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clinical exam > weight management > Flashcards

weight management Flashcards

1
Q

define body weight

A

the sum of bone, muscle, organs, body fluids and adipose tissue

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2
Q

some or all components of body weight are subject to normal variation and change resulting from:

(4)

A
  1. growth
  2. reproductive stress
  3. variation in physical activity
  4. effects of aging
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3
Q

consistency in body weight is orchestrated by:

(4)

A
  1. neural mechanisms
  2. hormonal mechanisms
  3. chemical machanisms
  4. individual genetic polymorphisms
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4
Q

define fat mass

A

fat from all body sources including the brain, skeleton and adipose tissue

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5
Q

define fat-free mass

A

includes water, protein and mineral components

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6
Q

proportions of _ mass are relatively constant from person to person

A

fat-free mass

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7
Q

lean body mass is muscle that

(4)

A
  1. is higher in men than women
  2. increases with exercise
  3. is lower in older adults
  4. is a major determinent of resting metabolic rate (RMR)
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8
Q

adjusted body weight calculation

A

(actual body weight - ideal body weight (Healthy BMI)) x 0.25 + ideal body weight

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9
Q

what is body fat a combination of?

A

combo of essential and storage fats
- that are expressed together as a percent total body weight

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10
Q

why is essential fat necessary and where is it stored?

A
  • necessary for normal physiologic functioning
  • stored in small amounts in the bone marrow, heart, lung, liver, spleen, kidneys, muscles and nervous system
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11
Q

what is storage fat and where is it stored?

A
  • it is the energy reserve
  • it accumulates under the skin and around the internal organs to protect them from trauma
  • most is expendable
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12
Q

what are the averages of total body fat for men and women

A

men: 18-24% of total body weight
women: 25 - 31% of total body weight

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13
Q

what does adipose tissue influence and where is it primarily located?

A

adipose tissue exerts a profound influence on homeostasis

located primarily:
- under the skin
- in the mesenteries
- in the omentum
- behind the peritoneum

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14
Q

what is white adipose tissue?

A

it stores energy as a repository for triglycerides
- cushions abdominal organs
- insulates the body to preserve heat

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15
Q

what is brown adipose tissue?

A
  • mainly located in scapular and subscapular areas
  • made up of small droplets and many more ion-containing mitochondria - which makes its appear brown
  • activated from cold exposure to regulate body temp
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16
Q

what do mature adipocytes consist of?

A

a large central lipid droplet surrounded by a thin rim of cytoplasm, containing the nucleus and the mitochondria

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17
Q

cells can store fat equal to ~-~% of their volume.

A

90-95%

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18
Q

what is hyperplasia?

A

increasing the number of cells

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19
Q

what is hypertrophy?

A

increasing the size of existing cells (as liipid is added)

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20
Q

increases in fat cell size are more common in _ and _ but cell number can _ after the fat content of existing cells has reached capacity

A

teens and adults
increase

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21
Q

most deposited fat comes directly from _

A

dietary triglycerides

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22
Q

the fatty acid composition of the adipose tissue mirrors the fatty acid composition of the _

A

diet

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23
Q

excess dietary carbohydrates and protein are converted to _ in the liver via _

A

fatty acids
lipogenesis

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24
Q

under normal conditions, little dietary carbohydrate is converted to _
- the conversion process requires _x more energy than is required to store dietary fat as fat

A

fatty acids
3x

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25
Q

semivolatile organic compounds accumulate in adipose tissues from exposure to:

A
  • toxins
  • chemicals
  • pesticides

these are released when adipose tissue is mobilized during wt loss

dont encourage women of higher weight to lose it during pregnancy (toxins, pesticides, chemical released into blood which could go to the fetus and we dont know what the result of that is)

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26
Q

what is lipoprotein lipase?

A

an enzyme that moves lipid from the blood into the adipose cell, by hydrolyzing TGs into FAs and glyceryol
- glycerol goes to the liver
- FAs enter the adipocyte and are re-esterified into TGs

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27
Q

body weight is a product of:

A
  • genetic effects
  • epigenetics effects
  • the environment
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28
Q

body weight regulation is often described as a homeostatic biological feedback system designed to “____” a stable blody weight
- regardless of energy ____ or energy ____
- is, unfortunately, assymetric in that it more vigorously _ weight loss than weight gain

A

Body weight regulation is often described as a homeostatic biological feedback system designed to “defend” a stable body weight
- Regardless of energy expenditure or energy intake
- Is, unfortunately, asymmetric in that it more vigorously defends weight loss than weight gain

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29
Q

what is known about body weight regulation is in the realm of _ regulation

A

appetite

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30
Q

adaptation to energy restriction is well known but highly _

A

unpredictable

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31
Q

satiety is associated with….

