Behavioral Medicine
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| obesity is a BMI of __ or greater | 30
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| overweight is a BMI of __ | 25-29.9
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| morbid obesity is a BMI of __ or higher or BMI of __ or higher with co-morbidities | 40, 35
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| there are an estimated __ obese adults worldwide | 320 million
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| there are an estimated __ overweight adults worldwide | 1.1 billion
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| one of the national health objectives is to reduce the prevalence of obesity among adults to less than __% | 15
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| for each 5kg/m higher BMI there is an associated __% higher mortality | 30
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| at a BMI of 30-35 median survival is reduced by __ years | 2-4
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| ata BMI of 40-45 median survival is reduced by __ years (comparable to the effects of smoking) | 8-10
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| __ deaths annually are attributable to obesity and sedentary lifestyle | 400,000
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| estimated __% of national healthcare expenditures is related to obesity and its negative outcomes | 10
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| almost __ dollars is spent annually on obesity related health care | 100 billion
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| BMI below __ is underweight | 18.5
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| BMI of __ is considered healthy weight | 18.5 - 24.9
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| BMI is a __ tool not a diagnostic tool | screening
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| detrimental health outcomes increase with a waist measurement of over __ inches in men and over __ inches in women | 40, 35
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| BMI is combined with what further assessments to arrive at a more accurate health risk | waist circumference, evaluations of diet, physical activity, family history, BP, physical inactivity
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| components of metabolic syndrome | abdominal obesity (40in men, 35in women), serum triglycerides (>150), HDL cholesterol (<40 men, <50 women), hypertension (>130/85), insulin resistance/fasting blood glucose (>100)
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| approximately __% of the population in industrialized countries have metabolic syndrome | 20-30
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| obese applicants are viewed as having | poor self discipline, low supervisory potential, poor hygiene, less ambition and productivity
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| surgery for weight loss is only indicated for those with a BMI of __ | 40 or greater, or 35 with comorbidities
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| pharmacotherapy for weight loss is only indicated for those with a BMI of __ | 30 or greater, or 27 with comorbidities
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| five steps to facilitate behavior change | identify behavior change goal, review when/how behaviors will be performed, have patient keep record of behavrior change, review progress at next treatment visit, congratulate patient on successes
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| cardinal behaviors of successful long-term weight management | self monitoring, low cal/low fat, eat breakfast daily, regular physical activity
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| points to assessing weight loss readiness | motivation (patient seeks wt reduction), stress level (free of major life crises), psychiatric issues (free of severe depression/substance abuse/bulimia), time (patient can devote 15-30 min/d to wt control for the next 26 weeks)
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| what do you do if the overweight/obese patient is not ready to lose wt | prevent wt gain and explore barriers to wt reduction
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| calories in a 12oz beer | 160
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| calories in a 5oz glass of wine | 100
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| calories in a 2oz shot of liquor | 128
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| recommended nutrient content of a weight reducing diet | 55% carbs, 15% protein, 30% fat (1-8% saturated, 15% monounsaturated, 10% polyunsaturated)
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| medications that can cause weight gain | psychotropic meds, beta blockers, DM meds, HAART, tamoxifen, steroid hormones
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| drugs currently approved by the FDA for treatment of obesity | orlistat, sibutramine, phentermine
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| the most successful treatment for weight loss and maintenance | combined intervention of a calorie-deficit diet, increased physical activity, and behavioral treatment
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| __ helps preserve fat free mass during weight loss | physical activity
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| considerable __ is necessary for weight loss maintenance | physical activity
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| with wt loss surgery max of wt loss is in the first __ | 18-24 months
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| max amount of wt loss with surgery | 100-180 lbs
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| Obesity Defn | high amt body fat in relation to lean body mass, or BMI ≥30
