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140 Cards in this Set
- Front
- Back
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Define obesity
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means grown fat by eating
excess accumulation of adipose tissue |
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Ways to measure body composition
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Bod Pod =air displacement
Hydostatic Weighing= water displacement method DEXA= bone mineral density & %body fag SKIN FOLD= calipers BIOELECTRICAL EMPIDENCE ANALYSIS= muscle that contains H2O and conduts ANTROPOMETRIC MEASUREMENTS= bmi, hip to waist |
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BMI categories
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under <18.5
normal 18.5-24.9 over 25-29.9 obese 1 30-34.9 obese 2 35-39.9 obese 3 >40 |
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Hip to waist ratio and risk factors for males and females
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waist= smallest below ribs
hip= largest around butt Very low >70 >80 Low 70-89 80-99 High 90-109 100-120 Very High >110 >120 |
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Global trends
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men are overweight women are obese
adult obesity double children overweight double adolecent overwieght tripled |
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Three states leading obesity
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West Virginia
Mississipi Alabama |
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Modernization and Urbanization
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Modernization (growth of industry and technology)
Modernization an abundance of food A decrease in overall physical activity. Urbanization (population growth in large cities). Associated with changes in diet More sedentary lifestyle. |
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Twin Studies
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Identical twins lost almost identical amounts of weight
Tremendous variability in the amount of weight lost between pairs of fraternal twins |
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Adoption Study
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Strong association
Adoptee BMI of Biological Parents BUT NOT Adoptee BMI of Adoptive Parents |
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Family Patterns and Critical periods
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Both parents 80% chance
one parent 40% neither 7-14% Critical Pregnancy, Menopause, Adolesecent |
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Energy Expenditure
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3500kcal = 1 lb fat
Resting Met rate = 60-75% maintain body function Thermal Effects of Feeding= 10% TH Effect of PA = 15-30% most variable and sed v phys |
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Spontaneous Daily Activity
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SDA usually decreases with decrease in body weight
Adding excersice can help |
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Fat Free Mass
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These yoyo dieters lose approximately 25% of their weight as fat-free mass (metabolically active tissue) that does not resynnthesize when weight is regained
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fat cells
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hypertrophy (increased size of existing cell)
___________ (increased # of cells) Combination of both. Fat content within a cell = 35% greater in obese Total # of fat cells = 3x greater in obese Obese: may have 75 billion fat cells compared to 27 billion in non-obese |
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Know Polymorphism,Founder Effect, Genetic Drift
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Polymorphism
Genetic variant, mutation Founder Effect In a population, if a few are carriers for an altered gene, many of their descendants may carry the gene Genetic Drift Populations with little genetic diversity |
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Energy Expenditure,
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Adrenergic receptor genes
Polymorphism of this gene = resistance to weight loss Uncoupling proteins UCP3 expression was lower in those who were diet-resistant |
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Appitite & leptin
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Leptin (protein hormone, considered the ‘appetite gene’)
Leptin = tells our bodies ‘we’ve had enough’. Without leptin, eat continuously. Obesity = related to very rare mutation in leptin gene Congenital leptin deficiency = treated with administration of leptin Obese with normal leptin levels who are given leptin = do not lose weight (unless in extreme dosages) |
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Appitite
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Melanocortin system genes
All mutations of this gene result in obesity. POMC gene: adrenal insufficiency, early onset obesity, red hair. Researchers have shown that treating such individuals with adrenocorticotropic hormone (known to have an anorexic effect) did not have much impact. |
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Insulin Resistance Drugs
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Adiponectin
Related to visceral adipose accumulation, and coronary artery disease. Researchers have shown that weight loss after gastric bypass surgery was greater for those with lower pre-surgery adiponectin levels. Hipatic lipase Related to increased LDLs, reduced HDLs, visceral adiposity, and insulin resistance. Visceral obesity and insulin resistance = related to high HL activity. Weight loss = associated with decreased HL activity. |
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Lessons From a Mouse
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Normal adult mouse = 30-35 grams
Genetically obese mouse = 80-90 grams Translation: a person weighing 450-500 lbs (p.10) Obese mice have a defective allele of the leptin gene. No leptin = no signal to stop eating. (p.11) |
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Amgen
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Pharmaceutical company - Amgen, bought the drug rights to leptin.
