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31 Cards in this Set
- Front
- Back
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T/F: Medications for weight loss are monotherapy.
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FALSE: must always be in support of, not in place of diet and physical activity.
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T/F: There is no pharmacological cure for obesity, and no agent that can induce lifestyle change.
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TRUE
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weight loss pharmacotherapy targets:
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-centrally mediated appetite satiety
-neural pathways of reward -peripheral gastric absorption of nutrients |
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T/F: currently, no agents are labeled for long-term maintenance even though obesity is a chronic condition.
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TRUE
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sympathomimetig drugs: phentermine, diethylpropion, benzphetamine and phendimetrazine mechanism of action:
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-inhibit norepi and dopamine uptake at nerve endings--hypothalamically induced anorexia
-schedule 3-4 drug- for abuse potential -short term -BMI>30 -SE: cardiovascular risks |
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orilast: pancreatic lipase inhibitor use:
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-<2 year use
-BMI>30 -dietary fat not absorbed--fecal fat loss -SE:liver, GI -need fat soluble vitamin supplementation |
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indications for bariatric surgery
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-BMI>40
-BMI>35 with comorbidities, ex. DM -failure of previous weight loss attempts -commitment to post op care--supplements and testing -exclusion of reversible causes of obesity-endocrine |
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mechanism of action of bariatric surgery
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-mechanically induced reduced food intake
-post op weight regain is common -restrict food volume capacity OR reduce food nutrient absorption |
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contraindications for bariatric surgery
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-current SA
-uncontrolled/severe psych illness -lack of understanding of risks -lack of post op commitment -extreme high risk |
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restrictive bariatric procedures
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-restrict food intake, intend early satiety
-vertical banded gastroplasty -lap performed adjustable gastric band -complications: band erosion, slippage, failure |
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nutrient absorption bariatric surgery
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-RYGB: upper stomach attached to proximal jejunum
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complications of surgery
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-surgical post op complications
-nutritional deficits -dumping syndrome |
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post-op bariatric surgery vitamins to supplement
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-MV,
-VIT B12 -folate -iron -vit c -calcium -vit d |
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post bariatric surgery monitoring
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--vit d, calcium, phis, PTH, alk phos and DEXA scan q 6 mos until stable
-full annual labs sent |
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motivational interviewing
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-ongoing interaction that providers use to stimulate lifestyle change as a part of the therapeutic relationship
-identify values and goals -patient directs changes -patient goals reinforced and autonomy respected |
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4 principles that guide MI
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-provider expresses empathy
-strategies facilitate the individuals identification of discrepancies between goals and behaviors -resistance is not confronted -self efficacy fostered |
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define obesity
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chronic condition in which bodys homeostasis balance between energy intake and expenditure is dysfunctional
-xcess energy stored in adipose tissue |
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BMI formula
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(lbs/in squared) x 703
kg/ height in m squared |
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BMI limitation
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doesn’t account for body fat, muscle, bone, physical fitness levels etc.
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bioimpedance analysis
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predicts body fat and lean mass by use of alternating current passing through the body, noninvasive, portable, safe inexpensive
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anthropometric measures
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skin folds, body circumference, height and weight *strong relationship between central adiposity and mortality
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BMIcategories: underweight, normal, overweight and obese
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Underweight BMI<18.5
Normal weight 18.5-24.9 Overweight 25-29.9 Obesity 1 30-34.9 Obesity 2 35-39.9 Obesity 3 >40 Obesity 4 50-59.9 Obesity 5 >60 |
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pathophysiology of obesity
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-increased energy intake and reduced energy expenditure
-kilocalorie abundance, sedentary lifestyle, genetic predisposition -dopamine and opioid mediated pleasure/reward pathways, hyperinsulinemia in obesity prevents dopamine clearance -leptin resistance: higher levels fail to initiate a anorexic plus increased energy expenditure effect that should follow an overabundance of stored energy -ghrelin: gut hormone involved in energy homeostasis—drives hunger to drive increased food intake -cholecystokinin: released in response to protein and fat digestionsends satiety signal to brain -GLP-1 acts on CNS, slows gastric emptying and regulates glucose through insulin and glucagon activity |
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medications that cause weight gain
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-neuroleptic and seizure medications: TCA, SSRI, antipsychotics
-antihistamines -hormone preparation: progesterone only medications -cardiac medications: BB -diabetes medications: insulin -environmental factors: environmental estrogens, genistein, BPA |
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factors that contribute to weight gain
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-decreased physical activity
-increased energy intake -genetics -maternal influences -medications -smoking cessation -gut microbial -sleep -stress |
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obesity exam
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-accurate height, weight and abd circumference
-hip circumference -abd girth-measured about the iliac crest -intertriginous area inspection -acanthosis nigricans -neck circumference >17 in men, and >16 in womenincreased risk of OSA -leg edema -fat pad on upper back |
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clinical presentation features for obesity patient
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-measure BMI in all adults!
-depression and eating disorder screening -current nutrition and physical activity levels -all medications -medical and surgical history -ask the patient to tell you their perceived reason for weight gain |
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d/x tests for obese patient
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-urinalysis, CMP-with glucose, BUN and Cr, thyroid panel, lipid panel, LFTs
-OGTT |
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management of obesity
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-reduced kilocalorie intake
-physical activity -behavioral changes -goal weight loss 10% -bariatric surgery goal: loss of >50% excess body weight loss |
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calories are from:
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proteins, carbs and fats
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T/F: when decreasing calories to lose weight, the patient should decrease protein intake.
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FALSE: protein intake remains the same, decrease fats and simple carbs
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