BMI Categories, Classification of Obesity, Waist Circumference, Abdominal Obesity PDF

BMI Categories, Classification of Obesity, Waist Circumference, Abdominal Obesity BMI Categories BMI (kg/m2) Category 70 Hyper Obese Classification of Obesity BM...

BMI Categories, Classification of Obesity, Waist Circumference, Abdominal Obesity BMI Categories BMI (kg/m2) Category 70 Hyper Obese Classification of Obesity BMI of 30 kg/m2 to 34.9 kg/m2 defines class 1 obesity ○ Factors to Consider Before Diagnosis: age, sex, hydration level, muscular composition, presence of fluid in non-circulatory (third) space, presence of sarcopenia, edema, high volume tumors Waist Circumference: WC> 40 in (men), WC> 35 in (women) → abdominal obesity ○ Waist-to-Hip Ratio: WHR≥ 0.9 (men), WHR≥ 0.85 (women) → abdominal obesity Prader-Willi Syndrome Definition: rare genetic disorder featured by a constant sense of hunger that usually begins at about 2 yrs Caused by deletion or imprinting defect in multiple genes on chromosome 15 (polygenic) Disrupts normal functions of hypothalamus and results in problems with hunger, growth, sexual development, body temperature, mood, and sleep Other Characteristics: rapid weight gain, unusual food seeking behavior, complications related to obesity Nutrition Management: diet and behavioral changes Make meal plans and set strict snack/meal times Focus on small portion sizes During Meal: eat slowly, avoid screen time, have pleasant conversations Maintain health and balanced diet Encourage physical activity Adipocytes and Adipose Tissue Definitions Adipose Tissue: storage site for more than 90% of the body’s energy reserves (metabolically active)  ○ Functions: insulation, cushioning, body temp regulation (brown adipose) ○ Adipose and Obesity: hypertrophy (enlargement, BMI40) Weight Reduction: decrease in fat cell size Adipocyte: metabolically active endocrine cell found in adipose tissue (produce adipokines) ○ Hormones: adiponectin (stimulates storage, increases insulin sensitivity) and leptin (satiety hormone- suppresses appetite, other functions- fertility) ○ Proinflammatory Cytokines: TNF-𝛼, CRP, and multiple adipokines Generate low grade chronic inflammation→ linked to many adverse health risks Adipokines: cell signalling proteins secreted by adipose tissue related to low grade state of inflammation and different pathologies Major Types Adipose Tissue: white, brown adipose tissue ○ White Adipose Tissue (WAT): large amount, energy storage ○ Brown Adipose Tissue (WAT): small amount, regulates energy expenditure and thermogenesis, metabolically active Exercise: been reported to increase WAT browning and energy expenditure General Weight Loss Goal for People with Obesity General Weight Loss Goal: specific, attainable, forgiving goals Initial Goal: weight loss by about 10% from baseline Diet: deficit of 500-1000 kcal/day → weight loss of 1-2 pounds per week ○ 3500 kcal per pound rule → reducing 500 kcal per day to lose 1 pound per week Common Treatment Options for Obesity Weight Loss Therapy: weight loss and improving dietary habits (lifestyle therapy) Not appropriate for pregnant/lactating women, patients with uncontrolled psychiatric illness, patients with active substance abuse, patients with eating disorders (need referral) Healthy Meal Plan: reduced calorie meal plan Modifying macronutrient compositions (Mediterranean diet, DASH diet, high protein intake, low carb/fat, high fiber) Physical Activity: reduce sedentary behavior Aerobic Physical Activity Training: progressive increase in volume and intensity of exercise ○ Ultimate Goal: ≥150 min/week of moderate exercise 3-5 times per week ○ Ex: walking, running, jogging, swimming laps, cycling, dancing Resistance Training: single set exercises that use the major muscle groups (2-3 times per week) ○ Ex: push ups, squats, lunges, planks Increase in nonexercise and active leisure activity should be encouraged to reduce sedentary behavior in all patients with overweight and obesity Behavioral Intervention: enhance adherence to prescriptions for a reduced calorie meal plan and increased physical activity Includes: self monitoring (weight, intake, physical activity), goal setting, face-to-face and group meetings, stimulus