Problem: most obese have abnormally HIGH levels of leptin. |
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Ghrelin
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Ghrelin
Hormone released from the stomach, and stimulates hunger Humans injected with ghrelin = intense hunger Communicates the state of energy balance to the brain Ghrelin = increases during fasting, among dieters, and after weight loss (weight regain?) |
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Adipose Tissue(brown v White)
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White = large abdominal area, large buttocks.
Visceral and Peripheral Brown = not as fatty as white. Primary function to ‘burn fatty acids for non-shivering heat generation’ Human babies = brown adipose tissue. Gone by adulthood |
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Adipose Tissue
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Visceral = in men, seen with MRI,found around organs, dangerous
Perefieral= subqutanous, in women, long term, around butt |
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Diabetes
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The body produces little or no insulin (T1) or
The cells don’t respond appropriately to the insulin that is produced (T2) 1 out of 15 people 1.3 mil new each year 6th leading cause of death |
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Type 1
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5-10% of diabetics
1 million people in the U.S Insulin Dependent or Independent Diabetes Mellitus? Auto_________ disease - body’s immune systems turns against itself. Destroys the beta cells Total destruction of the beta cells leaves the body without insulin CAUSES; genetic, viral, food |
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Type 2
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Insulin Resistance = body is less responsive to insulin
Body often pumps out great amounts of insulin to deal with the surplus of blood sugar Insulin = eventually demand exceeds production 90% are overweight over the age of 40 |
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Test of Diabetes
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Oral Gluclose Tolerance Test
Bloodsugar Monitor/acucheck (50-80$) Prickless Test(1000$) |
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Comorbid of Diabetes
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Reinopathy (eye damage,After 20 years, nearly 100% of Type 1 and 60% of Type 2 diabetics develop Retina receives inadequate blood supply)
Neuropathy (Nerve damage to arms and legs Numbness, tingling, reduced sensitivity to touch Reduction in sensitivity in the feet Kidney Disease (type 1) |
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Cellulite
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Gynoid lipodystrophy (GLD)-
1= doesn't appear 2- pinch test 3=eveident at rest,orange peel 4= possibly painful |
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Mattress phenomenon & hard v flacid
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For larger areas, skin of thigh pressed between two hands
Hard = observed in young women who perform regular PA. Evident orange peel effect when pinched. Flaccid = Found in inactive women, have lost weight suddenly. |
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Is cellulite Modifyable or no?
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No=cannot change predisobosing factors,diet and excercise cannot alter bands
Yes=gels, ointments, foams, creams, and lotions Active ingredients: antioxidants and vasodilators to increase vascular flow and lymphatic drainage. Vitamin C:Stabilizing or stimulating collagen deposition |
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Milieu Interieur
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milieu interieur’ or the internal environment.
