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84 Cards in this Set
- Front
- Back
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explain/list the BMI ranges
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underweight <18.5
normal 18.5-24.9 overweight 25-29.9 obese >30 |
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Calculate BMI
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(given formula)
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Obesity = excess body fat resulting from a state of positive energy balance due to...
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calories in > out
(energy intake exceeding energy expenditure) |
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Why is obesity considered a multifactorial condition
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evolutionary genes = "feast and store"
high caloric food is cheap/available |
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What are the 3 factors of:
Total Energy Expenditure (TEE) |
-basal metabolic rate (BMR)
-thermic effect of food (TEF) -thermic effect of physical activity (TEPA) |
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Define: Basal Metabolic Rate (BMR)
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minimum energy required for normal physiological functions
(at rest, fasted state) |
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What bodily processes does BMR include?
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Energy needed for vital organs:
Lungs, Integumentary, CNS, Kidney, Liver, Skeleton, Heart, Muscles |
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Why is BMR important in the regulation of energy balance and body composition?
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BMR is 50-75% of TEE
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List the condition under which BMR is measured?
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early morning
overnight fast (10-12hrs) >36 hours after exercise ------------------------------ Laboratory Setting: -measure O2 consumed -converted to caloric equivalent |
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How is BMR measured?
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collect/analyze O2 consumption
(converted to caloric equivalent) |
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According to the Harris-Benedict Equation, what factors influence BMR?
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gender
weight height age |
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What is the Harris-Benedict Equation?
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Female BMR=
655 + (4.35 x weight lbs) + (4.7 x height inches) – (4.7 x yrs) = kcal/day Male BMR=66 + ( 6.23 x weight lbs) + ( 12.7 x height inches ) - ( 6.8 x yrs ) = kcal/day |
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How does sedentary/moderate activity affect BMR?
list all the ranges... ex: 30yrs, female, 155lbs, 5'4" = BMR 1547.9 kcal/day |
Sedentary: 1547.9 x 1.2 =1857.5 kcal/day
Moderately active: 1547.9 x 1.55 =2397.9 kcal/day Difference = 540.5 kcal/day |
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How do you estimate BMR based on activity level?
(Harris-Benedict Equation x ActivityFactor) |
BMR x ActivityFactor:
-1.2 = sedentary -1.375 = light (1-3 days/week) -1.55 = mod (3-5 days/week) -1.725 = very (6-7 days a week) -1.9 = athlete (each increases by 0.175) |
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How many calories = 1 lbs of fat?
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3500 kcal / lbs
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Explain the TEF and how much of the TEE does it usually account for?
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Calories it takes to process food
~10% of TEE |
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Which foods have the highest Therogenic Effect?
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proteins
“complex carbs” (fresh fruit and vegetables) |
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Which foods have the lowest Therogenic Effect?
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Fats
processed food |
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What accounts for the variability of Thermic Effect of Physical Activity (TEPA)?
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Activity Level:
sedentary ~15% of TEE very active ~50+% of TEE |
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Which two areas of the brain are considered the main controls for energy homeostatsis and the regulation of body weight?
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ventromedial hypothalamus (VMH) nucleus
lateral hypothalamus (LH) nucleus |
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What is the satiety center of the brain?
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VMH (Ventromedial Hypothalmus) nucleus is the satiety center
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What is the hunger center of the brain?
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LH (Lateral Hypothalmus) nucleus is the hunger center
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Which one (VMH or LH), if stimulated, would cause hyperphagia?
(Hunger Center = over eating or eating more that is needed to support caloric needs) |
Stimulation: LH nucleus
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Which one (VMH or LH), if stimulated, would cause inhibition of food intake?
(satiety center) |
Stimulation: VMH nucleus
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What are the two groups of appetite regulating hormones?