control, systematic approaches for problem solving, stress reduction, mobilization of social support structures Behavioral lifestyle intervention should be tailored to patient’s ethnic, cultural, socioeconomic, and educational background Pharmacological Treatment: used in combination with lifestyle therapy, used if benefits outweigh risks (given to BMI>30 or >27 with risk factors/complications) Orlistat (Alli/Xenical): lipase inhibitor→ 30% reduced fat absorption (TAG not broken down→ excreted from body) ○ Dosing (120 mg Rx or 60 mg OTC): 1 capsule by mouth with meals 3 times a day ○ Side Effects: GI events related to increased fecal fat excretion, reduction in fat soluble vitamin levels (may need supplementation) GLP-1 Agonists (Wegovy/Ozempic): regulates insulin and blood sugar, reduces appetite, causes slower gastric emptying (feel full faster) ○ Side Effects: N/V, D/C, stomach pain, headache, fatigue, dizziness, feeling bloated, heartburn, gastroparesis, pancreatitis, low blood sugar (T2D), runny nose, sore throat ○ Long Term Therapy Required: discontinuation will cause weight regain and return of appetite and satiety to baseline levels Surgical Procedures: bariatrics surgery (patients 14+) BMI≥40 kg/m2 without coexisting medical problems and for whom the procedure would not be associated with excessive risk BM≥35 kg/m2 and 1+ severe obesity related complications (T2D, HTN, GERD, CVD) Other Eligibility Criteria: tried multiple diets with no sustained success, poorly controlled T2D, CVD, orthopedics, autoimmune, infertility, severe reflux) ○ Adolescents: BMI of 40+, 35-40 (significant associated illnesses like T2D and HTN) Bariatric Surgeries- Types, Nutritional Considerations Management Adjustable Gastric Band (AGB): restricts total amount of food that can be consumed at one time (slows flow of ingested nutrients) Reversible, adjustable, purely restrictive, no change in food pathway, low risk of nutrient deficiencies Adjustments needed in band is: ○ Too Tight: dysphagia, nighttime cough, heartburn, reflux ○ Too Loose: increase in portion size, hunger between meals, poor weight loss outcomes Sleeve Gastrectomy: 60-80% stomach removed Restrictive like AGB, leaves a larger volume than band (better weight loss results) Moderate/High Risk of Nutrient Deficiencies: ○ Removes Parietal Cells: decreased HCl and IF (intrinsic factor- activated in acidic environment, needed for B12 metabolism) ○ Lower ghrelin levels (hunger hormone→ stimulates appetite) ○ N/V frequently reported after surgery Roux en Y Gastric Bypass (RYGB): creation of small gastric pouch that accelerates delivery of nutrients to the colons (N/V) High risk of nutrient deficiencies (iron, calcium, vitamin D, thiamin, folate, B-vitamins) Nutritional Considerations Diet Progression: liquid diet→ pureed diet, soft diet (after 1-2 months) → regular bariatric diet ○ Immediately After Surgery: clear liquid diet→ thicker liquid→ pureed food 6-8 small meals, small portions, gradually increase sips/bites ○ After 2 Months: soft diet→ balanced meal with appropriate portions (¼ cup solids, ½ cup liquids) → chew well, 6-8 small meals (3 meals + snacks)  Meet protein needs with food (discontinue protein liquid supplement or powder) Ex: ricotta cheese, whole wheat bread, fresh apple, kale salad Avoid high fiber foods Difference Between Dumping Syndrome and Refeeding Syndrome Dumping Syndrome: group of symptoms (diarrhea, nausea, lightheadedness, tired after meal) caused by rapid gastric emptying (food moves too quickly from stomach to duodenum) Reasons for Dumping Syndrome: food choices (simple sugars, fatty foods), eating too much, eating too fast, drinking liquids with meals Early Dumping Syndrome: ~30 min after meal→ N/V, GI upset, lightheaded, headache, sweating ○ Sudden increase of food in SI causes sudden increase in enzymes and hormones for digestion and absorption→ GI upset Late Dumping Syndrome: ~1-3 hours after meal→ lightheaded, shaky, fatigue, sweating, hypoglycemia Treatment: first step is changing how and what to eat ○ Eating 6 small meals a day, eating more protein, fiber, and fat ○ Avoid large amounts of liquids that hasten GI transit (increases GI upset) Refeeding Syndrome: potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding Patients getting sudden increase in nutrients (enterally/parenterally) after prolonged starvation Any patient with negligible food intake for more than 5 days is at risk of developing refeeding problems Effects: hormonal and metabolic changes, serious clinical consequences Sudden increase in insulin, glycogen, fat, and protein synthesis Requires phosphate, magnesium, potassium into the cell and thiamin as a cofactor ○ Concentrations of electrolytes in serum falls ○ Significant risks of cardiac arrhythmia, neurological consequences (seizure, delirium, neuropathy), and respiratory failure Prevention 1. Patient screening for risk of refeeding syndrome 2. Slow reintroduction and advancement of calories provided from enteral or parenteral nutrition to patients ○ Limit caloric and fluid intake for first few days), replenish electrolytes 3. Clinical monitoring for cardiac, neuro, respiratory, fluid status 4. Laboratory monitoring of serum electrolytes and treatment of abnormalities Eating Disorders: Risk Factors and Different Types Eating Disorders: behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions Diagnostic criteria listed in the DSM-5 Affects physical, psychological, and social function→ can affect all ages, genders, ethnicities, SES backgrounds, body shapes, weights, and sizes Risk Factors: biological (genetic), psychological, sociocultural factors, history of dieting, early childhood eating/obesity/GI problems, sexual abuse and other trauma, personality traits (impulsivity, perfectionism), athletes, pregnant women, food restrictions (allergies, intolerances) Anorexia Nervosa (AN): restriction of nutrient intake relative to requirements, leading to significantly low body weight, intense fear of gaining weight, distorted body image with inability to recognize seriousness of significantly low body weight Types: restricting (weight loss from fasting or excessive exercise) and binge eating/purging (binge large amounts of food then purge through self induced vomiting, laxatives, diuretics) Signs/Symptoms: thin appearance, loss of muscle and fat, abnormal blood count and blood pressure, fatigue, dizziness, fainting, intolerance of cold, dry skin, thin hair Complications: anemia (low iron, nutrients), bone loss and fractures (low calcium, vit D), absence of period (low fat→ decreased estrogen), constipation (impaired colon function), electrolyte imbalance (diuretics, laxatives, purging), heart/kidney/brain problems, mental disorders (depression, OCD, anxiety) Management Strategies: goal is weight restoration and managing complications (correcting body composition) ○ Psychotherapy: normalize eating patterns and modify thoughts and beliefs Cognitive Behavioral Therapy, family based therapy ○ Medical Management: supplementation for nutrient deficiencies ○ Hospitalization: heart rhythm disturbance, dehydration, electrolyte imbalances, severe malnutrition, etc. May need tube feeding, risk of refeeding syndrome ○ Dietary Management: meal plans for weight gain goals (correct body composition) Weight Goal: gain 1-2 lb/week Supplementation and complication management Supervised eating, structured meal plan Verify claims of intolerances and allergies and identify specific deficiencies Bulimia Nervosa (BN): characterized by binge eating and inappropriate compensatory behavior to control weight gain with potentially dangerous consequences (occurs 1+ times/week for 3 months) Signs/Symptoms: facial and cheek swelling from enlarged parotid gland, sore throat, damaged teeth and gums, Russell’s sign (calluses on dorsal aspect of hand), nosebleed, dehydration Complications: dental enamel erosion and gum disease (gastric acid washing over teeth), GERD, esophageal spasm (irregular contractibility of esophageal muscles due to purging), constipation (chronic laxative abuse→ cathartic colon syndrome), IBS, absent or irregular periods, cardiac arrhythmia (hypokalemia due to self induced vomiting) ○ Cathartic Colon Syndrome: colon loses ability to move food out of body, will rely on laxative use to move food (stop laxative use→ colon becomes inactive) Management Strategies: cessation of binging and purging behavior ○ Psychotherapy: normalize