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Ronsard key Factors
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Circulation: capillaries weaken, buildup of fluids
Muscles:are underused and underdeveloped. Nutrition: quality of food Stress: proper digestion, circulation Age: early 20s and up |
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Cellulite Forming PAtterns
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Diet is firmly established during the teen years
Heavy salt, fat, and sugar Cycles of starving and binging Cellulite starts during these years but b/c the skin is taut, doesn’t necessarily show up Cellulite is often most present with excess adipose tissue - advantageous to keep to a minimum. |
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Eat Right
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No deprivation
No diet - need to be able to stay on it for life Limit: processed foods, sugar, fat, caffeine, alcohol, salt Increase: potassium, fiber, and water to detoxify system Loss of muscle tissue with dieting = leaves more room for cellulite to spread |
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Portion Sizes
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Large portion trend’ began in the 1970s, rose sharply in the 1980s
Competition among franchises Consumer demand Newer editions of cookbooks state fewer serving sizes for identical recipes from older editions plates from 10 in to 12.5 |
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Define Nutrition and kilocalorie
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science of food and how the body uses food in health and disease
Kilocalorie = Calorie = kcal Measure of energy content of food 1 Kcal = amount of heat it takes to raise the temp of 1 liter of fluid 1° C 1000 calories = 1 kcal |
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What to choose
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Breads, cereals, grains <2 fat/serving
Crackers <4 grams fat/serving Soups <2 grams fat/serving Meats Lean cuts, ground beef/turkey 91+% fat free Lunch Meats <4 grams fat/ounce Frozen entrees <4 grams fat/ounce |
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Info on Protien,Carb,Fiber
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Protein=4cal/grm
RDA = _______ grams per kilogram of body weight. Ex: 100 lbs = 45.4 kg Carb= 4cal/gr simple=milk or fruit but usually candy complex=bread, starch Fiber(25-25 gr perday)=soluble= decrese blood cholesterol and blood glucose (citrus fruits, oats, legumes, barley) insoluble= proper bowel function (wheat) 36.32 grams of protein |
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Criteria for cholesterol
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High Risk Optimal
Total >200 240 LDL >100 160 HDL <60 >40 Triglycerides >150 200 |
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typical cal intake
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women & older adults= 1600
teen boys, active men= 2800 children,activeteen grls=2200 Target weight x10 (for light activity) Target weight x15 (for moderate activity) Target weight x 20 (for heavy activity) |
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Fats
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the basic nutritional needs 30% of calories in the diet should come from fat
10-15% monounsaturated(peanuts,olive)(‘good fats’) 10% polyunsaturated(corn,sunflower)(‘good fats’) <10% saturated(coconut;solid at room temp)(‘bad fats’) People who are trying to lose weight should not eat less than 20% of total calories from fat |
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Healthy enviornment
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Schedule regular mealtimes
Eat meals together Plan for snacks Grocery shop AFTER eating Shop from a list Store less healthy foods out of sight Eat all food in the same place |
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high/low fat food choices
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Alfredo,Parmigiana,Au gratin,Tempura,Hollandaise Puffed
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eating on the go
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Choose ketchup, salsa or mustard over mayo on sandwiches and burgers.
Add veggies to sandwiches and pizza. Include green salads with fat-free dressing. For Salty Craving: pretzels, light popcorn, whole grain crackers, baked chips. At Vending Machines: 100% fruit juices, pretzels, peanuts. |
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Define Health and Quality of Life
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Health not just the absence of disease but rather a complete well being (social, physical, mental).
Quality of Life well-being as influenced by a person’s experiences, perceptions,and expectations. |
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Conditions and BMI
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obesity is associated with more than 30 med conditions and a strong realtionship with atleast 15 of those
(Dyslipidemia,Type 2 diabetes Coronary Artery,Disease,Stroke) |
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Mortality and BMI
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Linear - as obesity increases, mortality increases
Mortality slightly increase as BMI rises above 31 kg/m2 and then rapidly with body mass indexes above 35 kg/m2 |
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recommendations during pregnancy
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30-40 years ago women were instructed by their physicians to gain no more than 15 to 20 lbs.
Weight gain standards have been changed since then because of the number of low birth weight babies. |
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Costs for morbidity and mortality
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Direct
‘Include preventive, diagnostic, and treatment costs’ Indirect Morbidity and mortality costs Morbidity: ‘value of income lost from decreased productivity, restricted activity, absenteeism, and bed days’. Mortality: ‘value of future income lost by premature death’. 92.6 billion |
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Fuding inequities
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Public research funding for obesity is appallingly low given that it is a major public health crisis”.
“The National Institutes of Health (NIH) has a budget of more than $29 billion and is the largest public funder of medical research. In setting the priorities of its budget, the NIH has virtually neglected obesity research”. |
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3 budget priorites for NIH
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Number of people who have a particular disease.
Number of deaths caused by a disease. Degree of disability produced by a disease. |
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consumers spend on weight loss
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Consumers spend about $30 billion per year trying to lose weight or prevent weight gain
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partnership for healthy weight managment
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This partnership was made up of a group of representatives from government, academia, etc. in order to help the public make informed decisions on weight loss products and programs.