A

satiety is associted with the state, after eating, during which excess calories and nutrients are being stored

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32
Q

hunger is present when….

A

hunger is present when the satiety stores are being stored

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33
Q

hunger triggers are much _ than indicators of satiety

A

stronger

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34
Q

external cues for eating can easily override _

A

satiety

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35
Q

children are more able to eat less or more when _ or _ occurs

A

overfeeding or underfeeding

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36
Q

adults are less able to compensate for overeating over time, which leads to …

A

gradual elevation of weight over time

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37
Q

resting matabolic rate (RMR) explains _____ -_____% of total energy expenditure

A

60-70%

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38
Q

RMR declines with…

A

age
restriction of energy intake

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39
Q

when the body is deprived of adequate energy, the body conserves energy by dropping RMR as rapidly as _% in weeks

A

15%

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40
Q

what is activity thermogenesis?

A

activity termogenesis is energy expended in voluntary activity
- most variable component of energy expenditure

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41
Q

under normal circumstances activity thermogensis accounts for ____ - ____% total energy expenditure

A

~15-30%

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42
Q

nonexercise activity thermogensis (NEAT) is energy expended for all activity that is …

A

NOT sleeping, eating, or sports-like exercise

going to work, typing, doing yard work, fidgeting

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43
Q

NEAT varies as much as _kcal/day between individuals

A

2000 kcal

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44
Q

to reverse obesity, promote….

A

standing and ambulating for 2.5 hours/day and reengineer work, school, home environments to support a more active lifestyle

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45
Q

what does insulin do to affect weight

A

insulin controls the amount of glucose in the blood by moving it into the cells for energy

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46
Q

how does the hormone leptin affect body weight

A

leptin contributes to long-term fullness by sensing the bodys overall energy stores

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47
Q

how does the hormone adiponectin affect body weight

A

adiponectin is made by fat cells, it helps the body respond better to insulin by boosting metabolism

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48
Q

how does the hormone ghrelin affect body weight

A

ghrelin tells the brain when the stomach is empty, prompting:
- hunger pangs
- drop in metabolism

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49
Q

the stomach communicates with the brain via the _ nerve, which travels from the _ to the _

A

Stomach communicates with the brain via the vagus nerve, which travels from the brain to the stomach

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50
Q

when full, the stomachs _ _ sends a message to the brain indicating satiety

A

stretch receptors

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51
Q

what factors of weight are influenced by genes?

A

number and size of fat cells, regional distribution of body fat and resting metabolic rate

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52
Q

what can activate or deactivate obesity-triggering genes?

A

nutrition and/or lifestyle

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53
Q

classes of drugs known to lead to weight gain

6

A
  1. diabetes medications (glyburide)
  2. thyroid hormone replacement (synthroid)
  3. psychotropics (olanzapine)
  4. antidepressants (aripiprazole)
  5. steroids (predisone)
  6. antihypertensives (beta blockers)
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54
Q

shortned sleep alters _ regulation of both hunger and appetite

A

endocrine

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55
Q

recurrent sleep deprivation can modify the _, _ and _ of food intake

A

amount, composition and distribution

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56
Q

stress stimulates the release of _

A

cortisol

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57
Q

cortisol stimulates the release of _ to maintain blood glucose levels

A

insulin
- this leads to increased appetite

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58
Q

chronic stress with constantly elevated cortisol levels can leave to _ changes

A

appetite

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59
Q

cortisol is normally _ in early morning and _ around midnight

A

high / low

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60
Q

those with night-eating syndrome have delayed circadian rhythm related to genetic factors that alter _ levels

A

cortisol

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61
Q

what is sensory specific satiety?

A
  • as foods are consumed, they become less desirable, so people eat more when offered a variety of choices than when a single food is available
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62
Q

what is a benefit of sensory-specific satiety

A

the benefit is that this inclination encourages intake of a varied and nutritionally balanced diet

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63
Q

what is the negative of sensory specific satiety?

A

it can lead to overconsumption

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64
Q

levels of leptin which supresses appetite, are _ in the obese than in normal weight individuals

A

higher

they build a resistance to the effects of leptin

65
Q

passive overeating is partly resulting from _ portion sizes accepted as normal

A

large

66
Q

what are obesogens?