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Episodic Signals
Tonic Signals |
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A meal rich in fat or protein stimulates the duodenal mucosa to secrete this hormone. In addition to its effect on the gall bladder (release bile into duodenum) and pancrease (secretion of digestive enzymes), it stimulates the VMH and tells you to “slow down” your intake of food.
a. Ghrelin b. Cholecystokinin (CCK) c. Glucagon-like peptide-1 (GLP-1) d. Peptide YY e. Leptin |
b. Cholecystokinin (CCK)
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Persons who “ob” or “db” genes are homozygously mutated will not make this hormone and will suffer morbid obesity:
a. Ghrelin b. Cholecystokinin (CCK) c. Glucagon-like peptide-1 (GLP-1) d. Peptide YY e. Leptin |
e. Leptin
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A Tonic signal:
a. Ghrelin b. Cholecystokinin (CCK) c. Glucagon-like peptide-1 (GLP-1) d. Peptide YY e. Leptin |
e. Leptin
signals the brain that the body has had enough to eat produced by fat cells (adipocytes) |
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Blood concentrations are lowest shortly after a meal, then rise during the fast prior to the next meal:
a. Ghrelin b. Cholecystokinin (CCK) c. Glucagon-like peptide-1 (GLP-1) d. Peptide YY e. Leptin |
a. Ghrelin
(released during fasting state, so low postprandial) |
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An episodic signal that stimulates insulin secretion in response to a meal and stimulates the satiety center in the hypothalamus:
a. Ghrelin b. Cholecystokinin (CCK) c. Glucagon-like peptide-1 (GLP-1) d. Peptide YY e. Leptin |
c. Glucagon-like peptide-1 (GLP-1)
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Is a “starvation” signal in order to maintain adequate fat stores for survival during times of energy deficit:
a. Ghrelin b. Cholecystokinin (CCK) c. Glucagon-like peptide-1 (GLP-1) d. Peptide YY e. Leptin |
e. Leptin
weight loss=leptin down=increase food intake |
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Is called the hunger hormone because it is produced when the stomach is empty:
a. Ghrelin b. Cholecystokinin (CCK) c. Glucagon-like peptide-1 (GLP-1) d. Peptide YY e. Leptin |
a. Ghrelin
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Similar actions to CCK and GLP-1 in that it inhibits gastric emptying postprandially and suppresses appetite:
a. Ghrelin b. Cholecystokinin (CCK) c. Glucagon-like peptide-1 (GLP-1) d. Peptide YY e. Leptin |
d. Peptide YY
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What 3 research findings suggest a genetic component to obesity?
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72% obese children >=1 obese parent
adopted kids correlate with biological parents Monozygotic twins = similar BMIs (compared to dizygotic twins) |
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What demographic data collected since the 1960’s strongly suggests that there are more than just genetics involved obesity within the United States?
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USA:
-dramatic increase of obesity -among all cultural backgrounds |
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What is unique about the United States that also established that there is more than just genetics involved in obesity?
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1930's: Poor = Thin
Advent of corn syrup Present: Poor = FAT |
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In the United States, is there a relationship between socioeconomic level and obesity when considering ALL women?
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yes
high scoioeconomic (not poor) = low obesity |
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In the United States, is there a relationship between socioeconomic level and obesity when considering CAUCASIAN women?
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yes
poor = high obesity |
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In the United States, is there a relationship between socioeconomic level and obesity when considering Hispanic/Latino females?
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yes
poor = high obesity |
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In the United States, is there a relationship between socioeconomic level and obesity when considering non-Hispanic/African American females?
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no difference
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What ethnicity has the highest poverty rate in the United States?
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Non-Hispanic/African American 13%
Hispanic/Latinos 12% |
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What ethnicity, no matter the age or gender, has the highest prevalence of obesity?
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Non-Hispanic/African American
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What anatomical site should you use to guide you in measuring waist circumference?
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Iliac crest
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With a BMI of 25 to 34.9, at what waist circumference does it lose its predictive power?
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men: waist >40
women: waist >35 in (independent risk factor for obesity-related complications in adults) |
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What BMI is the cut off as the definition of “extreme obesity” and carries with it extremely high disease risk factors?
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BMI>40
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What characteristic of excessive fat/adipose tissue is thought to directly contribute to the cardiovascular and metabolic risks associated with obesity?
