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What are the different levels of BMI relating to normal, overweight, obesity, etc?
- 18-24= normal
- 24-29.9 = overweight
- 30-34.9 = obese
- 35-39.9= severely obese
- >40= morbidly obese
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What are some differences in serving size?
- Coffee: 45 calories --> 350 claories
- Bagel: 140 calories --> 350 calories
- Muffin: 210 calories --> 500 calories
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What are medical complications of obesity?
- pulmonary disease
- nonalcoholic fatty liver disease
- gall bladder disease
- gynecologic abnormaliities
- OA
- gout
- idipathic intracranial hypertension
- stroke
- cataracts
- coronary heart disease (diabetes, dyslipidemia, HTN)
- severe pancreaitis
- cancer (breast, uterus, cervix, colon, esophagus, pancreas, kidney, prostate)
- type 2 diabetes
- sleep apnea
- depression
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What is the surgical criteria for obesity?
- 18 years or older
- BMI of >40 OR
- BMI 35-39.9 with other conditions related to obesity- high CHO, DM, HBP, sleep apnea
- willing to make post-surgical lifestyle changes
- history of failed weight loss attempts
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What is the Allergan lap band criteria?
- BMI between 30-40 and 1 obesity related comorbidity
- 40% reached 30% weight loss within 12 months
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What are the appropriate and inappropriate surgical candidates?
- appropriate: meet medical criteria, motivated, good support system, willing to make change
- inappropriate: cosmetic purposes, unwilling to change/quit smoking, active substance abuse, unctonrolled psychiatric disorders
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What are some characteristics of Gastric Bypass (Roux-en-Y)?
- designed to limit food intakeand absorb less nutrients
- 30-60cc pouch
- can be reversed or revised but difficult
- faster initial weight loss
- usually requires 2-5 days hospitalization
- usually lose 60-80% EBW
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What is the diet of gastric bypass consist of?
- meal portion = 2oz servings
- clear liquid x 24 hours
- full liquid and soft- length varies depending on surgeon
- no added sugars or high fats
- avoid carbonation and caffiene
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What are some gastric bypass complications?
- early: leack, acute gastric dialiation, Roux-Y obstruction, PE, DVT
- late: stomal stenosis, nutritional deficiences, hernia (open only),marginal ulcer
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What is dumping syndrome?
- many pts view as complication but really side effect- it is so uncomfortablee that usually results in changed behavior
- occurs when patients eat sugars
- causes rapid HR, nausea, fainting, sweating because of new re-routing of intestine
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What are characterisitcs of laparoscopic adjustable gastric banding?
- adjustable silicone elastomer band
- designed to limit food intake (restrictive)
- 15-30cc
- usually requires overnight hospitalization
- slower weight loss with goal weight met 18-24 months post op
- usually lose 40-60 EBW
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What are some gastric band complications?
- obstruction
- migration of implant (band erosion, band slippage, port displacement)
- tubing related complications (port disconnection, tubing kinking)
- band leak
- port-site function
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What happens with a sllipped band?
- occurs in 10% patients
- common causes are overeating and chronic vomitting
- S/S: pain, sudden change in eating habits, intolerance of liquids, severe reflux, nausea
- must be repaired surgicaly
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What happens with erosion?
- occurs 1% nationally
- less frequent from improved technique but occurs when the band erodes into the stomach
- diagnosed with EGD
- S/S: port infection
- requires removal of the band which may or may not be able to be put back in
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What is the gastric band diet?
- lap band clear liquid diet: post op day 1
- 2 weeks: full liquid diet (anything that can go through a straw but don't use a straw)
- 2 weeks: mushies (anything that you can mash with a fork)
- no soft breads or thick meats (lifelong restriction)
- avoid carbonation
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What are bariatric rules?
- take small bites chewing 20-30 times
- measure 2 oz portions
- have 3 meals a day, but don't snack
- drink at least 6 C liquid between meals (sugar free and no claories)
- no liquids with meals
- PROTEIN- eat first, may need supplements, daily goal of 70 grams
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What are possible nutrient deficiences in gastric bypass or gastric band?
- gastric bypass: iron, B12, folate, calcium, zinc, vitamin D
- gastric band: folate- due to poor dietary intake
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What are key points to patient education?
- emphasize behavior modification
- reinforce that dietary changes are long term
- emphasize and enourage lifetime activity
- reinforce life long smoke free expectation
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How prevalent is obesity?
- 64.5% adults
- most prevalent in african american and hispanic women
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What are clinical ways to measure obesity?
- BMI
- waist circumference
- skin folds
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What are ways body weight is regulated through systems that control?
- short term appetite signals
- signals for fat storage/metabolism
- leptin
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What is leptin?
- a hormone produced by Ob gene in fat cells and has receptors to thalamus
- obesity may be associated with mutant Ob gene and/or leptin resistance
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How does leptin control appetites and energy expenditure?
- decreased leptin levels signals body to increase appetite, and decrease energy expenditure
- increased leptin levels signals body to decrease appetite
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What is obesity?
energy imbalance
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What are factors that contribute to energy imbalance?
- genetic factors
- behavioral factors
- cultural/environmental
- secondary causes
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How do genetic factors contribute to obesity?
- one obese parent increase child chance by 40%
- two obese parents, increase childs chance by 80%
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What are different behavioral factors that contribute to obesity?
- diestary habits- calorie overconsumption, high total fat intake, high refined sugar intake, low fiber intake, compulsive overeating
- physical activity
- psychological factors
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What are signs of compulsive overeating
- frequent binge episodes
- eat until uncomfortablly full
- eat fast while binging
- eat along
- feel disgusted after binging
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What are the cultural/environmental factors that contribute to obesity?
adults and kid watching >3hr/day of TV have 2x gretaer prevalence of obesity
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What are secondary causes of obesity?
- hypothyroidism (10% of obesity causes)
- hypercortisolism
- growth hormone deficiency
- sex steroid deficiency
- medicationsrestrictive dieting
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What are some medications associated with weight gain?
- glucocorticoids (treat inflammatory conditions)
- diabetes drugs (insulin & sulfonylureas
- epilepsy drugs
- antidepressants
- some meds for ADD
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Intervention is recommended for who?
- BMI > 30 or between 25-29
- high risk wait circumference and 2 or more CV risk factors
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What should intervention for obesity include?
- low claorie/low fat diet
- increased physical activity
- behavior modification
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What should the duration for obese exercise prescription?
- begin: 150 min/wk
- weight loss: 60-90 minutes activity (420min/wk)
- maintenence: 200-300 min/wk
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What should the intensity for obese exercise prescription be?
- 40-60% HRR/VO2R
- progress to 50-75% HRR/VO2R
- emphasis on duration and grequency before increasing intensity
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What is the resistance exercise prescription for obese pts?
- 8-12 RM, 1-2 sets, 2-3 days/wk, 1-2 min rest between sets
- 2-10% increase in load if can do 14 RM for 2 training sessions
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What are speical considerations for obese exercise prescription?
- orthopedic injuired (low impact activities)
- hyperthermia
- equipment modifications
- emphasis on benefits of activities even without weight loss
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What is the best predictor of long term weight maintenence?
physical activity
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How much weight loss significantly decreased BG levels in people with type 2 DM?
7% loss in BW
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What is a good short term, interim, and long term goal for weight loss?
- short term: 5-10% loss, 1-2lb/wk
- interim goal: maintenence
- long term goal: additional weight loss, long term weight maintenence
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