(endocrine disruptors)

A

chemical components foreign to the body that disrupt normal metabolism of lipids, ultimately resulting in obesity

67
Q

at high levels of exposure, obesogens:

5

A
  1. increase insulin resistance
  2. expand fat storage
  3. alter satiety and appetite regulation
  4. more significantly reduce RMR following weight loss
  5. decrease the level of rise in RMR with weight gain
68
Q

give three examples of obesogens/ endocrine disruptors:

A
  1. bisphenol A (BPA)
  2. phthalates
  3. organophosphates
69
Q

_ complex polysaccharides promote and maintain a healthy _

A

microbiome

70
Q

what are the clinical assessment tools for weight

A

bmi
waist circumference
waist/hip ratio

71
Q

studies have determined that the optimal BMI with the least risk of mortality is a bm of _ to _

A

23 - 24.8

above or below this is associated with increased mortality risk

72
Q

inflammation due to adipose tissue can result in the development of…

7

A
  1. hyperlipidemia
  2. metabolic syndrome
  3. diabetes mellitus
  4. muscle protein loss
  5. CVD
  6. stroke
  7. some cancers
73
Q

regional patterns of fat deposit differ between _ and _

A

men and women

74
Q

what are the 2 major types of fat deposition?

A
  • excess subcutaneous truncal-abdominal fat (apple shaped android fat distribution_
  • excess gluteofemoral fat in thighs and buttocks ( pear shaped gynoid fat distribution)
75
Q

diagnosis of metabolic syndrome requires three or more of these abnormalities…

5

A
  1. waist circumfrence of 40 or more” in men and 35 or more” in women
  2. serum triglycerides 1.69 mmol/L or more
  3. HDL level less than 1.04 in men and less than 1.30 in women
  4. blood pressure of 135 / 85 mm Hg or higher
  5. fasting glucose of 5.5 mmol/L or more
76
Q

wide spread weight bias and discrimination have been documented in _, _ and _

A

education, employment and health care

77
Q

goal of obesity treatment should be to acieve…

A

enough weight loss to significantly imrpove overall health

78
Q

mobilizing fat is more efficient and spared _ _ _

A

lean body mass

79
Q

steady weight loss over a longer period favors:

A
  • reduction of fat stores
  • limits loss of protein tissues
  • limits the decline in resting energy expenditure that can accompany energy restriction
80
Q

recommend calorie deficits resulting in a loss of around 0.5-1 lb/week for those with BMI -
and 1-2 lb/week for those with BMI _
- when these deficits are maintained, they lead to a 10% weight loss in _ months

A

27-35
>35
6 months
- after the 6 months, focus is to maintain weigh

81
Q

men lose weight faster than women of similar size because of their…

A

greater lean body mass and high resting metabolic rate

82
Q

what are the 3 main focuses when restructuring a persons lifestyle

A
  1. environment
  2. nutrient intake
  3. physical activity
83
Q

when restructuring a persons lifestyle it is important to use 4 main methods, what are these?

A
  1. goal setting
  2. stimulus control
  3. cognitive restructuring
  4. relapse prevention
84
Q

stimulus control involves:

A
  • identifying stimuli that may encourage incidental eating
  • indentifying and limiting exposure to high risk situations
85
Q

possible strategies to use in stimulus control

A
  • learning to shop (with a plan)
  • avoiding shopping when hungry
  • keeping high-cal foods out of the house
  • limiting times and places of eating
  • consciously avoiding situations where overeating occurs
86
Q

problem solving in lifestyle modification is a process of…

6

A
  1. defining the intake problem
  2. generating possible solutions
  3. evaluating and choosing the best solution
  4. implementing the new behaviour
  5. evaluating outcomes
  6. reevaluating alternative solutions (as needed)
87
Q

cognitive restructuring teaches patients to…

A

idenify, challenge and correct negative thoughts that undermine their efforts to lose weight and maintain weight loss

88
Q

a cognitive therapy (CBT) program underscoring the connection between _ and _ and how to manage that connection has proven useful

A

emotions and eating

89
Q

settling on appropriate treatment depends on the patients:

