Flashcards in Obesity Deck (46)
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1
#1 cause of preventable disease and disability
Obesity
2
BMI classifications
Overweight: 25-29.9
Obesity>30
Class I: 30-34.9
Class II: 35-39.9
Class III: >40 (severe obesity)
3
When might BMI not be accurate?
Body builder
4
When do you measure waist circumference?
When a pt has a BMI b/w 25-35 kg/m2
5
Based on waist circumference, who is at increased risk of obesity?
>40 inches in men
>35 inched in women
6
Ethnic variability of waist circumference
35.4 inches for males and 31.5 inches for female in the Asian population
7
How do you create a negative energy balance?
Increase activity and decrease calories consumed
Create 500-1000 calories per day deficit=weight loss of 1-2 lbs per week
8
Labs important for obesity
History and PE
Fasting glucose and/or HbA1C
TSH
Liver enzymes
Fasting lipids
9
Ideas for nutrition counseling
Balance calories
Enjoy food but eat less
Avoid oversize portions
Know foods to eat more and less often
Make 1/2 plate fruits and veggies
Switch to skin or 1% milk
1/2 of grains are whole grain
Reduce sodium
Drink water instead of sugary drinks
10
DASH diet
Emphasize vegetables, fruits, low-dat dairy with moderate whole grains, fish, poultry and nuts
11
Mediterranean diet
Plant-based: fruits, veggies, whole grain braids and cereals, beans, nuts and seeds
Principal source of dietary fat is olive oil
Fish and poultry but limit red meat
12
Recommended diets for type 2 DM
DASH, mediterranean, carb counting, limit sugar
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Recommended diets for CVD
DASH, low Na, mediterranean diet
14
Recommended diets for CKD
DASH, renal diet (less animal protein)
15
Recommended diets for celiac disease
Gluten free
16
Very important modifiable risk factor
Sedentary lifestyle
17
Who do you screen for obesity?
ALL adults
18
Most effective high intensity obesity interventions
Two x mo for >3 mos (12-26 sessions a year) or intensive, multicomponent behavioral intervention
19
Strategies for counseling
Ask/address
Advise
Assess (readiness to change)
Assist
Arrange f/u
20
Goals of obesity intervention
Prevent, treat or reverse complications of obesity
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When do you see significant health benefits with weight loss?
5% body weight loss
22
Obesity tx based on low risk
(BMI of 25-29.9 with no CVD RF or other comorbidities)
Diet and counseling to prevent weight gain
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Obesity tx based on moderate risk
(BMI 25-29.9 AND >1 CVD RF or BMI 30-34.9)
Intensive multicomponent behavioral modification and SOME drug therapy (>27)
24
Obesity tx based on high risk and very high risk
(BMI of 35-40 is high and >40 is very high)
Intensive multicomponent modification and consider drug therapy, bariatric surgery
25
When do you consider drug therapy?
BMI>30 or >27 with comorbidities
(<5% weight loss in 3-6 mos is when to start discussing-with a goof lifestyle program)
26
Goals of drug therapy
Reduce weight (4-8% in 6-12 mos)
Improve health
Minimize adverse effects
27
What does Orlistat (Alli/ Xenical) do?
Alter fat digestion by inhibiting pancreatic lipases
Increases fat in stools
28
Side effects of Orlistat
May decrease absorption of fat soluble vits (ADEK) so much take a multi vitamin daily
Unpleasant GI side effects
29
What does liraglutide do?
GLP-1 receptor agonist (daily SQ injection)
Pts with type 2 DM
30