Module 7: Obesity

underweight BMI

< 18.5 kg/m²

normal BMI

18.5 - 24.9 kg/m²

overweight BMI

25.0 - 29.9 kg/m²

obese (class I) BMI

30.0 - 34.9 kg/m²

obese (class II) BMI

35.0 - 39.9 kg/m²

morbidly obese

≥ 40.0 kg/m²

assessment for obesity

BMI, waist circumference, waist-to-hip ratio, body shape, determination of fitness level

determining intensity of fitness activity

Talk test, Borg Rating (6-20)

secondary obesity

result of metabolic problems, congenital and/or chromosomal abnormalities

causes of primary obesity

calories in > calories out, genetics, prenatal/early life, physiologic regulation, lifestyle and environment (restricted activity, food, sleep), mental health

FTO

strongest genetic link associated with obesity. located on Chromosome 16

three modifiable prenatal factors for obesity

mother’s smoking habits during pregnancy, mother’s weight gain during pregnancy, mother’s blood sugar levels during pregnancy (development of gestational diabetes)

three modifiable postnatal factors that influence weight in later life

how rapidly infant gains weight, how long infant is breastfed, how much infant sleeps

leptin

hormone that suppresses hunger and decreases food consumption. with obesity, can have genetic deficiency or insensitivity

ghrelin

hormone that stimulates appetite. can trigger over-eating, with obesity decline after meal (post-prandial decline) does not occur

incretins

hormone that slows gastric emptying, decrease appetite

insulin

hormone that facilitates uptake of glucose into cells, decrease appetite

impact of increased concentrations of free fatty acids in obesity

inhibits insulin secretion and insulin-stimulated glucose uptake by cells in Type II DM

complications associated with obesity

metabolic syndrome, diabetes, dyslipidemia, HTN, non-alcoholic liver disease, PCOS, obstructive sleep apnea, osteoarthritis, urinary stress incontinence, gastroesophageal reflux disease, immobility, psychological disorder due to stigma

metabolic syndrome

collection of risk factors that increase risk for developing diabetes, stroke, and cardiovascular disease. criteria based on waist circumference, triglyceride count, HDL, BP, FBP (any 3 of 5)

pharmacotherapy for obesity

reserved for those with BMI greater than/equal to 30 kg/m² or with BMI greater than/equal to 27 kg/m² in presence of at least one weight-related condition (HTN, T2DM, dyslipidemia)

criteria for bariatric surgery

BMI > 40, BMI 35-39.9 with presence of serious weight-related health concern, demonstrated commitment to making necessary lifestyle changes for surgery to work

laparoscopic adjustable gastric banding (LAGB)

a minimally invasive surgery that places an adjustable silicone band around the upper stomach to create a small pouch, which restricts food intake and promotes fullness. reversibly/temporary

vertical sleeve gastrectomy

a bariatric surgery that removes about 85% of the stomach, leaving a banana-shaped "sleeve" to help with weight loss by restricting food intake and altering hormones that affect hunger. weight loss more limited

Roux-en-Y gastric bypass

better weight loss. a bariatric surgery that creates a small stomach pouch and reroutes the small intestine to bypass a portion of the stomach and small intestine, which helps with weight loss by restricting food intake and decreasing calorie absorption.

risk for dumping syndrome, vitamin deficiencies

intragastric balloon procedure

involves placing a temporary deflated balloon into the stomach via endoscopy to promote weight loss. balloon filled with saline to help you feel fuller and eat less

dumping syndrome

a condition where food moves too quickly from the stomach into the small intestine, causing symptoms such as diarrhea, N/V, abdominal cramping, sweating, lightheadedness, tachycardia to occur 30-60 minutes after eating.

eat small/frequent meals, avoid sugars, chew well, drink liquids 30-45 minutes after eating