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IVF and fertlity decline
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The extra tissue between the probe and ovary make ultrasound images appear very "fuzzy“
This makes it very difficult to clearly see ovaries and eggs For IVF, a needle is pushed in vaginally to reach the eggs in the ovaries If the ovaries are too high, the needle cannot safely get the eggs out |
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appropriate weight gain
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Appropriate weight
(0-13 wks) After 1st trimester Underweight 30-40 lbs Normal weight 25-35 lbs Overweight 15-25 lbs Obese 15 lbs Twins 40-50 lbs |
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Foods to avoid and PICA
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Cheeses Soft, ‘fresh’ such as feta, goat, Brie, Camembert, blue cheese
Milk, juices, apple cider, cheese Raw foodsEgg(mousse/ tiramisu), raw/uncooked meats, fish, or shellfish Processed meats Hotdogs/deli meats |
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Complications with pregnancy
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Pregnancy hypertension Inability/ difficulty placing epidural Wound infection
Gestational diabetes Overdue births Endometrial infection Menstrual disturbances are 3x greater for those who have severe obesity Longer labors Urinary Tract Infection |
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Risks for obese mothers
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Stillbirth
Prematurity Macrosomia Neural Tube Defects Higher rates of childhood obesity |
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macrosomia
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large birth weight baby
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exercise and pregnancy
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Previous experience
Pregnancy complications Physician approval 4-6wks resume exercise after delivery after 3rd mo avoid excersie use Lamaze and Kegal exercises Valsalva Maneuver= holding breath |
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prader-wili-syndrome
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Prevelance=Approximately 1 in 10,000-15,000 births
Effects both genders,all race Cause=Flaw in hypothalamus Abnormality on chromosome 15 at the time of conception(dad) Character=Hypotonia, Hypogonadism, Obesity,almond shaped eyes,narrow forhead,downteraned eyes |
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hyperphagia
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pathologically excessive appittie and eating
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PWS do's and dont's
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DO=Lock cabinets and refrigerator
Clear the table of food immediately after meals Keep food off the counters Keep candy dishes off of coffee tables, etc. Keep lives structured DON'T=Use food as reward/ punishment Argue Nag Tease/ use sarcasm |
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BMI % with childhood overweight
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Overweight =85th %
Obese = 95th % |
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orthopedic complications and pshycho effects on childhood obesity
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Orthopedic Complications
Bone and cartilage not strong enough Young children= bowing/ overgrowth of leg bones Pain and limited ROM due to excess weight on growth plate of the hip Psychosocial Effects and Stigma Teasing, jokes, derogatory name calling, hurtful comments by family, peers, strangers Reported negative assumptions such as laziness, being unclean |
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preventions for parents
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parents dont' think Pe should be removed but believe illegal drugs to be the highest risk and obesity to be the lowest
In terms of being somewhat or very concerned about their child’s weight, 30% said yes. |
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reccoment for curb child obesity
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Enroll child in structured activities (gymnastics, soccer, dance, martial arts)
Limit TV time Prepare foods together Avoid rushing meals |
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What type of ED effects people and who are they?
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Bulimia, Caucasians,
Slower reaction time Lesser ability to concentrate anxiety that take up working memory capacity Greater likelihood for depression and low self-esteem |
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Risk factors and emotional health
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Genetics – evident through twin studies
Genes Abnormal serotonin levels Higher BMI History of dieting Substance use Maternal eating difficulties Childhood eating difficulties Sexual abuse negative comments from parents especially mothers have a negative efffect on emoional health, 82% of women report neg comments as a child |
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how fo foster a healthy body image in children
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Avoid teasing in the family
Encourage healthy eating and exercise, not dieting Model good behavior Don’t complain about your own body Don’t be critical of other’s weight or shape Avoid categorizing food as good or bad Don’t avoid activities such as swimming, dancing, etc. that bring attention to weight or shape |
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refeeding syndrome
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Most likely in those who are severely malnourished
Tachycardia Congestive heart failure Sudden cardiac death How can you minimize this syndrome? slow it down |
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cost for residential treatment
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83 days , around $950 a day
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BED and ENOS
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Binge Eating Disorder (BED) is an officially recognized eating disorder according to the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV-TR).
