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79 Cards in this Set
- Front
- Back
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Bariatric Surgery
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Weight loss surgery
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Bariatric Surgery
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Weight loss surgery
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What BMI is recommended for weight loss surgery?
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BMI > 40
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What BMI is recommended for weight loss surgery?
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BMI > 40
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What patient statuses are evaluated prior to surgery?
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Psychological status
Medical status Nutritional status |
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What patient statuses are evaluated prior to surgery?
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Psychological status
Medical status Nutritional status |
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What are the three parts of the small intestine?
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Duodenum
Jujunem Ileum |
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What are the three parts of the small intestine?
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Duodenum
Jujunem Iliac |
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Which bariatric surgery was common in the 1970's?
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Jununoileal Bypass
*used to be standard, now we don't do it |
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Which bariatric surgery was common in the 1970's?
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Jununoileal Bypass
*used to be standard, now we don't do it |
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What problems arose from jujunoileal bypasses?
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- Vomiting
- Dehydration - Electrolyte Imbalance - Abdominal Pain |
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What problems arose from jujunoileal bypasses?
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- Vomiting
- Dehydration - Electrolyte Imbalance - Abdominal Pain |
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Why did these problems occur?
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It took out all but the last 10% of the intestines
so malabsorption occurred frequently |
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Why did these problems occur?
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It took out all but the last 10% of the intestines
so malabsorption occurred frequently |
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How does it help you lose weight?
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very little absorption and calories are excreted out the feces
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How does it help you lose weight?
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very little absorption and calories are excreted out the feces
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What gastric bypass procedures replaced it?
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1. Gastric bypass
2. Vertical banded gastroplasty 3. Roux-en-Y gastric surgery 4. Gastric balloon |
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What gastric bypass procedures replaced it?
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1. Gastric bypass
2. Vertical banded gastroplasty 3. Roux-en-Y gastric surgery 4. Gastric balloon |
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How does Gastric Bypass work?
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A gastric bypass first divides the stomach into a small upper pouch and a much larger, lower "remnant" pouch and then re-arranges the small intestine to allow both pouches to stay connected to it.
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How does Gastric Bypass work?
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A gastric bypass first divides the stomach into a small upper pouch and a much larger, lower "remnant" pouch and then re-arranges the small intestine to allow both pouches to stay connected to it.
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What is the gold standard for bariatric surgery?
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Roux-en-Y Gastric Bypass
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How does it promote weight loss?
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Bypass the stomach and duodenum
Leaves small bowel so there is still absorption Cut about about 30% of intestines |
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What are the side effects?
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Vomiting
Electrolyte Imbalance Malabsorption |
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How does the vertical banded gastroplasty work?
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A small pouch is created in order to
control portion size of food Intestines stay intact, so we don't lose absorption Food leaks through band slower Not as successful as gastric bypass |
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What are the side effects?
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Abdominal discomfort
Vomiting |
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How does a Gastric Balloon work?
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An inflatable balloon is placed in the stomach to
promote full feeling Takes up about 3/4 of stomach |
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How long is the balloon usually implanted for?
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6 months
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What are the side effects?
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Stomach Ulcers
(from stomach trying to digest it) Vomiting |
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Who is responsible for regulating weight loss drugs?
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The FDA
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What about over the counter drugs?
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They just have to prove they're safe,
not that they actually work |
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What are three important considerations for weight loss drugs?
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1. Risk vs. Benefit
2. Potential for abuse 3. Weight-loss potential |
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What BMI is recommended for weight loss drugs?
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BMI > 27
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What else qualifies someone for them?
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- Someone who isn't ready for surgery
- Inability to lose weight through behavior changes (like diet, exercise, and lifestyle changes) - People with family history of obesity |
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What are some contraindications to not use weight loss drugs?
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- Cardiovascular problems
- Arrythmias - Liver or kidney disease - Pregnancy - Psychiatric illness |
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What are anorectic drugs?
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Appetite Suppresors
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How do they work?
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Activate "fight or flight system"
Ramps up metabolism and decreases appetite |
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What are the two main categories of anorectic drugs?
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Catecholamergic and Serotonergic
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Catecholamergic
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suppress appetite by elevating NE and dopamine in CNS
ex. amphetamines, phentermine, phenylpropanolamine |
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Serotenergic
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suppress appetite by elevating levels of serotonin in the CNS
ex. fenfluramine, fluoxetine, dexfenfluramin |
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What three drugs were used to make Fen-Phen?
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1. Phentermine
2. Fenfluramine 3. D-fenfluramine |
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What problems resulted from Fen-Phen?
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- Mitral Valve Prolapse
- HTN of lungs - Congestive Heart Failure *was because of Fen and D-Fen |
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Which new drug has been developed instead of Fen-Phen?
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Sibutramine
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What is Orlistat?
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Fat replacer marketed as Alli
It reduces caloric intake by blocking absorption Causes anal leakage and rectal bleeding |
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What are some new drugs being developed?