A
  • goals
  • health risks
90
Q

dietary modifications - treatment options

A
  1. balanced, reduced calorie macronutrient adjusted eating plan, increased physical activity and lifestyle modification
  2. balanced reduced calorie macronutrient adjusted eating plan, increased physical activity, lifestyle modification AND pharmacotherapy
  3. Bariatric surgery + individually prescribed eating regimen, physical activity and lifestyle modification
  4. prevention of weight regain by actively balancing energy intake/output
  5. mindset interventions (e.g. cognitive restructuring, motivational interviewing, psychological counselling)
91
Q

explain what a restricted energy eating plan is

A

most widely prescribed method of weight reduction
- should be nutritionally adequate except for energy, which is decreased to the point at which fat stores must be mobilized to meet daily energy needs
( a deficit of 500 - 1000 kcal/day usually meets this goal)
- energy level varies between 1200 and 1800 k/cal per day
- can be tailored to individual preferences
- should be encouraged to eat mainly whole foods

92
Q

1.2 g/kg/day of protein appears to be adequate to:
.
.
.
when energy intake is restricted

3

A
  1. minimize loss of lean body mass
  2. prevent reduced resting energy intake
  3. preserve bone mineral density
93
Q

alcohol contributes _ % kcal/g

A

7

94
Q

vitamin and mineral supplements that meet age-related requirements are recommended when intake is _ kcal for women and _ kcal for men

A

Vitamin & mineral supplements that meet age-related requirements are recommended when intake is:
- less than or equal **1200 kcal for women **
- less than or equal to 1800 kcal for men

95
Q

goal of commercial and self help programs is to provide…

A

structure and replace higher calorie foods

96
Q

per serving, most meal replacements contain:
_ g protein
- _ amounts of CHO
- _ g fat
- _ g fibre
- _% of the daily allowance for vitamins and minerals

A

10-20 g protein
varied amounts of CHO
0-10 g fat
5 or less g fibre
25-30% of the daily allowance for vitamins & minerals

97
Q

formula diets are meal replacements that are:
.
.
.

A
  • commercially prepared
  • ready-to-use (or a powder that can be mixed)
  • portion controlled
98
Q

where can formula based meal replacements be found?

A

over the counter in drug stores, weight loss settings, supermarkets or in a clinical setting

99
Q

usually drinks or shakes are:
.
.
.

A
  • milk (casein or whey), pea protein, rice protein, or soy boased
  • high in calcium
  • have 150-250 kcal / 9oz
100
Q

describe Very-Low Calorie Diets (VLCDs)
- how many kcal they provide
- protein
- how long they are prescribed
- what they are designed to provide

A
  • provide less than 800 kcal/day
  • relatively rich in protein (0.8-1.5 g/kg / day)
  • usually prescribed for 12-16 weeks
  • designed to include full complement of vitamins, minerals, electrolytes and essential fatty acids (but not calories)
101
Q

adverse side effects of VLCDs

9

A
  1. increased risk of gallstones
  2. cold intolerance
  3. fatigue
  4. lightheadedness
  5. hair loss
  6. constipation or diarrhea
  7. dry skin
  8. menstrual irregularities
  9. gout
102
Q

reduced energy diets should be…

balanced lower cal diets

A
  • nutritionally sound
  • not harmful
  • feasible to maintain over time
103
Q

reduced energy diets require sustainability in…

3

A
  • ease of adherence
  • availability and affordability of foods
  • cultural and social acceptability
104
Q

diets that decrease caloric intake result in _
all low cal diets result in loss of _

A

weight loss
body fat

105
Q

high fat, low CHO keto diets cause a greater loss of _ than _

A

body water than body fat

106
Q

low carb diets cause ketosis and can significantly increase _ concentrations

A

blood uric acid

107
Q

blood lipid levels _ as body weight decreases

A

decrease

108
Q

energy restriction improves _ control

A

glycemic

109
Q

as body weight decreases, blood pressue _

A

decreases

110
Q

what is the most variable component of energy expenditure?

A

physical activity

111
Q

increased lean body mass in proportion to fat through physical activity, helps to balance lost lean body mass and _ in RMR

A

decrease

112
Q

positive effects of increased physical activity
.
.
.