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Adipocytokines / Macrophages
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What are the two ways by which exercise increases total body expenditure?
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1. Calories burned by exercise (TEPA)
2. EPOC (excess post-exercise consumption) |
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What is the FITT&P principle?
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F-frequency
I-Intensity T-time T-type P-progression |
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In terms of lifestyle, what must exercise become in order to “keep the weight off”
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daily habit
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Is there any benefit of obese individuals if exercise does not caused a decrease in weight loss?
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Yes
Increased insulin sensitivity (improves blood glucose level) |
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What are the two classes of drugs that reduce energy intake?
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Noradrenergic agents
Serotonergic agents |
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What is the common mode of action for drugs that reduce energy intake?
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Induce anorexia
(centrally mediated pathway in the hypothalamus) |
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What are their side effects, of drugs that reduce energy intake, separately and in combination (e.g., fen-phen)?
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Noradrenergic:
-insomnia -anxiety -irritability -headache Serotonergic agents (alone/combination): -valvular heart disease -pulmonary hypertension |
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What action does Orlistat (Xenical) have and, therefore, how is it thought to cause weight loss?
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inhibits action of pancreatic lipases
(preventing breakdown of dietary triglycerides into free fatty acids and thus prevents the absorption of dietary triglycerides) |
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What are the side effects of Orlistat (Xenical)?
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Flatus
Steatorrhea |
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How do agents in the thermogenic class of drugs increase energy expenditure?
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Ephedrine (Ma huang) / Caffeine:
-Increase metabolism -release norepinephrine, b1/b2/b3 agonist -caffeine is synergist with ephedrine |
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Why has the FDA ruled in prohibiting the sale of dietary supplements containing ephedrine alkaloids?
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Ephedrine links to:
MI / Stroke |
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Explain Episodic Signal
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-appetite-regulating hormone
-GI tract: periodically releases -acute nutritional state (feeding/fasting) |
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Example of a fasting-state hormone?
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Ghrelin
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Example of a feeding/satiety state hormone?
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CCK (cholecystokinin)
GLP-1 (glucagon-like-peptide-1) Peptie YY |
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Explain Tonic Signal
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-appetite-regulating hormone
-adipose tissue releases -chronic nutritional state (how fat am I?) |
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Example of a tonic signal hormone?
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Leptin
Insulin |
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Differentiate between the two Bariatric surgeries:
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Roux en-Y (gastric bypass):
-divide stomach (1-2 tbsp) -reroute to more distal portion of small intestine Laparoscopic (adjustable gastric band surgery): -band around the upper stomach near the esophagus |
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Which end is the “roux” end in a Roux en-Y gastric bypass surgery?
The "Y" end? |
A - Roux end
B - "Y" end |
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Roux en-Y proximal gastric bypass?
Roux en-Y distal gastric bypass? |
A - proximal
B - distal |
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When comparing proximal and distal Roux en-Y surgeries, which one results in a reduced absorption (malabsorption) of food?
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Distal Roux en-Y
(the small intestines were cut DISTAL, so less absorption) |
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Which of the following is considered to be the probable cause of weight loss due to Roux en-Y surgery.