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| BMI defn | measure of wt relative to height: wt in kg div by the square of pt’s ht in meters
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| Obesity trends in US | epidemic: 60M (doubled since 1980)
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| Overweight: adult defn | An adult who has a BMI between 25 and 29.9
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| Obese: adult defn | An adult who has a BMI of 30 or higher
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| Morbidly Obese: adult defn | Adult who has BMI of 40 or higher (w/o comorbids) or who has BMI of 35 or higher with co morbidities
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| BMI Below 18.5 = | Underweight
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| BMI 18.5 to 24.9 = | Healthy weight
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| BMI 25.0 to 29.9 = | Overweight
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| BMI 30 or higher = | Obese
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| Considered an alternative to direct measures of body fat = | BMI
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| How is BMI used? | Screening tool - not a diagnostic tool
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| Risk for developing heart dz, etc, increases with waist measurement of: | > 40 inches (men) & > 35 inches (women)
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| BMI: kids/teens: | age & sex-specific; calculated same as for adults
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| BMI percentile = | Plotted on CDC BMI-for-age growth charts (for girls or boys) to obtain a percentile ranking
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| BMI percentile growth charts show: | wt status categories used w/ kids & teens (underweight, healthy weight, at risk of overweight, and overweight)
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| Underweight: percentile: | < 5th%
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| Healthy weight; percentile: | 5th% to < 85th %
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| *At risk of overweight: percentile: | 85th % to < 95th %
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| *Overweight: percentile: | ≥ to 95th %
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| Reasons that age and sex are considered for children and teens | Amt of body fat changes with age; amt of body fat differs between girls and boys
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| Health consequences of overweight & obesity for adults | HTN; dyslipidemia; T2DM; Coronary heart dz; Thromboembolic events; Sleep apnea / resp problems; Gallbladder dz; Osteoarthritis
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| Metabolic syndrome defn | Abd obesity (waist > 102 cm /40 in (M) & >88 cm / 35 inches (F); TG ≥ 150; HDL ≤ 40 (M) & ≤ 50 (F); BP ≥130/85; Fasting blood glucose ≥110
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| Psychosocial consequences of obesity | Negative attitudes; Stereotypes (lead to Stigma, Rejection, Prejudice, Discrimination); Verbal, physical & relational forms; Subtle and overt expressions
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| Obesity & peer victimization | Vulnerability to bias increases with body wt; among the heaviest youth, 60% report victimization
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| Personal consequences of obesity = | Psychological-low self esteem/ depression; Social (rejection); Economic (poor job satisfaction / reward); Medical (multiple co morbid conditions)
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| Selection of obesity tx | Diet, Exercise, Behavior Tx at any obesity category; pharm tx (≥30; ≥27 w/comorbids) (never tx w/drugs alone); surgery (≥ 40; ≥35 w/comorbids)
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| Should first try non-pharm interventions for obesity for how long? | At least 6 months
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| Behavioral Treatment of Obesity (Outpatient) | structured, goal-oriented: realistic, ST goals; frequent pt visits to enhance compliance; LT contact: maintain motivation; ID office staff (weigh-ins & review self-monitoring); written education materials
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| Responding to Nonadherence | Don’t take behavior personally; assume problem = lack of planning; Do not criticize pt; ID obstacles & how to handle them; acknowledge difficulty of behavior change; encourage; new plan, shorten interval required for success
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| Effect of High-Protein, Low-Fat Diet on Body Wt: | Lose more wt than high-carb diet
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| FDA approved drugs to tx obesity | Orlistat; Sibutramine, Phentermine (ST)
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| Phentermine: AE | Amphetamine like response (irritability / tremulousness / increased HR); high BP; caution in pt w/ HTN & underlying heart dz
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| Orlistat MOA | prevents fat digestion and absorption by binding to GI Lipases
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| Guidelines for Increasing Physical Activity | Assessment (med / psych readiness; current activities, barriers to activity); physical activity plan; start activity slowly & gradually increase planned aerobic to 200 min/wk; enhance compliance
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| Weight loss surgery: when: | BMI >40 or >35 with comorbids; if med tx has failed
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| Weight loss surgery: maximum wt loss: | in first 18-24 months
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| CDC definition of physical activity | Moderate intensity activity (increases HR) for >30 minutes for >5 days/week, or vigorous intensity for >20 min for >3 days/week
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