A
  • strengthen cardiovascular integrity
  • increased sensitivity to insulin
  • expending additional energy/calories
113
Q

adults 18-64 should accumulate _ min moderate to vigorous intensity aerobic physical activity per week
- in bouts of _ min

A

150+ min / week
- in bouts of 10 or more mins

114
Q

beneficial to add bone and muscle strenthening activities using _ muscle groups at least _ day/week

A

2 or more
2 day per week

115
Q

for weight maintenance or prevention of weight gain, _ - _ min of weekly physical activity may be more effective

A

200-300 min

116
Q

even if unable to achieve higher levels of activity, there is evidence indicating that participating in at least _ min/day of moderate intensity activity can have significant health benefits

A

30 min/day

117
Q

resistance training increase _ , adding to RMR and _ bone mineral density

A

lean body mass
increasing

118
Q

aerobic exercise is important for cardiovascular health through
. elevated _
. _ expenditure
. energy _
. loss of _

A

elevated RMR
calorie expenditure
energy deficit
loss of fat

119
Q

non physiologic benefits of physical activity include:

A
  • relief of boredom
  • increased sense of control
  • improved sense of well being
120
Q

Recommendations for exercise from the American College of Sports Medicine differ for weight loss vs. weight maintenance
- physical activity less than 150 min/week has a _ effect on weight loss
- physical activity more than 150 min/week results in _ weight loss
- phsyical activity between _ - _ min/week results in the greates weight loss

A

Physical activity less than 150 min/week has a minimal effect on weight loss
Physical activity more than 150 min/week results in modest weight loss (2-3 kg)
Physical activity between 225-420 min/week results in the greatest weight loss (5-7.5 kg)

121
Q

Pharmaceutical agents for weight loss/ maintenance can:
.
.
.

A
  • decrease appetite
  • decrease absorption of fat
  • increase energy expenditure
122
Q

what 4 prescription medications are approved for overweight and obesity in canada?

A
  1. naltrextone-buproprion (contrave)
  2. liraglutide (saxenda) - injection
  3. orlistat (xenical)
  4. semaglutide (wegovy)
123
Q

explain CNS acting pharmaceutical agents for weight loss/maintenace

A
  • some act on the brain, increase availability of norepinephrine
    ( anorexic agents such as amphetamines have a high potential for abuse and are not recommended for treatment of obesity)
  • serotoninergic agents
    (act by increasing serotonin levels in the brain
  • non-CNS agents
    (ex. orlistat)
124
Q

common side effects of CNS acting agents are:
.
.
.
.

A
  • dry mouth
  • headache
  • insomnia
  • constipation
125
Q

explain the non-diet paradigm

A
  • maintain that the body will attain its natural weight if the individual eats healthfully, becomes attuned to hunger and satiety cues
  • focus is on achieving health and not attaining a certain weight
  • encourages size acceptance and respect for the diversity of body shapes and sizes
126
Q

non diet studies consistenly show improvements in physchological variables:
.
.
.

A
  • self-esteem
  • quality of life
  • depression
127
Q

non diet bahvioural programs typically address:
.
.
.
.
. sometims included: _

A
  • emotional eating triggers
  • balanced nutrition
  • social support
  • exercise
  • sometimes included: cognitive restructuring (CBT)
128
Q

what. isconsidered the only long-term effective treatment for extreme or class three obesity with a BMI of 40 or more? (or with a BMI 35 or more with comorbidities)

A

bariatric surgery

129
Q

before being considered for bariatric surgery, person must demonstrate having failed in a comprehensive program including:
.
.
.
.
.

A
  • calorie restriction
  • exercise
  • lifestyle modification
  • psychological counseling
  • family involvement
130
Q

once accepted for bariatric surgery, the patient is evaluated for:
.
.

A
  • physiologic and medical complications
  • psychologic problems
131
Q

what is the ultimate goal of bariatric surgery?

A

to decrease the amount of food that can be eaten at one time and produce early satiety

132
Q

after bariatric surgery, the diet progrsses from:
.
.
.
.

A
  • clear liquid (first 24 hours)
  • full liquid (week)
  • puree (month)
  • soft (4 weeks)
  • regular diet as tolerated (after 8 weeks)
133
Q

complications of bariatric surgery may include…

A

vitamin deficiencies
electrolyte problems
intestinal failure

134
Q

what is a laparoscopic sleeve gastrectomy?
- what are its complications?

A

involves removing around 80% of the stomach and creating a thin gastric pouch by sewing or stapling the stomch longitudinally

complications:
- gastric bleeding
- stenosis
- leak
- reflux (most common)

135
Q

what is gastric bypass surgery?

A

involves reducing the size of the stomach with the stapling procedure
- then connecting a small opening in the upper portion of the stomach to the small intestine by means of an intenstinal loop

use of the lower part of the stomach is omitted
- patients may having dumping syndrome as food empties quickly into the duodenum

136
Q

16 or less& of gastric bypass patients experience postoperative complications including:

A
  • aastomotic leaks
  • strictures
  • perforation
  • gastric fistula
  • bowel obstruction
  • wound infections
  • respiratory failure
  • intractable nausea and vomiting
137
Q

what is laparascopic adjustable gastric banding (LAGB)?