a. Malabsorption of calories contributes to weight loss. b. Because of the limited size of the stomach, the patient cannot eat a lot of food at one time and is put on a mealtime schedule of 5 to 6 small meals daily. c. The operation completely counteracts the adverse effects of destructive eating behavior. d. The patient cannot graze between meals. |
B. limited size of the stomach
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Anastomotic ulcer:
a. Roux en-Y Surgery b. Laparoscopic adjustable gastric band c. Characteristic of both d. Neither a characteristic of Roux en-Y surgery or laproscopic adjustable gastric band |
a. Roux en-Y Surgery
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Dumping syndrome:
a. Roux en-Y Surgery b. Laparoscopic adjustable gastric band c. Characteristic of both d. Neither a characteristic of Roux en-Y surgery or laproscopic adjustable gastric band |
a. Roux en-Y Surgery
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Nutritional deficiencies:
a. Roux en-Y Surgery b. Laparoscopic adjustable gastric band c. Characteristic of both d. Neither a characteristic of Roux en-Y surgery or laproscopic adjustable gastric band |
a. Roux en-Y Surgery
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An inflatable silicone device that is placed around the top portion of the stomach:
a. Roux en-Y Surgery b. Laparoscopic adjustable gastric band c. Characteristic of both d. Neither a characteristic of Roux en-Y surgery or laproscopic adjustable gastric band |
b. Laparoscopic adjustable gastric band
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Causes reduced absorption (malabsorption):
a. Roux en-Y Surgery b. Laparoscopic adjustable gastric band c. Characteristic of both d. Neither a characteristic of Roux en-Y surgery or laproscopic adjustable gastric band |
a. Roux en-Y Surgery
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Erosion of the stomach wall:
a. Roux en-Y Surgery b. Laparoscopic adjustable gastric band c. Characteristic of both d. Neither a characteristic of Roux en-Y surgery or laproscopic adjustable gastric band |
b. Laparoscopic adjustable gastric band
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Uses a small access port placed just under the skin for adjustments:
a. Roux en-Y Surgery b. Laparoscopic adjustable gastric band c. Characteristic of both d. Neither a characteristic of Roux en-Y surgery or laproscopic adjustable gastric band |
b. Laparoscopic adjustable gastric band
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The operation completely counteracts the adverse effects of destructive eating behavior:
a. Roux en-Y Surgery b. Laparoscopic adjustable gastric band c. Characteristic of both d. Neither a characteristic of Roux en-Y surgery or laproscopic adjustable gastric band |
d. Neither a characteristic of Roux en-Y surgery or laproscopic adjustable gastric band
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Anastomotic stricture:
a. Roux en-Y Surgery b. Laparoscopic adjustable gastric band c. Characteristic of both d. Neither a characteristic of Roux en-Y surgery or laproscopic adjustable gastric band |
a. Roux en-Y Surgery
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Creation of a small (1-2 tbsp) thumb-sized pouch from the upper stomach, accompanied by bypass of the remaining stomach:
a. Roux en-Y Surgery b. Laparoscopic adjustable gastric band c. Characteristic of both d. Neither a characteristic of Roux en-Y surgery or laproscopic adjustable gastric band |
a. Roux en-Y Surgery
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Anastomotic leakage:
a. Roux en-Y Surgery b. Laparoscopic adjustable gastric band c. Characteristic of both d. Neither a characteristic of Roux en-Y surgery or laproscopic adjustable gastric band |
a. Roux en-Y Surgery
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Productive Burping:
a. Roux en-Y Surgery b. Laparoscopic adjustable gastric band c. Characteristic of both d. Neither a characteristic of Roux en-Y surgery or laproscopic adjustable gastric band |
b. Laparoscopic adjustable gastric band
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Weight regain is possible:
a. Roux en-Y Surgery b. Laparoscopic adjustable gastric band c. Characteristic of both d. Neither a characteristic of Roux en-Y surgery or laproscopic adjustable gastric band |
c. Characteristic of both
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Re-construction of the gastrointestinal (GI) tract so that a segment of the small intestine is brought up to the proximal remains of the stomach:
a. Roux en-Y Surgery b. Laparoscopic adjustable gastric band c. Characteristic of both d. Neither a characteristic of Roux en-Y surgery or laproscopic adjustable gastric band |
a. Roux en-Y Surgery
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Restricts the volume of food which can be eaten:
a. Roux en-Y Surgery b. Laparoscopic adjustable gastric band c. Characteristic of both d. Neither a characteristic of Roux en-Y surgery or laproscopic adjustable gastric band |
c. Characteristic of both
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Symptoms of Dumping Syndrome:
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Anxiety attack
Fast HR Sweating Nausea Diarrhea/Vomiting |
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What nutritional deficiencies are associated with Roux en-Y Surgery?
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Iron
Zinc Thiamine (B1) Vitamine B12 (intrinsic factor) Protein Vitamin A Folate |
