Untitled Quiz
55 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary brain region involved in the homeostatic control of food intake?

The arcuate nucleus of the hypothalamus

What are the two types of adipose tissue?

  • White adipose tissue (WAT) and Brown adipose tissue (BAT) (correct)
  • Fat tissue and muscle tissue
  • Yellow adipose tissue and Orange adipose tissue
  • Glycogen tissue and Adipose tissue

    • An adult who never was obese as a child or adolescent, gains excess weight. Fat cells generally increase in number, not size

    False

    What are the types of macronutrients? (Select all that apply)

    <p>Fats</p> Signup and view all the answers

    Complex carbohydrates are long strands of sugar molecules strung together.

    <p>True</p> Signup and view all the answers

    What is the name of the acute increase in resting metabolic rate (RMR) in the hours after eating, accounting for 5%-15% of total daily energy expenditure?

    <p>Post prandial thermogenesis</p> Signup and view all the answers

    What are the two benefits of using The Harris Benedict Equations?

    <p>It tells you the patient’s energy intake, and it allows you to make a reasonable estimate of the expected rate of weight loss if the patient is adhering to the diet.</p> Signup and view all the answers

    Very low energy diets that are ketogenic produce the worst results

    <p>False</p> Signup and view all the answers

    The most reliable skinfold measurement is the triceps skinfold.

    <p>True</p> Signup and view all the answers

    What is the most popular operation for weight loss surgery?

    <p>Sleeve gastrectomy</p> Signup and view all the answers

    Roux-en-Y bypass is particularly useful in improving type 2 diabetes

    <p>True</p> Signup and view all the answers

    Obesity is a chronic condition which is cured by weight loss.

    <p>False</p> Signup and view all the answers

    What is the name of the impaired response of the body to insulin, resulting in elevated levels of glucose in the blood?

    <p>Insulin resistance</p> Signup and view all the answers

    What are some of the signs of insulin resistance?

    <p>A waistline of 40 inches in men &amp; 35 inches in women, blood pressure reading of 130/80 or higher, a fasting glucose level over 100 milligrams per deciliter (mg/dL), a fasting triglyceride level over 150 mg/dL, an HDL cholesterol level under 40 mg/dL in men and 50 mg/dL in women, skin tags. Patches of dark, velvety skin, a condition called acanthosis nigricans, Damage to tiny blood vessels in your eyes, a condtion called retinopathy.</p> Signup and view all the answers

    What is the main symptom of leptin resistance

    <p>Constantly feeling hungry and increased food intake despite having adequate or excess amounts of body fat</p> Signup and view all the answers

    What is the hormone that increases hunger?

    <p>Ghrelin</p> Signup and view all the answers

    What are the factors that can influence body weight?

    <p>Genetic causes, built environment, medical conditions, gut microbiota, viruses, medications, sleep deprivation, stress, menopause, and environmental toxins.</p> Signup and view all the answers

    What is the definition of "obesity"?

    <p>Is excess body fat accumulation with multiple organ-specific pathological consequences.</p> Signup and view all the answers

    Fat production in adipocytes is strongly stimulated by insulin.

    <p>True</p> Signup and view all the answers

    What is the key peripheral hormone involved in body weight regulation?

    <p>Leptin</p> Signup and view all the answers

    What are the three most commonly used procedures in weight loss surgery?

    <p>Adjustable gastric banding, sleeve gastrectomy, and Roux-en-Y bypass</p> Signup and view all the answers

    What is the least invasive, but requires the most follow-up and revision, weight loss procedure?

    <p>Adjustable gastric banding</p> Signup and view all the answers

    Gastric sleeve is rapidly becoming the least popular operation.

    <p>False</p> Signup and view all the answers

    What is the name of the weight loss surgery that has the longest history and is considered standard in many centers?

    <p>Roux-en Y bypass</p> Signup and view all the answers

    Most women put on weight at menopause.

    <p>True</p> Signup and view all the answers

    What is the name of the first question you should ask during a patient’s obesity assessment?