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Leptin
- suppresses appetite - increases energy expenditure Neuropeptide Y antagonists - blocks NPY, which stimulates eating Galanin antagonists - opposes Galanin, which stimulates eating (particularly fats) |
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What are some weight loss drugs sold over the counter?
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Orlistat (Alli)
Phenylpropanolamine (PPA) - active ingredients are Dexatrim and Control |
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What is a dietary supplement?
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Product other than tobacco usually ingested in pill, capsule, tablet, or liquid form
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What are some common weight loss ones?
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- Ephedra/ Ma huang: speeds up metabolism
- Caffeine: speeds up metabolism - Chromium: reduces fat and increases LBM - St. John's Wort: suppresses appetite - Trytophan: suppresses appetite; reduces anxiety - Dieter's tea: prevents calorie absoprtion |
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What are our ideal weight/suggest weight/ BMIs based on?
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- Metropolitan Life Insurance Company tables
- Dietary Guidelines for Americans - Based on height, weight, gender, and frame |
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What is the equation for percent overweight?
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(Scale weight - Ideal weight) / (ideal weight)
all times 100 |
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What are our caloric requirements based on?
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- METS
- Paced activities (jogging, walking, cycling) |
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What is a MET?
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"Metabolic Equivalent"
1 MET = 3.5 mL/kg/min |
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Why do we use METS?
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- Provides easy reference for activity
- Easy to convert to kcal expended |
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What are the catergories of METS?
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Light: <3 METS
Moderate: 3 - 6 METS Vigorous: >6 METS |
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What is the running equation?
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VO2 = (.2 x S) + (.9 x S x G)
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What is the walking equation?
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VO2 = (.1 x S) + (1.8 x S x G)
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How do you convert speed from mph to m/min?
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Multiply it by 26.8
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How do we convert from relative to absolute terms?
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Times it by body weight and divide by 1000
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What are the benefits of exercise?
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- Increases EPOC
- Increases caloric expenditure - Increases LBM - Increases metabolic rate - Regulates appetite - Counteracts decrease in metabolism - Increased self esteem |
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What is EPOC?
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Excess post exercise oxygen consumption
Replenishes O2 stores after exercise |
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How does exercise regulate appetite?
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Exercise ↓ ghrelin which then ↓ hunger
It also ↑ peptide YY, which suppresses the appetite |
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What aerobic exercise intensity is best for fat burning?
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60 - 65%
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What are the mental benefits of exercise?
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- Acute mental benefits
• relieves stress - Enhances mood - Chronic mental benefits • improves self preception • improves self esteem • improve achievement and empowerment • improves depression and anxiety |
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Why do we hit a weight plateau?
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Because of increases LBM
- it's made of water so it has a high density - loosing fat and gaining muscle equal each other out |
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What type of fat is easiest to burn?
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Central fat
Peripheral is harder |
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Individual weight loss variations are due to?
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- Genetic differences
• metabolic rate - Fat pattern • central vs peripheral - # of fat cells - mechanical effciency |
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What caloric expenditure is recommended for obese people?
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300 - 500 cals/session
or 2000 cals/week |
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Recommended Cardiovascular Exercise for Obese
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F: 5+ days a week
I: Moderate Intensity (3-6 METS) T: 20-60 mins a day T: Aerobic |
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Recommended Resistance Exercise for Obese
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F: 2-3 days/week
I: 30-40% peak strength 6-8 METS T: 15-20 reps T: 8-12 muscle groups |
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What are the most common orthopedic problems for obese people?
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1. Back
2. Knees 3. Hips and Ankles |
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What are some important things to keep in mind
when designing a program for the obese? |
• Exercise abilities vary
• They perceive increases in intensity as greater than they really are • Resist new experiences in exercise • Barriers to exercise affect them more • Injuries and orthopedic problems |
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What are the 5 priorities in exercise for weight loss?
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1. 2,000 kcal/weel
2. Intensity of 50-60% 3. 7 days/week 4. Increase NEAT 5. 10,000 steps a day |
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Does anaerobic or aerobic burn more fat?
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Aerobic
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Aerobic characteristics
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• large muscle exercises
• all three macronutrients provide fuel • sustain for longer time |
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Anaerobic characteristics
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• more intense exercise
• less fat burned • high intensity • mostly carbohydrates used • sustain for less time |
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Structured vs. Lifestyle activity
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STRUCTURED
• visit to the gym • treadmill running • cycling class • stair climber LIFESTYLE • taking the stairs • parking farther away • window shopping • gardening |
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What is the best way to measure activity expenditure?
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VO2
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How long does a bout have to be to be considered useful?
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At least 10 minutes
CV benefit is the same in continuous or multiple short bouts |
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Adherence tips for exercise
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- Develop a specific plan
- Keep records - Involve others - Avoid injuries - Make activity enjoyable - Perservere |
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Who should see a physician before exercising?
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Men > 45 and Women > 55 who:
• have chronic disease (cardiac, pulmonary, metabolic) • have risk factors for chronic disease ( 2 major risk factors, or 1 risk factor and S&S of CHD) |