Of those who seek professional treatment for obesity, 1/5 meet the criteria for BED. EDNOS = Eating Disorder Not Otherwise Specified |
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Conditions with all AN,BED,BN
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ANOREXIA:Downy hair
Abnormally slow HR and BP Dehydration/ kidney failure Dry skin Hair loss BED:High BP High cholesterol High triglycerides Type II diabetes Gallbladder disease BN:Gastric rupture Inflammation of the esophagus Tooth decay Constipation Pancreatitis |
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males and eating disorders
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Underweight liking their appearance
77% of men Dissatisfied with their weight 41% of men Media Dieting Ideal of muscularity Plastic surgery options (pectoral/calf implants) |
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pregancy prone to ED
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ANOREXIA:Placental infarction
Neonatal cardiac problems Preeclampsia Maternal anemia Diabetes BULIMIA:Low birth weight Early eating difficulties of mother The greater number of obstetric complications for the mother, the greater risk of the child developing an eating disorder. Placental infarction (tissue death) |
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womb implications on adult health
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Low birth weight
Increased risk for bulimia nervosa Increased risk of heart disease Increased risk for hypertension Increased risk for obesity Increased risk for diabetes Increased risk for schizophrenia High birth weight For females, to increased risk of breast cancer. Increased risk for later obesity. |
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osteopenia vs osteoporosis
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OSTEOPENIA:Low bone mass and can lead to osteoporosis
Most severe bone loss is associated with Earlier onset of anorexia nervosa Longer duration anorexia nervosa OSTEOPOROSIS:“porous bones” In anorexics, osteoporosis develops in about 38-50% of cases Predisposes an individual to fracture |
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osteoporosis facts
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Effects predominantly spongy bone called tribecular
90% of sufferers are females Osteoporosis is nearly an epidemic now in females over the age of 60 years As bones become more fragile, they will break more easily and with less force than they would if they were strong and healthy. MES = minimal essential strain The first clue that someone has osteoporosis is usually a broken bone; however, this is an indication that the disease has caused the bones to become very weak and brittle No cure exists for osteoporosis The best treatment is to achieve peak bone mass as a child |
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OPERATIONAL DEFINITION
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T = 0 No different from standard
T > 0 More dense than standard T < 0 Below the standard T = -1.0 10% below standard T = -1.0 to -2.4 Low bone density, osteopenia T = > -2.5 Osteoporosis *Most older women have a T-score below the standard |
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unalteralbe risk factors vs modifiable
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YES:eating distordes, Medications,smoking, high alchol intake, exercise, inadequate diet
NO:age, female, ethniticity, family history, small body frame, irregualar periods |
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primary and seconday amenorrhea
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Amenorrhea:
A lack of menstruation during the reproductive years. Amenorrhea decreases bone density at an age when bone formation should still be occurring Primary: When a female has not experienced menarche by either 16.5 years of age or within 2 years after the development of secondary sexual characteristics Seconardy:The absence of menstruation for greater than 6 months in a woman with previously normal cycles |
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Female Training
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women cannot excersie at the same rate as men because it causes damage to their reproductie cycles
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Female athlete Traid
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Eating Disorders, Amenorrhea, Osteoporosis
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Reversing bone damage
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Not effective: Hormone replacement, calcium supplements
Effective: weight gain, better nutrition, menstration |
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Why we screen clients
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To choose the appropriate program1:
self-help non-clinical clinical |
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self help v non clinical v clinical
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SELF HELP:Groups
Overeaters Anonymous Popular diet books Manuals Magazines Problems:Not individualized –more geared toward universal views Nonclinical:Commercial based franchises Consultants who guide the program Graduates of the program or certified professionals Intensify self-help efforts Provide support/ education Problems: Differing education/ expertise of consultants. Sometimes they are just graduates of the program CLINICAL:Monitor/ supervise treatment, alone or part of multidisciplinary team. May be affiliated with a hospital or university. Licensed professionals Psychologists Registered dietitians Physicians Methods Nutrition Medicine clinic VLCD |
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Recommendations for stress testing a diabetic
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70% of diabetes do not engage in physical activity.