    <p>Were you obese in early childhood?</p> Signup and view all the answers

    What is the name of the key question that helps you recognize a patient’s set point for weight gain?

    <p>What has been your heaviest weight?</p> Signup and view all the answers

    You should ask the patient "Do you suffer from heartburn" during an assessment?

    <p>True</p> Signup and view all the answers

    Which of the following questions should be asked if you suspect a patient may have sleep apnea? (Select all that apply)

    <p>Are you a restless sleeper?</p> Signup and view all the answers

    If the answers to those questions are yes, and you feel the patient may have sleep apnea, you should refer to a sleep physician for further assessment.

    <p>True</p> Signup and view all the answers

    For the assessment of the respiratory systems, it is important to ask the patient whether they have had asthma in the past.

    <p>True</p> Signup and view all the answers

    What is the name of the common complication of obesity that specific questions should be asked about during a patient’s assessment?

    <p>Obstructive sleep apnea</p> Signup and view all the answers

    You should ask the patient, "Do you have any significant medical issues such as high blood pressure, elevated cholesterol, or diabetes?"

    <p>True</p> Signup and view all the answers

    It’s important to ask a patient if they have had any surgery during a patient’s assessment.

    <p>True</p> Signup and view all the answers

    You should ask the patient "Do you have any ulcers in your legs?"

    <p>True</p> Signup and view all the answers

    You should ask the patient "Have you ever suffered from depression or anxiety" during a patient’s assessment?

    <p>True</p> Signup and view all the answers

    What kind of questions will help you decide if the patient is capable of controlling their own diet?

    <p>Who do you live with?, Who is responsible for the cooking?</p> Signup and view all the answers

    You should ask the patient “are you working?”, “what sort of work do you do?”

    <p>True</p> Signup and view all the answers

    What additional question should be asked during a patient assessment related to their work?

    <p>Do you work unusual hours?</p> Signup and view all the answers

    You should ask the patient if they do any exercise and if their work requires physical activity?

    <p>True</p> Signup and view all the answers

    For a physical examination, make sure that the patient has taken off their shoes and coat.

    <p>True</p> Signup and view all the answers

    The distance from the bottom of the feet to the top of the head in a human body, standing erect is called height.

    <p>True</p> Signup and view all the answers

    Waist circumference is considered a reasonable indicator of intra-abdominal or visceral fat.

    <p>True</p> Signup and view all the answers

    What is the name of the horizontal plane midway between the lowest ribs and the iliac crest?

    <p>Waist circumference mid</p> Signup and view all the answers

    Males with waist circumference greater than 94 cm, females with waist circumference greater than 80 cm are considered to have increased risk

    <p>True</p> Signup and view all the answers

    Waist circumference is divided by hip circumference to get waist-hip ratio.

    <p>True</p> Signup and view all the answers

    The waist-to-height ratio impacts healthy longevity.

    <p>True</p> Signup and view all the answers

    A waist circumference of less than half your height will lower your health risks.

    <p>True</p> Signup and view all the answers

    Body fat and lean muscle mass are the basis for bioelectrical impedance analysis.

    <p>True</p> Signup and view all the answers

    What is the name of the technique that uses calipers to pinch skin in seven different areas of the body?

    <p>Skinfold measurements</p> Signup and view all the answers

    To estimate the total body fat, four skinfolds are measured:

    <p>True</p> Signup and view all the answers

    The triceps skinfold provides information about fat reserves of the body and the calculated muscle mass provides information about the protein reserves.

    <p>True</p> Signup and view all the answers

    The skinfold is lifted 1 cm and recorded with the caliper held in the left hand.

    <p>False</p> Signup and view all the answers

    Skinfold measurements should not be taken when the skin is wet.

    <p>True</p> Signup and view all the answers

    The triceps skinfold is the least reliable skinfold measurement.

    <p>False</p> Signup and view all the answers

    Study Notes

    Obesity Evidence & Practice

    • Obesity is linked to several health issues, including heart disease, type 2 diabetes, hyperlipidemia, hypertension, and osteoarthritis.