A

a band creating the reduced stomach pouch can be adjusted so that the opening can be made smaller or enlarged
- the band filled with saline, has a tube exiting from it to the surface of the belly
- this allows for the injection of additional fluid or reduction of fluid into the lap band

patients like bc it is reversible but docs think complication / benefit

138
Q

bariatric surgery required lifelong follow-up and monitoring. what should be monitored by the RD?

A
  • total body fat loss
  • full macronutrient AX including
    (thiamine, B12, folate, iron, vit D, calcium, Vit A, E, K (fat soluble), zinc, copper)
139
Q

what does an intragastric ballon do?
what are the complications

A
  • it is a nonsurgical management
  • a balloon made of silicone is placed endoscopically in the stomach for 6 months
  • during this time patients are expected to learn and develop healthy eating habits that persist when the balloon has been removed

complications:
- abdominal pain
- nausea
- esophagitis
- flatulence
- gastric ulcer

140
Q

energy requirements for weight maintenance after weight reduction are lower than at the original weight because smaller bodies have smaller _

A

RMRs
(resting metabolic rate)

141
Q

common behaviours for keeping weight off inlcude…

A
  • eating a relatively low fat diet (24%)
  • eating breakfast every day
  • weighing regularly (once per day to once per week)
  • engaging in high levels (60-90 min/day) of physical activity
142
Q

how can repetitious diets be useful for controlling intake?

A

because people tend to overeat when they have many choices at mealtimes

143
Q

what. isthe plateau effect and how can people move out of this phase?

A

people in a weight loss program arrive at a weight plateau (when weight remains the same for a long period)
- to move out of this phase, reestablishing an energy deficit is required

144
Q

does childhood obesity increase risk of obesity in adulthood?

A

yes

145
Q

children who are obese after _ years of age have a greater probability of obesity in adulthood if either the mother or father is also obese.

A

6 years

146
Q

children or adolescents with a BMI greater than the 85th percentile and complications of obesity, or with a BMI greater than the 95th percentile without complications should be assessed for…

A

genetic markers
endocrine issues
psychologic conditions
secondary complications
- HTN
- dyslipidemia
- type 2 DM
- sleep apnea
- orthopedic problems

147
Q

what is the primary goal in wight management for kids and teens?

A

to ahieve healthy eating and activity, NOT to achieve ideal body weight

148
Q

for those 2-5 years old with no secondary complications of obesity, goal is either:
.
.

if secondary complications are present _ may be the goal

A
  • prolonged weight maintenance
  • slowing rate of weight gain

weight loss

149
Q

children who already exceed optimal adult weight can safetly lose wieght at _ - _ lbs per year until optimal adult weight. isreached

A

10-12

150
Q

balanced macronutrient intake for children includes:
- _ - _ % CHO
- _ - _ % fat
- _ - _ % protein

A

45-60% CHO
25-40% fat
10-35% protein

151
Q

low vitamin _ is predominant in obese children

A

D

152
Q

_ interventions are the only type of effective treatment in weight management for kids

A

family-centered
- should be long term

153
Q

undernutrition can lead to under functioning of the _, _ and _.
- other risk factors include:
.
.
.
.

A

pituitary, thyroid gonads and adrenal glands

  • loss of energy
  • susceptibility to injury and infection
  • distorted body image
  • other psychological problems
154
Q

underweight or unintentional weight loss can be caused by:
.
.
.
.
.

A
  1. inadequate oral food and beverage intake
  2. excessive physical activity
  3. inadequate capacity for absorption and metabolism of foods consumed
  4. wasting diseases that increase the metabolic rate and energy needs as in cancer, AIDS, or hyperthyroidism
  5. excess energy expenditure during psychologic or emotional stress
155
Q

list pharmaceutical appetite enhancers

A
  1. corticosteriods
  2. megestrol acetate
  3. mirtazapine
  4. dronabinol
  5. anabolic agents (testosterone)
156
Q

add _ - _ kcal per day to encourage weight gain

A

500 - 1000
- leads to 1-2lb weight gain per week

157
Q

when increase intake to gain weight it is important to increase gradually to avoid…

A
  • gastric discomfort
  • discouragment
  • electrolyte imbalanced
  • cardiac dysfunction
158
Q

high energy diets should aim for _ % fat, and minimum _ - _% protein

A

30% fat (majority MUFAs and PUFAs)
12-15% protein

clinical exam (3 decks)

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