The American Diabetes Association recommends that the diabetic receives stress testing if they have the following: Older than 35 T2 diabetes >10 years T1 diabetes >15 years Risk factors for coronary artery disease Retinopathy Neuropathy |
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7 positive and 1 negative risk factors
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FAMILY HISTORY:coronary revascularization,sudden death
before 55 years of age in father or male first-degree relative before 65 years of age in mother female first-degree relative SMOKING:6 MO SED LIEFSTYLE:less than 30 min per day 3x a week OBESE:BMI > 30 kg/m2 OR waist girth >102 cm for men >88 cm for women OR waist/hip ratio > 0.95 for men > 0.86 for women HYPERTENSION: Systolic BP > 140 mmHg OR Diastolic BP > 90 mmHg DISLIPIDEMIA: LDLs > 130 OR HDLs <40 mg/dL IMPARED FASTING GLU:Fasting blood glucose of > 100 mg/dL on at least 2 separate occasions (-) HIGH HDL>60 |
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signs and symptoms with diseases
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Dypsnea=abnormally uncomfortable awareness of breathing)
Ischema= cloted blood flow syncope=loss of consciousness Orthopnea=recumbent position at rest that is relieved after sitting up or standing anginal=Pain, discomfort in chest, neck, jaw, arms Intermittent claudication= Pain in limbs due to insufficient blood supply (usually due to atherosclerosis) |
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Criteria for low moderate and high risk testing
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Low Risk=Men <45 years of age and women <55 years of age who are asymptomatic and meet no more than one risk factor threshold
Moderate Risk=Men > 45 years and women > 55 years or those who meet the threshold for two or more risk factors High Risk=Individuals with one or more signs and symptoms or known cardiovascular, pulmonary, or metabolic disease |
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define PA v excercise v physical fitness
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PA='bodily movement that is produced by the contraction of skeletal muscle and that substantially increases energy expenditure'
EXCERCISE='planned structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness' FITNESS=multidimensional concept comprised of skill-related and health-related fitness’ |
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5 health related components of fitness
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BODY COMPOSITION
FLEXABILITY CARDIO RESPITORY ENDURANCE MUSCULAR ENDURANCE MUSCLE STRENGTH |
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best for measuring body composition of an obese person
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DEXA:width, lenght, max capac
BODPOD:tight fit,tight cloth SKINFOLD:calipers too small HYDRO WEIGH: bathing suit Tests = to estimate Physical working capacity, obese almost always suffer from low PWC...always use proper warm up and cool down techniques |
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Highest rate of change
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Ability to move a joint through complete range of motion
Issues for those overweight/ obese: General health (activities of daily living) Overweight more flexible? Rate of change effects= 1 week |
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Risks for excersie
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Vigorous physical exertion increases the risk of sudden cardiac death and acute myocardial infarction.