    Regulation of Body Weight: The Central Pathway

    • The hypothalamus plays a crucial role in regulating body weight by integrating signals from the periphery about short-term and long-term energy stores.
    • The arcuate nucleus in the hypothalamus is the primary brain region for controlling food intake.
    • Within the arcuate nucleus, two interconnected neuron groups influence energy balance.
    • Neuropeptide Y (NPY) and agouti-related peptide (AgRP) stimulate food intake.
    • Proopiomelanocortin (POMC) cells, which make α-melanocyte-stimulating hormone (α-MSH) inhibit food intake.
    • Both NPY/AgRP and POMC neurons project to other hypothalamic regions.

    Regulation of Body Weight: The Peripheral Pathway

    • Hedonic pathways, based on sensory input (sight, smell, taste), and emotional/social factors influence food intake/expenditure.
    • Leptin, a hormone produced by adipocytes, in proportion to fat mass, inhibits food intake and increases energy expenditure. It is a long-term signaling mechanism.
    • Ghrelin, cholecystokinin (CCK), GLP-1 (glucagon-like peptide-1), PYY (peptide YY), and amylin are hormones that influence short-term food intake/expenditure.

    Adipocytes

    • Adipocytes (fat cells) store energy as fat.
    • Two main types are white adipose tissue (WAT) and brown adipose tissue (BAT).
    • White fat cells (unilocular) contain a single lipid droplet.
    • White fat cells produce several adipokines including resistin, adiponectin, leptin, and apelin.
    • Brown fat cells (multilocular) contain many lipid droplets. Brown fat is also called "baby fat" and is used for generating heat.

    Number of Fat Cells

    • Fat cells increase primarily in size, not number in adults.
    • There's some inconclusive evidence about fat cell number increase in extremely severe obesity.
    • Decreasing the number of fat cells via dietary intervention is difficult.

    Endocrine Role of Adipocytes

    • Adipocytes synthesize estrogens from androgens, potentially affecting infertility.
    • Adipocytes produce leptin which regulates appetite and acts as a satiety factor.

    Insulin Resistance

    • Insulin resistance is an impaired response to insulin leading to elevated blood glucose levels.
    • Some signs of insulin resistance include a large waist circumference, high blood pressure, high fasting glucose levels, high triglycerides, and low HDL cholesterol.

    Leptin Resistance

    • Leptin resistance occurs when leptin's ability to suppress appetite or increase energy use is impaired.
    • The main symptoms of leptin resistance are continuous hunger and increased food intake despite adequate or excess body fat.

    Obesity Definition

    • Obesity is characterized by the expansion of fat mass through adipocyte size increase (hypertrophy) and, to a lesser extent, cell proliferation (hyperplasia).
    • Fat production in adipocytes is strongly stimulated by insulin.

    Factors Influencing Body Weight

    • Genetic predisposition is a strong factor in obesity.
    • Identical twins usually have similar weights, with obesity or thinness being consistent.
    • The built environment, such as increasing availability of high-energy foods and reduced physical activity, contributes to the obesity epidemic.
    • Certain medical conditions, such as hypothalamic disorders and gut microbiota, can affect body weight.
    • Viruses, medications, stress, and menopause can influence body weight.
    • Environmental toxins also influence body weight.

    Types of Body Fat Distribution

    • Central adiposity (android obesity) is high risk for metabolic disease. Fat is mainly distributed around the trunk and upper body.
    • Peripheral adiposity (gynoid or bear shape obesity) has a low metabolic risk. Fat is distributed around hips and lower body.

    Classification of Obesity

    • BMI (Body Mass Index) is calculated as weight (kg) divided by height (m²) squared.
    • Obesity classes are based on BMI values as determined by the World Health Organization.

    Obesity Staging System (Edmonton)

    • This system stages obesity based on pre-clinical risk factors and co-morbidities (mental/physical health issues) that arise from obesity.
    • Stage 0 obesity indicates no risk factors.
    • Stage 4 and 5 obesity reflect irreversible end-organ damage from the disease.

