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Normal Body weight. BMI?
Class I obesity. BMI?
Class II obesity. BMI?
Class III obesity. BMI?
Equation for true BMI>
weight/height2 = kg/m2
Equation for approx BMI?
pounds/inches2 x 704
Minimum body fat for females to have regular menstruation?
Complications of Amenorrhea?
Infertility and an earlier onset of osteoporosis
Minimum Body fat for males?
Male complications of BMI < minimum?
"Chronic fatigue, immuno compromisation"
Which is worse visceral fat or subqutaneous fat?
"Which is more significant, Upper or lower body?"
Diseases for which obesity is a Major risk factor?
- thromboembolic disease
- Low HDL
- Sleep apnea
- Restrictive lung
- Colo-rectal cancer
- Breast cancer
Etiologies for Obesity
- High fat/caloric intake
- Increased food volume intake
- Decreased physical activity
- genetic (Prader-Willi syndrome)"
most common genetic cause of MARKED obesity
Prevalence of Secondary obesity
Endocrine causes of secondary obesity
Hypo- or hyperthyroidism; Cushing's
Weight reduction goals
10% (initial); 1-2lbs/wk; lose in 10lb increments; motivation
Formula for maintenance calories
Current weight x 13 - 500calories/day = 1lb/wk weight loss
Who gets a low calorie diet?
BMI>25 with comorbities
What is a low calorie diet?
800-1000 calories/day (.8g protein per kg daily)
Who gets a very low calorie diet?
BMI>35 with or without comorbities
What is a very low calorie diet?
- High protein
- no fat
- 600-800 calories/day
Physician requirement for very low diet?
Maximum goal of weight loss
NOT lower than patient's lowest weight since 21
Medication for behavior modification in Obese patients?
SSRI for sad
NIH guidelines to use medication for weight loss?
- BMI >30
- BMI >27 w/ obesity related risk factors
Contraindications for use of weight-loss medications
- Uncontrolled CVD
- Pregnant or lactating
- Hx of psychiatric disease
- <18 yo; Drug interactions (MAOIs)
Medications for weight loss?
- Phentermine (NorEpi receptor agonist)
- Sibutramine (NE/Seratonin RUI)
- Orlistat (lipase inhibitor)
- Olestra (fat substitute / nondigestable)
Who is a canditate for Bariatric surgery?
- BMI>35 w/ comorbities
What is Roux-en-Y gastric bypass (RYGB)?
- Distal stomach is resected
- proximal stomach is attached to jejunum
- duodenum is attached to distal small intestine
What is VBG?
Vertical Band Gastroplasty; Stomach band surgery
Pros of Bariatric surgery?
- Laproscopic procedures
- 40-75% weight loss
- 0-2.5% mortality rates
Complications of Bariatric Surgery?
- Peptic ulceration (1-11%)
- Outlet stenosis (3.5-22%)
- leak / sepsis (0-2.5%)
- Staple disruption (1.6-48%)
- need for surgical revision (17-45%)
Lesser complications of Bariatric surgery?
- Wound problems
- abdominal hernias
- Dumping syndrome
- Pulmonary edema
Leading cause of staple disruption?
Over-ingestion of liquids of semisolid foods
What is dumping syndrome
Post-bariatric surgery complication where undigested food travels to the small bowel too fast (comes w/ cramps, nausea, diarrhea)