Exercise however only provokes preexisting conditions. Heel cracks Joint discomfort Increased risk for fracture DOMS |
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FITT
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Frequency
Intensity Time Type |
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Factors effecting adherence
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Clinicians:Advise too much, too soon = poor adherence from client
Clinician:may have a difficult time relating to those leading more sedentary lifestyles ‘Putting’ themselves in an overweight body Patience Knowledge of clients physical limitations Clothing:Moderate-intensity can be done in almost all clothing types Note that overweight/ obese individuals may feel uncomfortable in typical exercise clothes Footwear:ADA recommends silica gel or air insoles and polyester or blend socks = keep feet dry Sneakers lose their joint-protecting properties after 400 miles of walking or jogging |
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lifestyle activities v traditional excercise
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30 min per day lifestyle activity and eating low-calorie self-selected diet VERSUS traditional structured vigorous aerobic activity
Conclusion=Individual may be less intimidated doing lifestyle activity program just excersie alone without any diet changes can have posite long term effects |
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How much PA
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PA estimates
Ancestral humans 1000 kcals expended 3000 kcals consumed Today’s humans 300 kcals expended 2100 kcals consumed To ward off obesity epidemic We need a 3:1 ratio, thus today’s humans need to expend 700 kcals per day, thus an additional 400 kcals burned per day Maintain weight loss that one has sustained = 60-90 min moderate-intensity per day. To prevent crossing over from overweight to obese = 45-60 min moderate-intensity per day. |
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Weight loss medication
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BMI > 30without comorbidities
BMI > 27with comorbidities Hypertension Dislipidemia Diabetes Sleep apnea Osteoarthritis Failure at previous attempts to lose weight Family history of overweight or risk factors Clinicians judgment of patients commitment to engaging in healthy diet and exercise |
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Agree v Disagree with weight loss medication
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Agree: helps to aid w/lifestyle change but isn't a replacement
Disagree: easy way out,Reluctance from some health professionals b/c medication use may focus attention off healthy diet and physical activity |
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Aortic Valve Abnormalities
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Phentermine/Fenfluramine
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3 ways medication causes weight loss
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decrease engery intake, decrease in nutrient absoroption, *incrase energy expenditure( no FDA drug)
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DEA schedule
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Schedule II drugs, increase availability of dopamine and norepinephrine, too much abuse potential
Schedule III drugs, less abuse potential, but are not often prescribed by physicians Schedule IV drugs, little or no abuse potential, focus on norepinephrine release |
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Orlistat
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works via lipase inhibitor and adverse conditioning
Ingesting large amounts of fat, side effects Soft oily stool Cramping |
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Sibutramine(Meridia)
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Sibutramine (Meridia), reduces the reuptake of both norepi and serotonin, and is FDA approved
Those with the following should not be prescribed Sibutramine: Poorly controlled blood pressure Heart disease Irregular heart beat History of stroke |
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off label use
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Not approved and taking for weight loss considered ____________ use
Not FDA approved for weight loss therapy Longer than recommended Combination therapies Ex:Provigil (sleep disorders) Zyban (smoking) |
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Average weight loss with medication & goal BMI
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9-26 lbs max out after 6 months
BMI 24 |
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what drug is approved by FDA for children?
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Orlistat
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what drug is approved the most for weight loss by FDA
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Appitite suppressents
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Criteria for weight loss surgery
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BMI > 40 or more (about 100 lbs overweight for men and 80lbs overweight for women). BMI of 35 to 39.9 with serious medical conditions related to obesity that would improve with weight loss
Have attempted (and failed) previous weight loss efforts Understand the risks, benefits, and side effects Committed to lifestyle changes,needed for long-term successful weight loss No medical, psychiatric, or emotional conditions Realsitic expectations of the surgery |
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Three types of surgery
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Restrictive: “limit food intake by creating a narrow passage from the stomach into the larger lower part, reducing the amount of food the stomach can hold and slowing passage of food
Combination: Malabsorbtive:“do not limit food intake, but instead exclude most of the small intestine so fewer calories are absorbed. no longer recommended because they result in severe nutritional deficiencies.” |
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Names for 2 Restrictive and 2 combination
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restictive:
Adjustable Gastric Banding (AGB) Vertical Banded Gastroplasty (VBG) combination: Roux-en-Y Gastric Bypass (RGB)*most common Biliopancreatic Diversion (BPD)* most complicated |
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dumping syndrome
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after a meal high in simple CHO which contain sugars that are rapidly absorbed by the body and move too quickly through the body
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criteria for surgery in children
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Tried for at least 6 months to lose weight and not successful
Severely overweight: BMI >40 Reached their adult height >13 for girls, >15 for boys 4. Serious weight-related health problems Type II diabetes Heart disease Etc. 5. Emotionally prepared 6. Referred to a team of experts |