    Assessment in Obesity Management

    • A comprehensive patient history, including questions about previous weight, weight loss attempts, history of obesity in family, and medical history (including comorbidities).
    • A thorough systems review is necessary to identify potential issues, including cardiovascular, respiratory, renal, musculoskeletal, and psychological problems.
    • Dietary habits and physical activity levels are also important aspects to assess
    • Skin condition is also assessed.

    Physical Examination for Obesity

    • Anthropometric measurements include weight, height, waist circumference, hip circumference, and waist-to-hip ratio.

    Body Measurement Rules

    • Use a non-stretching measuring tape, not stretching or too tight to avoid distorting the measurement.
    • Take the measurements in minimal clothing with clothing uniform across measurements.
    • Place the tape measure parallel to the ground.
    • Measure at the same time of the day or in similar conditions to ensure consistency and minimize errors in the measurements.

    Waist-to-Height Ratio

    • The ratio is calculated by dividing waist circumference by height.
    • A lower waist-to-height ratio is associated with a lower risk of health issues.

    Bioelectrical Impedance Analysis (BIA)

    • BIA uses low frequency electrical currents to measure body fat and lean muscle mass.

    Skinfold Measurements

    • Skinfold measurements are a quick, indirect method to estimate body fat percentage through pinching the skin.
    • Measurements are taken at seven different body sites.

    Procedure of Skinfold Measurements

    • Firmly grasp the skinfold between the thumb and index finger of one hand.
    • Lift the skinfold.
    • Measure with the caliper in the other hand.
    • Perform the measurement 4 seconds after releasing the caliper pressure.
    • Repeat the measurement at each site to ensure reliability.

    Reliability of Skinfold Measurements

    • The triceps skinfold is typically the most reliable of skinfold methods.
    • There are many factors that influence the reliability, including the type of caliper used, tester skill, and hydration status at the time of measurement.

    Body Fat Interpretation Charts

    • Charts provide a way to interpret skinfold measurements in terms of lean or overfat status. These reference charts are age- and sex-specific.

    Continue Assessment

    • The assessment of obesity involves radiography techniques like DEXA, CT, and MRI scans.

    Physical Examination Continued

    • Assess patient hands for palmar crease pallor, darkening of knuckles, acanthosis nigricans, and palmar erythema.
    • Assess the neck for goiter and carotid bruits, and palpate the abdomen for hepatic enlargement or tenderness.
    • Assess the patient for evidence of any lung, abdominal, or leg issues.

    Laboratory Investigations

    • Laboratory investigations should be based on patient history and examination.
    • Common investigations include fasting glucose, HBA1c, lipid profile, liver function tests, electrolytes, urea, full blood examination (CBC), uric acid, cortisol, and thyroid function.

    Dietary Therapy

    • Principles of dietary therapy include maintaining nutritional status, supporting metabolism of nutrients, and correcting deficiencies/diseases. Diet therapy goals include providing rest to the body and implementing strategies to change body weight.
    • Macronutrients in the diet include carbohydrates (4 kcal/g), proteins (4 kcal/g), and fat (9 kcal/g). These are essential for energy and other body functions.
    • Carbohydrates are broken down to glucose,
    • Protein is essential for tissue growth/repair.
    • Fat stores energy, cushions organs, and affects hormones and vitamins.

    Energy Expenditure

    • Energy expenditure is the sum of basal metabolic rate, post-prandial thermogenesis, and physical activity. Basal rate is the energy needed to maintain bodily functions. Post-prandial rate is the increase during digestion and digestion-related activities.
    • Calculating energy expenditure using the Harris-Benedict equation is necessary to determine appropriate caloric intake. This equation depends upon an individual's age, height, weight, and activity levels.

    Case Study (Example)

    • A 40-year-old woman, weighing 140 kg and 1.65 m tall, with a sedentary lifestyle, requires a calculated caloric intake reduction for weight loss.

