Obesity Flashcards

(46 cards)

1
Q

1 cause of preventable disease and disability

A

Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

BMI classifications

A
Overweight: 25-29.9
Obesity>30
Class I: 30-34.9
Class II: 35-39.9
Class III: >40 (severe obesity)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When might BMI not be accurate?

A

Body builder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When do you measure waist circumference?

A

When a pt has a BMI b/w 25-35 kg/m2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Based on waist circumference, who is at increased risk of obesity?

A

> 40 inches in men

>35 inched in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ethnic variability of waist circumference

A

35.4 inches for males and 31.5 inches for female in the Asian population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you create a negative energy balance?

A

Increase activity and decrease calories consumed

Create 500-1000 calories per day deficit=weight loss of 1-2 lbs per week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Labs important for obesity

A
History and PE
Fasting glucose and/or HbA1C
TSH
Liver enzymes
Fasting lipids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ideas for nutrition counseling

A
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

DASH diet

A

Emphasize vegetables, fruits, low-dat dairy with moderate whole grains, fish, poultry and nuts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Mediterranean diet

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Recommended diets for type 2 DM

A

DASH, mediterranean, carb counting, limit sugar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Recommended diets for CVD

A

DASH, low Na, mediterranean diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Recommended diets for CKD

A

DASH, renal diet (less animal protein)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Recommended diets for celiac disease

A

Gluten free

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Very important modifiable risk factor

A

Sedentary lifestyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Who do you screen for obesity?

A

ALL adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Most effective high intensity obesity interventions

A

Two x mo for >3 mos (12-26 sessions a year) or intensive, multicomponent behavioral intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Strategies for counseling

A
Ask/address
Advise
Assess (readiness to change)
Assist
Arrange f/u
20
Q

Goals of obesity intervention

A

Prevent, treat or reverse complications of obesity

21
Q

When do you see significant health benefits with weight loss?

A

5% body weight loss

22
Q

Obesity tx based on low risk

A

(BMI of 25-29.9 with no CVD RF or other comorbidities)

Diet and counseling to prevent weight gain

23
Q

Obesity tx based on moderate risk

A

(BMI 25-29.9 AND >1 CVD RF or BMI 30-34.9)

Intensive multicomponent behavioral modification and SOME drug therapy (>27)

24
Q

Obesity tx based on high risk and very high risk

A

(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
Side effects of liraglutide
N/v
31
What does lorcaserin (belviq) do?
Selective serotonin agonist to decrease appetite
32
When do you not use phentermine/topiramate (qysmia) for weight loss?
Pts with HTN, CAD or hyperthyroidism
33
When is phentermine?
Sympathomimetic (only for 12 wk use)
34
Most widely prescribed weight loss drug
Phentermine (lots of SEs like neuro ones and potential for abuse)
35
Necessary monitoring for obesity drug therapy
Monitor weight BP, HR and SEs (weekly for 4 weeks and monthly for 3-4 mos)
36
What should you do if pt does not lose 3-4% of weight in first 3 mos on a drug?
Discontinue
37
What are some therapies that are not recommended for weight loss?
Dietary supplements (caution with OTC weight loss supplements) hCG (requires 500 cal/day diet) Calcium
38
When do you consider bariatric surgery?
BMI>40 BMI 35-39.9 and >1 or 1 serious comorbidity BMI 30-34.9 and difficult to control type 2 DM or metabolic syndrome
39
What must you do before bariatric surgery to lead to greater weight loss post op?
Lose 8% excess body weight
40
Contraindications for bariatric surgery
Eating disorders, untreated mental illness, drug of EtOH abuse, coagulopathy, severe cardiac disease, inability to comply with lifelong dietary requirements
41
How does bariatric surgery affect weight loss?
Restrict caloric intake Malabsorption Decrease appetite and improve metabolism by changing release of hormones
42
Types of bariatric surgery
Sleeve gastrectomy Roux-en-Y gastric bypass Adjustable gastric band Intragastric balloon and duodenal switch
43
What is the physical activity vital sign?
How many days/wk do you engage in moderate or greater physical activity (>brisk walk) On the days you exercised, how many minutes was it?
44
Physical activity guidelines
At least 150-300 min/wk of moderate intensity exercise of 75-150 min/wk of vigorous intensity aerobic physical activity (or combo of 2) AND muscle strengthening >2 days/wk
45
FITT exercise prescription
Frequency (aim for >5 days/wk but set a goal) Intensity (aim for moderate to vigorous) Time (aim for >30 min but no minimum sessions) Type (walking is good start when sedentary)
46
What do you use for awareness of exertion?
Talk test: moderate is can talk but not sing and vigorous is cannot say more than a few words w/o pausing to breathe