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costs for surgery
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$20,000-30,000
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foods after surgery
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Protein:
Healing of wounds To maintain healthy organ function, 4 ounces of PRO/day Sugary Foods: High in cals and fat Dumping syndrome Impede room for necessary vitamins and minerals Fat: Difficult to digest Heartburn Diarrhea Nausea Meats Red meats Chicken Tough steak Pork The connective tissue in the meat tends to not break down Blockage – vomiting Starches Bread Pasta Rice Absorb water and swell, which can cause blockage of the stomach pouch outlet |
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Risks of sugery
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flip through slides
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3 benefits of gastric bypass
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weightloss, no more sleep apnea, no more type 2 diabetes or if still there decrease in meds
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bariatric surgery and depression
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Surgery-suicide intervals
12 months 27 months 26 months Pre-surgery and post-mortem BMIs 37.7 to 22.2 kg/m2 42.0 to 25.0 kg/m2 39.5 to 29.4 kg/m2 “Depressive disorder may persist in the bariatric surgery patient despite successful control of obesity”. |
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rates of anxiety and depression in the obese
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Rates of anxiety and depression are 3-4 times higher among obese individuals compared to leaner peers.3
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effects of childhood abuse on obesity
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Obese patients seeking gastric bypass surgery reported higher rates of childhood maltreatment than normative community samples
32% reported childhood sexual abuse 37% reported some form of non-sexual childhood abuse or neglect Patients who reported childhood sexual abuse (32%) had significantly higher levels of depression at 12 months after surgery. A history of childhood sexual abuse is associated with Depression Anxiety Eating disorders “Childhood sexual abuse is remarkable common and is thought to affect up to 1/3 of women and 1/8 of men.” |
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effec of depression on metabolic syndome
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Depression is associated with the metabolic syndrome and ischaemic heart disease11
Correlations between depressive symptoms and Visceral obesity in men Elevated glucose levels in women Metabolic Syndrome: obesity, hypertension, hyperlipidemia, glucose intolerance |
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NES v NS-RED
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NES=classified as neither sleep nor ED
Little/ no appetite for breakfast Eats more after dinner than during dinner Consumes ½ of daily energy intake during and after dinner but before breakfast Has difficulty falling/ staying asleep and wakes frequently and eats Tense, upset, guilty while eating NS-RED=closer to sleep 1-3% of the population (3-9 million people) 10-15% of those with eating disorders are affected As with NES, NS-RED has found to have a genetic link Tend to be dieters, thus vulnerable and hungry for night binges May have a history of Alcoholism Drug abuse Sleep walking Restless legs Sleep apnea |
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genetic link in NES & NS-RED
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yes both have a genetic linke
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stress & food of NES , NS_RED
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NS-RED= uncommon foods, foods high in fat and sugar
NED=carbs NED v BED=BED is typically done in short episodes whereas NES involves continual eating throughout the night. BED often produces euphoria during, NES often produces guilt or shame. |
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treatment for NS-RED
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Treatment
Clinical interview Sleep-disorder center Avoid sleeping pills Interventions for stress and anxiety reduction Stress management classes Assertiveness training Counseling Reducing alcohol and caffeine intake Soft/ rhythmic music at night Family members lock cupboards and refrigerators at night and hide the keys Baby alarms or burglar alarms triggered by motion |
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transtheoretical model
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precontemplation
contemplation preparation action maintainance |
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Law of inital values
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incrase weight will initally lose more weight
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SMART
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specific
measurable action oriented realistic timely |
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define self efficacy
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people's beliefs about their capabilities to produce designated levels of performance that exercise influence over events that affect their lives. A strong sense of efficacy enhances human accomplishment and personal well-being in many ways.
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internal v external locus of control
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Internal locus of control
A person’s belief that the outcomes of their life are determined by their actions External locus of control A person’s belief that the outcomes of their life are determined by other people, external events, or chance. |
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5 problems with attrition
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Procedures to decrease drop-out rates
Fun Interesting Show results Motivating staff $ down barriers= time, money support, transportaion |
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foster autonomy or control?
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autonomy
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intervention via team or clients family?
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intervention via team for long term sucess
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broad definition of sucess
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Broader definitions of success in weight management
Physiological (body comp, cardio) Behavioral (program completion, meeting exercise and diet goals) Maybe it takes more than just one try Psychosocial (quality of life, self worth, mental health) |
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individual therapy
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Individual therapy for each
Low self-motivation External locus of control Low self-esteem Low self-body image |
