Nutrition Ch 14

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  1. Lower range of overweight
    BMI 25-26.9

    Diet, PA, and behavior modification = with comorbidities
  2. Upper range of over weight
    BMI 27-29.9

    Diet, PA, and behavior modification = with comorbidities

    Pharmacotherapy = with comorbidities
  3. Obesity class 1
    BMI 30-34.5

    Diet, PA, and behavior modification= Yes

    Pharmacotherapy = Yes
  4. Obesity class 2
    BMI 35-39.9

    Diet, PA, and behavior modification= Yes

    Pharmacotherapy = Yes

    Surgery = with comorbidities
  5. Obesity class 3
    BMI >=40

    Diet, PA, and behavior modification= Yes

    Pharmacotherapy = Yes
  6. 10 Tips to a great plate
    1) Balance calories: be physically active

    2) Enjoy your food but eat less: don't eat too fast

    3) Use a smaller plate, bowl, and glass: choosing smaller options

    4) foods to eat more often: vegetables, fruits, whole grains, and fat-free or 1% milk and dairy products

    5) make half you plate fruits and vegetables: choose red, orange, and dark green vegetables

    6) switch to fat-free or low-fat (1%) milk

    7) to eat more whole grains, substitute a whole-grain for refined products

    8) Foods to eat less often: cut back on foods high in solid fats, added sugars, and salt

    9) compare sodium in foods: choose lower versions of foods. "low sodium", "reduced sodium", or "no salt added".

    10) drink water instead of sugary drinks: a good way to cut calories
  7. Behavior modification ideas
    Think thin:

    Why you want to lose weight; set long term goals; avoid crash diets for certain occasions; give yourself nonfood rewards; learn to distinguish hunger for cravings

    Plan ahead:

    Only keep food in kitchen and not scattered around the house; stay out of kitchen unless cooking or cleaning; avoid tasting while cooking; low calorie foods in front in fridge and high calorie towards back; remove temptation; plan meals, snacks, and groceries

    Eat wisely:

    Never skip meals; wait 10 before eating if you have urge; eat before starving and stop when satisfied; serve food from stove to the plate to avoid large portion sizes; eat the low calorie foods first; drink water with meals; use a small plate; chew thoroughly and eat slowly; eat before attending a social function

    Shop smart:

    Never shop when hungry; shop from a list; buy foods in quantity that you need; stock up on fruits and vegetables

    Change your lifestyle:

    keep busy with hobbies or projects; brush teeth immediately after eating; trim recipes; keep food and activity and hunger records; give yourself permission for planned indulgences; exercise; get more sleep
  8. Phentermine
    FDA approved

    Short term weight loss

    Appetite suppressant

    Side effects: increased blood pressure and heart rate, sleeplessness, nervousness
  9. Diethylpropion
    FDA approved

    Short term weight loss

    Appetite suppressant

    Dizziness, headache, sleeplessness, nervousness
  10. Phendimetrazine
    FDA approved 

    short term weight loss

    appetite suppressant 

    Sleeplessness, nervousness
  11. Orlistat
    FDA approved

    Longer term weight loss

    (children 12 years and older can use)

    Lipase inhibitor

    Side effects: gastrointestinal issues (cramping, diarrhea, oily spotting), rare cases of severe liver injury reported
  12. Lorcaserin
    FDA approved

    Long term weight loss if tolerated and effective

    appetite suppressant

    Side effects: headache, dizziness, fatigue, nausea, dry mouth, and constipation
  13. Osymia
    FDA approved

    Long term weight loss

    appetite suppressant; seizure treatment

    Side effects: like SE for phentermine plus numbness of skin, change in taste, birth defects, suicidal thoughts
  14. Bariatric Diet recommendations

    1-2 days after surgery
    Drink clear liquids that are sugar free, noncarbonated, and caffeine free.

    Sip liquids; avoid using a straw to avoid swallowing air
  15. Bariatric Diet recommendations

    3-7 days after surgery
    Ingest a minimun of 48-64 oz/day of total fluids with 24-32 oz of clear liquids plus 24-32 oz of full liquids.

    Clear liquids should be sugar free or artificially sweetened and include salty fluids.

    Use full liquids with <= 15 g sugar per serving


    • Lactaid milk or soy milk with added soy or whey powder
    • Plain or blended yogurt
    • Greek yogurt
    • Blended soup
  16. Bariatric Diet recommendations

    2-3 weeks
    Increase clear liquids; total fluid intake/day should be 48-64 oz

    Replace full liquids with soft, moist, diced, ground, or pureed protein foods as tolerated, such as scrambled eggs; ground meats, poultry, or fish with gravvy, broth, or light mayonnaise (to moisten); bean soups; cottage cheese; low-fat cheese; yogurt; sugar-free liquid protein supplements (eg sugar-free instant breakfast) or milk fortified with sugar-free whey (protein powder may be used in place of a meal).

