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Obesity Mgmt
Clinical Medicine II
| Question | Answer |
|---|---|
| What are the ethnic variations in obesity | NA>AA>Hispanic>caucasion,low SES and education, Rural>urban W>M, Age |
| What ↑ prevelance of obesity | sedentary life-styles, eating patterns, abundance of food |
| What is obesity comorbities to (5) | HD, cancer, stroke, DM, HTN (now listed 2nd leading COD) |
| How has child obesity changed over the years | 3 fold increase! |
| Causes of childhood obesity | not eating to guidelines, not enough fruits and vegetables, ↑ sweetened bevereages, ↑tv and game time, too little exercise |
| Where does endocrine control of appetite come from | hypothalamus, many of them, |
| What are factors of hunger | endocrine, behavioral/environmental, psychological, cultural, psychological, cultural self control |
| Where does satiety come from | neural, hormonal and metabolic fb (hypothalamus) |
| Hormonal influences from the GI system on appetitie | polypeptide YY, CCK, neuropeptide Y, leptin, ghrelin, insulin |
| What produces ghrelin, fxn | stomach & pancreas, stimulates hunger, ↑ before meals and↓ after meals |
| Counterpart to ghrelin | leptin |
| What ↑ghrelin levels | rise w/ dieting and wt loss, makes it difficult to lose weight |
| Why does gastric-bypass ↑ wt loss? | reduced levels of ghrelin, satiety occurs earlier |
| What produces leptin | apidose tissue, signals level of energy reserves to hypothalamus, induces satiety when at higher concentrations: ↑ leptin ↓ food intake, |
| Functions of leptin | modulates satiety and hunger, modulates energy expenditure |
| When does insulin rise and fall | low bw meals, higher during meals |
| Fxns of insulin | promoting fat synthesis, insulin promotes weight gain, want to control the trouphs and peaks |
| What are incretins | GI hormones, glucagon-like-peptide-1, gastric-inhibitory-peptide, inhibits glucagon release and HGP production |
| Fxn in incretins | promotes insulin sensitivity, ↓ gastric emptying, ↓ abosorption,→ ↓ food intake |
| Two supplements of incretins | Byetta and Victoza |
| Long term affects of incretins | pancreatitis, glucose intolerance |
| What is amylin | islet amyloid polypeptide (IAPP), ↓ appearance of nutrients/glucose in plasma, inhibits glucagon, ↓ insulin needs, promotes satiety, ↓ food intake, slows gastric empyting, inhibits digestive secretion |
| Where is amylin secreted from | beta bells from the pancreas w/ insulin |
| What is #1 cause of obesity | genetics as much of 70% varability of BMI bw individuals |
| What is # 1 cause of prevalence in obesity | environment |
| What are different genetic factors contributing to obesity | metabolic rate, thermic response to food, spontaneous physical activity, ethnic differences and pattern of weight gain |
| What does and ↑ of LBM lead to | ↑ basal metabolic rate (but is NOT proportional!) |
| A person w/ a low BMR might need what | 300-500kcals less per day |
| What is the < amount of calories needed for BMR | not <1000kcals/day |
| What affects thermogenesis | brown adipose tissue (in human infants and other mammals used for heat production and cold adaption) possibly see is some adults? |
| What is TEE | total energy expenditure, BMR, is often lower in obese patients |
| What happens with hyperthyroidism | hypermetabolic, and ↑ temperature (thermogenesis?) |
| What is the set point theory | in prisons, fed some people twice as much (different amounts of wt gain) some returned to their normal wt, some did not |
| Many endocrine causes to obesity | Hypothyroidism, menopause, PCOS, ↑ cortisol levels, insulin resistance |
| How does menopause cause obesity | ↓ estrogen and GH→rapid ↑ in visceral fat |
| Why can both low and high levels of leptin cause hunger | leptin causes ↑food intake, but in obesity, there may be a defect in the receptor, leptin resistance? |
| What gene can be linked to obesity | leptin gene, seen hypogonadotropin hypogonadism, |
| Leptin levels in most obese individuals | elevated (defective |
| What may be linked to insulin resistance | high carbohydrate diets and high glycemic index foods |
| ↑ carbs causes what | ↑ insulin, down regulation of receptors? Diabetes |
| What does hyperinsulinemia cause | fat synthesis, insulin inhibits lipolysis, euglycemia preferred |
| What does physical activity have on obesity | greatest impact on prevention and maintenance |
| How do we lose weight | input |
| What is the greatest impact on wt loss and maintanence | physical activity or exercise |
| How does wt gain overlap with psych issues | ↑ wt w/depression and antidepressant medications |
| How many kcals is 1 pound | 3500 |
| How many kcals/day will show wt gain | 100kcal/day, 10kcal/day will show overweight in 25 years… |
| Problem w/ DM tx | start them on insulin, usually show wt gain initially |
| What is accounting for the rising INCIDENCE of obesity | eating patterns, lack of activity, and life-style changes |
| What is MC etiology of obesity | genetics |
| How do we dx a pt w/ obesity | BMI, Waist circumference, comorbid conditions |
| BMI classifications | overweights 15-30, obese: >30, mod: 30-35, severe 35-40, very severe >40 aka class I, II, III of obesity |
| Obese waist circumference | Men >40 Women >35 |
| What disease does upper body waist fat distribution associated w/ | insulin resistance, DM, HTN, Hyperlipidemia, CVD, metabolic syndrome, hyperandrogenism |
| Cardiac risks | HTN >140/90, LDL >160, HDL <35, FBG 110-125, FHx M<55, F<65, Physical inactifity, TG >200 (>3: high risk) |
| When do we address the obesity issue | if there is a concern for medical necessity or if the pt asks (even tho we want to prevent…) |
| Lifestyle modifications | diet, exercise, behavior modifications |
| 3 ways to lose wt | lifestyle modifications, pharmacotherapy, bariatric surgery |
| How do we promote wt loss w/ food intake | ↓ intake 500-1000kcal/day for 1-2lb/wk loss |
| How do we maintain wt loss for sedentary adults | ↓ 20-25 kcal/kg |
| What are some meal plan patterns | exchange diet, My pyramid, NCEP dietary guidelines/DASH, 2005 diet for Americans |
| What will ↑ LBM and BMR | exercise, particularly resistance training |
| How can we control rebound hunger | ↓ CHO intake |
| Goal fat intake | 30% calories |
| Wt loss program should include what | diet, exercise, behavior modifications |
Created by:
becker15
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