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What are the different levels of BMI relating to normal, overweight, obesity, etc?
- 18-24= normal
- 24-29.9 = overweight
- 30-34.9 = obese
- 35-39.9= severely obese
- >40= morbidly obese
What are some differences in serving size?
- Coffee: 45 calories --> 350 claories
- Bagel: 140 calories --> 350 calories
- Muffin: 210 calories --> 500 calories
What are medical complications of obesity?
- pulmonary disease
- nonalcoholic fatty liver disease
- gall bladder disease
- gynecologic abnormaliities
- idipathic intracranial hypertension
- coronary heart disease (diabetes, dyslipidemia, HTN)
- severe pancreaitis
- cancer (breast, uterus, cervix, colon, esophagus, pancreas, kidney, prostate)
- type 2 diabetes
- sleep apnea
What is the surgical criteria for obesity?
- 18 years or older
- BMI of >40 OR
- BMI 35-39.9 with other conditions related to obesity- high CHO, DM, HBP, sleep apnea
- willing to make post-surgical lifestyle changes
- history of failed weight loss attempts
What is the Allergan lap band criteria?
- BMI between 30-40 and 1 obesity related comorbidity
- 40% reached 30% weight loss within 12 months
What are the appropriate and inappropriate surgical candidates?
- appropriate: meet medical criteria, motivated, good support system, willing to make change
- inappropriate: cosmetic purposes, unwilling to change/quit smoking, active substance abuse, unctonrolled psychiatric disorders
What are some characteristics of Gastric Bypass (Roux-en-Y)?
- designed to limit food intakeand absorb less nutrients
- 30-60cc pouch
- can be reversed or revised but difficult
- faster initial weight loss
- usually requires 2-5 days hospitalization
- usually lose 60-80% EBW
What is the diet of gastric bypass consist of?
- meal portion = 2oz servings
- clear liquid x 24 hours
- full liquid and soft- length varies depending on surgeon
- no added sugars or high fats
- avoid carbonation and caffiene
What are some gastric bypass complications?
- early: leack, acute gastric dialiation, Roux-Y obstruction, PE, DVT
- late: stomal stenosis, nutritional deficiences, hernia (open only),marginal ulcer
What is dumping syndrome?
- many pts view as complication but really side effect- it is so uncomfortablee that usually results in changed behavior
- occurs when patients eat sugars
- causes rapid HR, nausea, fainting, sweating because of new re-routing of intestine
What are characterisitcs of laparoscopic adjustable gastric banding?
- adjustable silicone elastomer band
- designed to limit food intake (restrictive)
- usually requires overnight hospitalization
- slower weight loss with goal weight met 18-24 months post op
- usually lose 40-60 EBW
What are some gastric band complications?
- migration of implant (band erosion, band slippage, port displacement)
- tubing related complications (port disconnection, tubing kinking)
- band leak
- port-site function
What happens with a sllipped band?
- occurs in 10% patients
- common causes are overeating and chronic vomitting
- S/S: pain, sudden change in eating habits, intolerance of liquids, severe reflux, nausea
- must be repaired surgicaly
What happens with erosion?
- occurs 1% nationally
- less frequent from improved technique but occurs when the band erodes into the stomach
- diagnosed with EGD
- S/S: port infection
- requires removal of the band which may or may not be able to be put back in
What is the gastric band diet?
- lap band clear liquid diet: post op day 1
- 2 weeks: full liquid diet (anything that can go through a straw but don't use a straw)
- 2 weeks: mushies (anything that you can mash with a fork)
- no soft breads or thick meats (lifelong restriction)
- avoid carbonation
What are bariatric rules?
- take small bites chewing 20-30 times
- measure 2 oz portions
- have 3 meals a day, but don't snack
- drink at least 6 C liquid between meals (sugar free and no claories)
- no liquids with meals
- PROTEIN- eat first, may need supplements, daily goal of 70 grams
What are possible nutrient deficiences in gastric bypass or gastric band?
- gastric bypass: iron, B12, folate, calcium, zinc, vitamin D
- gastric band: folate- due to poor dietary intake
What are key points to patient education?
- emphasize behavior modification
- reinforce that dietary changes are long term
- emphasize and enourage lifetime activity
- reinforce life long smoke free expectation
How prevalent is obesity?
- 64.5% adults
- most prevalent in african american and hispanic women
What are clinical ways to measure obesity?
- waist circumference
- skin folds
What are ways body weight is regulated through systems that control?
- short term appetite signals
- signals for fat storage/metabolism
What is leptin?
- a hormone produced by Ob gene in fat cells and has receptors to thalamus
- obesity may be associated with mutant Ob gene and/or leptin resistance
How does leptin control appetites and energy expenditure?
- decreased leptin levels signals body to increase appetite, and decrease energy expenditure
- increased leptin levels signals body to decrease appetite
What is obesity?
What are factors that contribute to energy imbalance?
- genetic factors
- behavioral factors
- secondary causes
How do genetic factors contribute to obesity?
- one obese parent increase child chance by 40%
- two obese parents, increase childs chance by 80%
What are different behavioral factors that contribute to obesity?
- diestary habits- calorie overconsumption, high total fat intake, high refined sugar intake, low fiber intake, compulsive overeating
- physical activity
- psychological factors
What are signs of compulsive overeating
- frequent binge episodes
- eat until uncomfortablly full
- eat fast while binging
- eat along
- feel disgusted after binging
What are the cultural/environmental factors that contribute to obesity?
adults and kid watching >3hr/day of TV have 2x gretaer prevalence of obesity
What are secondary causes of obesity?
- hypothyroidism (10% of obesity causes)
- growth hormone deficiency
- sex steroid deficiency
- medicationsrestrictive dieting
What are some medications associated with weight gain?
- glucocorticoids (treat inflammatory conditions)
- diabetes drugs (insulin & sulfonylureas
- epilepsy drugs
- some meds for ADD
Intervention is recommended for who?
- BMI > 30 or between 25-29
- high risk wait circumference and 2 or more CV risk factors
What should intervention for obesity include?
- low claorie/low fat diet
- increased physical activity
- behavior modification
What should the duration for obese exercise prescription?
- begin: 150 min/wk
- weight loss: 60-90 minutes activity (420min/wk)
- maintenence: 200-300 min/wk
What should the intensity for obese exercise prescription be?
- 40-60% HRR/VO2R
- progress to 50-75% HRR/VO2R
- emphasis on duration and grequency before increasing intensity
What is the resistance exercise prescription for obese pts?
- 8-12 RM, 1-2 sets, 2-3 days/wk, 1-2 min rest between sets
- 2-10% increase in load if can do 14 RM for 2 training sessions
What are speical considerations for obese exercise prescription?
- orthopedic injuired (low impact activities)
- equipment modifications
- emphasis on benefits of activities even without weight loss
What is the best predictor of long term weight maintenence?
How much weight loss significantly decreased BG levels in people with type 2 DM?
7% loss in BW
What is a good short term, interim, and long term goal for weight loss?
- short term: 5-10% loss, 1-2lb/wk
- interim goal: maintenence
- long term goal: additional weight loss, long term weight maintenence