quiz #3- obesity & bariatric medicine
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quiz #3- obesity & bariatric medicine
obesity, weight loss, bariatric medicine
What are the different levels of BMI relating to normal, overweight, obesity, etc?
24-29.9 = overweight
30-34.9 = obese
35-39.9= severely obese
>40= morbidly obese
What are some differences in serving size?
: 45 calories --> 350 claories
: 140 calories --> 350 calories
: 210 calories --> 500 calories
What are medical complications of obesity?
nonalcoholic fatty liver disease
gall bladder disease
idipathic intracranial hypertension
coronary heart disease (diabetes, dyslipidemia, HTN)
cancer (breast, uterus, cervix, colon, esophagus, pancreas, kidney, prostate)
type 2 diabetes
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?
: meet medical criteria, motivated, good support system, willing to make change
: 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
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?
: leack, acute gastric dialiation, Roux-Y obstruction, PE, DVT
: 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)
What happens with a sllipped band?
occurs in 10% patients
common causes are overeating and chronic vomitting
: 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
: 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
: full liquid diet (anything that can go through a straw but don't use a straw)
: mushies (anything that you can mash with a fork)
no soft breads or thick meats (lifelong restriction)
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?
: iron, B12, folate, calcium, zinc, vitamin D
: 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?
most prevalent in african american and hispanic women
What are clinical ways to measure obesity?
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?
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
What are signs of compulsive overeating
frequent binge episodes
eat until uncomfortablly full
eat fast while binging
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
What are some medications associated with weight gain?
glucocorticoids (treat inflammatory conditions)
diabetes drugs (insulin & sulfonylureas
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
What should the duration for obese exercise prescription?
: 150 min/wk
: 60-90 minutes activity (420min/wk)
: 200-300 min/wk
What should the intensity for obese exercise prescription be?
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)
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?
: 5-10% loss, 1-2lb/wk
long term goal
: additional weight loss, long term weight maintenence