    Consume protein at the beginning of each of 4-6 meals/snacks per day with limited portion sizes

    Chew food thoroughly

    Avoid fluids with meals and until at least 30 minutes after eating

    Use small plates and utensils to help control portion sizes
  17. Bariatric Diet recommendations

    4 weeks after surgery
    Add well cooked, soft vegetables and soft and/or peeled or canned fruit, such as

    • Whipped winter squash
    • Soft cooked carrots
    • Banana
    • Water-packed canned peaches

    Adequate hydration is vital during rapid weight loss phase
  18. Bariatric Diet recommendations

    5 weeks after surgery
    Continue to eat protein with some fruit or vegetable at each meal

    Consider consuming salads at 1 month postoperatively if tolerated

    Avoid rice, bread, and pasta until the 60 g of protein plus fruits and vegetables can be consumed comfortably daily
  19. Bariatric Diet recommendations

    As hunger increases and tolerance improves
    Remember that a healthy solid food diet consists of adequate protein, fruits, vegetables, and whole grains

    Keep in mind that calorie needs are individualized according to height, weight, and age

    Avoid raw fruits and vegetables that are highly fibrous, such as celery, corn, tomatoes, and oranges; they may be eaten if well cooked or pureed

    Consume 3 meals and 2 snacks per day of limited portion size

    Continue with 48-64 oz of clear liquids that are noncarbonated, calorie free, and caffeine free

    Chew foods thoroughly

    Avoid liquids for at least 30 minutes before and after eating
  20. Comparison of Anorexia and Bulimia Nervosa

    Major characteristics

    • Complusive pursuit of thinness
    • Intense fear of becoming fat; intense preoccupation with food
    • Self-worth based on size and shape


    • Lack of sense of control regarding eating
    • Fear of being overweight
  21. Comparison of Anorexia and Bulimia Nervosa

    Onset and population

    Usually develops during adolescence or young adulthood; 90%-95% are female


    Usually develops during adolescence or young adulthood; is more likely to occur in men than anorexia
  22. Comparison of Anorexia and Bulimia Nervosa

    Typical eating and exercise behaviors

    Semistarvation with compulsive exercise; onset of disorder is usually preceded by dieting behavior


    Gorging (1200-11,500 calories in a short amount of time) followed by purging, such as self-induced vomiting, excessive exercise, abuse of laxatives, emetics, diuretics, or fasting; "dieting" is a way of life but bingeing may occur several times per day and may be planned
  23. Comparison of Anorexia and Bulimia Nervosa


    Less than 85% of expected weight, which is a BMI of 17.5 or less for adults


    Flunctuations are normal; weight may be normal or slightly above normal
  24. Comparison of Anorexia and Bulimia Nervosa

    Emotional Symptoms

    Vicarious enjoyment of food; denial of the condition can be extreme; body image disturbance; pronounced emotional changes; low self-esteem


    Displays mood swings; full recognition of the behavior as abnormal; ongoing feelings of isolation, self-deprecating thoughts, depression, and low self-esteem
  25. Comparison of Anorexia and Bulimia Nervosa

    Physical symptoms

    Lanugo hair on the face and trunk; brittle listless hair; dry skin, brittle nails, intolerance of cold


    May appear normal

    Swollen salivary glands in cheeks

    Sores, scars, or calluses on knuckles or hands
  26. Comparison of Anorexia and Bulimia Nervosa

    Cardiovascular effects

    Bradycardia, hypotension, orthostatic hypotension


    Arrhythmias; palpitations; weakness
  27. Comparison of Anorexia and Bulimia Nervosa

    GI effects

    Delayed gastric emptying, decreased motility, severe constipation


    Bloating, constipation, flatulence; gastric dilation with rupture is a risk
  28. Comparison of Anorexia and Bulimia Nervosa

    Endocrine/metabolic imbalances

    Cold sensitivity; fatigue; hypercholesterolemia, hypoglycemia; amernorrhea or menstrual irregularities


    Menstrual irregularities, dehydration, and electrolyte imbalances may occur secondary to vomiting and laxative abuse; rebound fluid retention with edema
  29. Comparison of Anorexia and Bulimia Nervosa


    Osteopenia, osteoporosis, muscle wasting and weakness


    Dental erosion; muscular weakness
  30. Comparison of Anorexia and Bulimia Nervosa

    Growth status

    Arrested growth and maturation


    Usually not affected
  31. Comparison of Anorexia and Bulimia Nervosa

    Nutrient deficiencies

    Protein-calorie malnutrition; various micronutrient deficiencies


  32. Nutrition therapy for anorexia nervosa
    Gassy foods:

    Cruciferous vegetables (broccoli, cauliflower, cabbage), dried peas and beans, dried prunes and raisins, carbonated beverages, garlic, onions, melon, and products containing sorbitol

    Limit fatty or fried foods

    • Avoid caffeine because it is a stimulant and mild diuretic
    • _________________

    Help control symptoms of constipation and fluid retention with a high-fiber or low-sodium diet
  33. Nutrition therapy for bulimia nervosa
    A high-protein and/or high-fiber snack slightly before the times of the day when the binge is more likely to occur may help promote satiety and keep blood glucose levels within normal range
Card Set:
Nutrition Ch 14
2014-10-30 05:33:59

Exam #3 Obesity and Eating Disorders
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