eating patterns and modify thoughts and beliefs (seen effective for teens and children with disorder) cognitive behavioral therapy, family based therapy, support group ○ Pharmacotherapy: antidepressants (selective serotonin reuptake inhibitors (Prozac, fluoxetine) shown to reduce symptoms of BN) ○ Dietary Management: education and meal planning (3 meals with snacks per day) ○ Hospitalization or treatment programs if needed ○ Tooth Carre: patients who persist in vomiting→ rinse mouth with water or fluoride rather than brushing teeth within 30 minutes of each episode  Patients with BN who purge by vomit tend to brush their teeth immediately after→ accelerates dental erosion Binge Eating Disorder (BED 1+ times/week for 3 months): consists of (1) consuming a larger amount of food than other people would be able to consume in similar circumstances and similar period (usually within 2 hour period), (2) lacking control of eating and feeling guilty after eating (no compensatory behavior (purging) as in BN) Signs and Symptoms: eating behavior out of control, overweight or obese, obesity related complications (T2D, CVD, joint problems, etc), poor quality of life and social isolation, negative emotions and mental disorders Management Strategies: reduce binging episodes and achieve healthy eating habits ○ Psychotherapy: control eating, manage relationship stress, regulate emotions ○ Pharmacotherapy: targets binge eating episodes, not weight management Vyvanse: for ADHD, can help moderate to severe BED (FDA approved) Antidepressants (Prozac), antiepileptics (Topamax) ○ Weight Loss: moderate calorie restriction, exercise, behavioral modification, or weight loss medication/surgery ○ Diet: monitor eating patterns and keep record of each meal and trigger of binge episode Identify triggers to binge eating and hunger cues Create a pattern of eating with 3-4 hour gaps between meals Create a pattern of weighing once per week to avoid excessive weight checking or avoidance of weighing at all Other Specified Feeding and Food Intake Disorder (OSFED): eating or feeding disturbances that cause clinically significant distress or impairment but do not meet full DSM-5 criteria for diagnosis Risk Factors: share same concerns about eating, body, shape, and weight as AN/BN/BED OSFED Examples: catch all category, highest prevalence ○ Atypical Anorexia Nervosa: all criterias met, except despite significant weight loss, individual’s weight is within or above normal range ○ Purging Disorder: recurrent purging behavior to influence weight or shape in the absence of binge eating ○ Binge Eating Disorder (of low frequency and/or limited duration): all criteria for BED met, except at a lower frequency and/or for less than 3 months Avoidant Restrictive Food Intake Disorder (ARFID): people who limit the amount or type of food eaten, involves a disturbance in eating resulting in persistent failure to meet nutritional need and extreme picky eating (loss of interest, dislike for specific tastes/textures/smells/colors, fear and anxiety) Atherosclerosis Definition: thickening or hardening of the arteries (slows and limit blood flow to organs) Buildup of plaque (fatty substances, cholesterol, oxidized LDL-C, cellular waste products, calcium, fibrin) in the inner lining of artery Risk Factors: genetics, environmental factors, aging, high blood pressure, high cholesterol, high TAG, diabetes, insulin resistance, obesity, smoking, inflammation from an unknown cause or from disease (arthritis, lupus, psoriasis, IBD) Nonmodifiable: family history (genetics), ethnicity, age, sex Modifiable: obesity, physical inactivity, diet, smoking Modifiable/Nonmodifiable: dyslipidemia, hypertension, diabetes Hypertension Definition: elevation in blood pressure where more than two consecutive readings are out of normal range Prevalence: silent killer (no obvious symptoms in early stage) Nearly half of American adults have hypertension (48.1%, 119.9 million) About 1 in 4 adults with high blood pressure has their blood pressure under control (22.5%, 27 million) Diagnostic Criteria (Systolic and Diastolic): diagnosis must be confirmed by medical professional Category Systolic (mmHg) Diastolic (mmHg) Normal protein) → most dense (lipid