 40 inches and women greater than 35 inches: very high

morbidly obese (cass III)

• BMI: greater than or equal to 40

• % over ideal body weight: > 100%

• % of fat: greater than 45 %

• disease risk relative to normal weight and waist circumference in inches men less than or equal to 40 inches and women less than or equal to 35 inches: extremely high

• disease risk relative to normal weight and waist circumference in inches men greater than 40 inches and women greater than 35 inches: extremely high

Waist circumference cutoffs/cut points

BMI advantages

• not invasive

• easy to obtain information

• inexpensive

BMI disadvantages

• can’t distinguish fat from muscle

• “last option” if client does not consent to other assessments

visceral fat

subcutaneous fat

sagittal abdominal diameter

• measure abdominal height in supine position

• visceral adiposity

importance of waisit circumference

body compostion methods

• skinfolds

• bioeletric impediance (BIA)

• BodPod

• Underwater weighting

• DEXA

skinfolds

• estimation of subcutaneous fat

• room for error due to technician

• important to practice this skill in order to misclassify someone into a classification

bioelectric impedance

• not very accurate

• electrical current sent through the body

• hydration levels effect results

BodPod

• air displacement

• pretty accurate

• not very accessible

DEXA

• full body scan

• gold standard assessment

• physician prescription

• expensive

• regional fat distribution and bone density

Underwater weighing

• used ot be the golden standard

• practcality concern since it is hard to get someone to breathe out all of their air

Considerations for people of size

• equipment modifications

• appropriate blood pressure cuff sizing

• scale limitations

• chair accommodations

• mobility considerations

• existing comordbidies

medical history

• valuable

• provide a lot of information

• helps determine disease risk and or statues

demographics

HPI

medications

allergies

PMH

family history

social history

endocrine disorders

genetic syndromes

eating disorder screening

biometric and laboratory values

• Comprehensive Metabolic Profile or panel (CMP)

• complete blood count (CBC)

• HbA1c

• lipid profile (or panel)

• TSH

• T3/T4

• blood pressure

• ausculation

• acanthosis nigricans

• leg edema

CMP

• evaluate kidney and liver function, blood glucose, and electrolyte balance

• determine if exercise is appropriate or medical refferal is needed

CBC

• make up of blood

• platelates, red blood cells, white blood cells, etc

HbA1c

• help diagnose pre diabetes or diabetes

lipid profile

• assess cardiovascular risk

• cholesterol, triglycerides, LDL, HDL

TSH values

T3/T4, TSH

• influence metabolism

• hyperthyroid

• hypothyroid

blood pressure values

• tracks high blood pressure

• over 120 or 80

auscultation

• heart and lung sounds

acanthosis nigricans

• skin

• darkended skin folds related to insulin resistance

• help with diagnosis of insulin resistance and/or diabetes

leg edema

• renal or lymphatic dysfunction

blood pressure classifications

• normal

• elevated

• Stage 1 hypertension

• Stage 2 hypertension

• Hypertensive crisis

Lipid classifications

• total cholesterol

• LDL

• HDL

• Triglycerides

Total cholesterol values

• optimal

• borderline

• high

optimal total cholesterol values

less than 200 mg/dL

borderline high total choleserol values

200 - 239 mg/dL

high total cholesterol values

240 mg/dL and above

LDL values

• optimal

• near optimal/above optimal

• borderline high

• high

• very high

optimal LDL values

less than 100 mg/dL

near optimal/above optimal LDL values

100-129 mg/dL

borderline high LDL values

13

HSL values

Triglyeride values

Metabolic syndrome

Diagnosis criteria for metabolic syndrome

energy expenditure

energy expenditure components

• resting metabolic weight

• TEF

• physical activity energy expenditure

RMR

TEF

Physical activity energy expenditure

MET formula

hours x body weight (kg) x METs = calories

Food history purpose

• baseline assessment

• follow-up

• energy balance

• dietary call

baseline assessment

follow-up

energy balance

dietary recall

treatment goals

• weight-loss goals

• weight maintenance

• diet

• physical activity

• behavior change

weight-neutral language

respectful terminology

motivational interviewing principles

strategy categories

• cognitive

• affective

• behavioral

• social

cognitive strategies

affective strategies

behavioral strategies

social strategies

insulin resistance definition

insulin resistance mechanism

hyperglycemia

connection between insulin resistance and metabolic syndrome

sedentary behavior effects

role of exercise

importance of non-exercise activity

fat metabolism

lipolysis

FFA release

hormonal regulation

adrenergic receptors

beta receptors

alpha 2 receptors

exercise intensity effect on fat metabolism

regional lipolysis

obesity and fat metabolism

age differences in fat metabolism

gender differences in fat metabolism