    Approaches to Reducing Energy Intake

    • Several approaches exist, including very low energy diets (VLEDs), reduced energy diets, low-carbohydrate diets, and intermittent diets.

    Very Low-Energy Diets (VLEDs)

    • VLEDs severely restrict caloric intake to encourage rapid weight loss.
    • This is typically a short-term strategy.
    • Micronutrient supplementation is necessary when on VLEDs.
    • VLEDs can be in powder, bar, or meal-replacement form.
    • A medical practitioner should guide the VLED, including what the patient can and cannot consume.

    Reduced Energy Diets

    • Reduced energy diets provide a moderate reduction in caloric intake based on estimated needs.
    • Weight loss of approximately 0.5 kg per week can usually be expected

    Low-Carbohydrate Diets

    • Dietary strategies that reduce carbohydrate intake, leading to ketogenic metabolism.

    Intermittent Diets

    • Intermittent diets follow periods of restricted feeding with periods of normal calorie intake.

    Exercise Therapy

    • Moderate exercise uses only a small proportion of daily energy expenditure
    • Exercise is necessary with diet to reduce muscle loss.
    • Exercise targets have different guidelines for intensity and duration, based on an individual's capacity.
    • Metabolic Equivalent Tasks (METs) can assess and measure the calorie burn of different activities and intensities.

    Outcomes of Interest

    • Exercise guidelines for obese individuals, such as those provided by the ACSM, OMA, or TOS, may help in recommending suitable exercise programs.

    Specific Exercise Recommendations

    • Adults aged 18-64 years: 150-300 minutes of moderate-intensity activity weekly OR 75-150 minutes of vigorous-intensity activity weekly.
    • Adults older than 65 years need the same level and type of activity, but also include efforts at balance training to reduce risk of falls

    Aerobic and Anaerobic Exercise

    • Aerobic exercise, such as running, cycling, or swimming, uses oxygen effectively for energy production without creating lactic acid.
    • Anaerobic exercise, like weightlifting, stresses muscles to the point where oxygen supply is insufficient and lactic acid production occurs.

    Patient Clearance and Exercise

    • Patients with obesity should be evaluated by a medical professional for any co-morbidities before starting an exercise program, and an appropriate questionnaire should guide the practice.
    • 200-300 minutes of exercise of moderate/vigorous intensity per week may be suggested for individuals seeking weight loss.

    Exercise Considerations

    • Guidance with appropriate equipment, exercise intensity, locations, and frequency is important.
    • Exercise intensity and duration should gradually increase as the patient's condition permits
    • Adjustments are needed based on orthopedic risk or mobility.
    • Intensity of exercise should be appropriate and may vary based upon physiological ability

    Target Heart Rate

    • Target heart rate zones during exercise sessions help ensure that an adequate increase in cardiac output is accomplished.

    Medication Considerations in Obesity Management

    • Medications and lifestyle adjustments that encourage long-term weight loss are effective for the patient, including combinations rather than individual agents.
    • Individual efficacy may vary based on the patient's history and health factors.
    • Medications should be discontinued if there is no satisfactory response or if the patient becomes intolerant of the medication.

    Surgical Interventions in Obesity Management

    • Surgical procedures are indicated for when diets and medication have not effectively provided weight loss.
    • Common surgical procedures for weight loss (bariatric surgery) include adjustable gastric banding, sleeve gastrectomy, and Roux-en-Y bypass.

    Post-Surgical Considerations

    • After surgery, dietary restrictions are often necessary.
    • Regular follow-up visits and adjustments are necessary, particularly during the initial post-surgery period.

    Summary of Obesity Management

    • A combination of diet, exercise, and medication is typically necessary for successful weight loss and long-term maintenance in individuals with obesity.
    • A chronic disease state necessitates long-term dietary and exercise changes to ensure sustained weight gain prevention.
    • Medical oversight and guidance of these changes are necessary to achieve the best outcomes.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Obesity1 PDF

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser