E1 CMN -Obesity

What is the BMI range of overweight?

25-29.9

(moderate amount of excess fat)

What is the BMI range of obesity?

30.9-39.9

(excess fat that adversely affects health)

What is the BMI range of morbid/severe obesity?

> 40

(very high risk for serious health consequences)

What factors contribute to obesity?

overeating, less energy expenditure, inc susceptibility to being obese, inc resistance to wt loss & maintaining wt loss

What diseases are common comorbidities of obesity?

CV disease, T2DM, HTN, stroke, dyslipidemia, gallbladder disease, DJD, CA, OSA, GYN irregularities, respiratory problems

With modest weight gain, fat cells increase in ______

size

With significant weight gain, fat cells increase in ______

size & number

With weight loss, fat cells decrease in ______

size but not number

3 critical periods for weight gain:

- gestation & early infancy

- "adiposity rebound"- period of normal weight gain (5-7 y/o)

- adolescence/puberty

Substantial wt gain during a critical period for wt gain is associated w/ what?

inc risk for obesity and related disease in adulthood

What are the 3 methods to assess a healthful weight?

BMI, body fat composition, fat distribution pattern

Which method of assessing healthful weight provides an estimate, but not an exact percentage and has a margin of error of 3-20%?

Body fat composition

What does apple shaped fat distribution indicate?

Upper body obesity distribution pattern

What body fat distribution pattern is associated with inc risk of T2DM, heart disease, and HTN?

Apple shaped

What does pear shaped fat distribution indicate?

Lower body obesity distribution pattern

Which body fat distribution pattern is common in premenopausal women?

Pear shaped

What calculation is used to assess risk for heart disease and HTN and is a more accurate predictor of mortality in older people than BMI?

Waist-to-hip ratio

The (higher/lower) the waist-to-hip ratio, the higher your risk for CV disease

Higher

What pts may surgery be recommended for?

BMI > 40

BMI > 35 with co-morbid conditions (DM, HTN, HLD)

*considered a last resort

What should be done before a weight loss surgery?

Psych eval: evaluate the pts emotional stability and make sure they understand long-term lifestyle changes & aren't compulsively eating

What is Gastric bypass surgery?

attaches the lower part of the small intestine to a reduced stomach, less food is absorbed and food consumed bypasses the stomach & duodenum

What is Gastric banding?

a band constricts the stomach reducing food intake

What is Gastroplasty?

stomach “stapling”; stomach is reduced in size by removing the lateral 2/3, leaving the stomach in the shape of a tube

*reversible if not done laparoscopically

What is vertical banded gastroplasty?

upper stomach near the esophagus is stapled vertically to create a smaller stomach pouch; the outlet of the pouch is restricted by a band or ring

What is a restrictive form of bariatric surgery and is classified as severely dangerous operation by the AMA?

Vertical banded gastroplasty

What are types of horizontal gastric banding?

"Adjustable gastric banding", Laparoscopic adjustable gastric banding (LAGB), gastric banding

What is horizontal gastric banding?

“adjustable” gastric banding; inflatable balloon is connected to a small reservoir that is placed under the skin of the abdomen through which the diameter of the band can be adjusted

What are complications of Horizontal gastric banding/LAGB?

Heartburn, band erosion, pouch dilatation, erosive esophagitis, dumping syndrome

What is the gold standard for bariatric surgery?

Roux-en-Y gastric bypass

What is dumping syndrome?

occurs post-gastrectomy & post gastric bypass when the undigested stomach contents are transported, or "dumped", into the small intestine too rapidly

T/F: HTN, DM, and HLD are reversed with bariatric surgery if the patient maintains their weight loss, eats a healthy diet & exercises

True

What heart healthy diet is high in plants and low in animal foods?

Mediterranean diet

What are high fat & PTN low carb diets that restrict eating and pose a risk of ketosis?

Dr. Atkins diet, Sugar busters, Protein powder, CHO addict’s diet