Week 7 Obesity NUR 425 PDF

**[Week 7: Obesity ]** ***Assessment of obesity *** - Body mass index (BMI)  - Measured by kilograms/metres squared  - BMI 25-29.9 overweight  - BMI 30 and over classified as obesity  - Issues with BMI measurement - does not account for muscle mass and distrib...

**[Week 7: Obesity ]** ***Assessment of obesity *** - Body mass index (BMI)  - Measured by kilograms/metres squared  - BMI 25-29.9 overweight  - BMI 30 and over classified as obesity  - Issues with BMI measurement - does not account for muscle mass and distribution of fat  - Waist circumference  - Assigned male at birth: \>/ 102 cm  - Assigned female at birth: \>/ 88 cm  - Waist-to-hip ratio  - Calculated by dividing the waist measurement by the hip measurement  - Less than 0.8 is optimal  - Assigned male at birth: 0.9 or greater  - Assigned female at birth: 0.85 or greater  - Body shape  - Android obesity (apple shaped)  - Higher health risks compared to gynoid obesity  - Gynoid obesity (pear shaped)  ***Obesity: Genetic factors *** - Causes are not clear and are still being investigated  - Several genes thought to be related to weight gain  - Link found between FTO (fat mass and obesity-associated) gene and the BMI  - Variants of this gene may play a role in weight gain  ***Obesity: Role of hypothalamus*** - Hypothalamus produces peptides that influence how nutrients are used and stored  - Evidence that decreased neuropeptide production is associated with weight gain  - Research is examining how hormones & peptides that interact with the hypothalamus influence weight gain  ***Obesity: Role of Hormone Dysregulation *** - Weight gain can be influenced by hormones that stimulate & suppress appetite  +-----------------------------------+-----------------------------------+ | **Ghrelin** | **Leptin** | +===================================+===================================+ | Appetite stimulant | Appetite suppressant  | +-----------------------------------+-----------------------------------+ | Mostly produced by the stomach, | Mostly produced by adipocytes  | | regulated by pattern of food | | | intake  | Signals satiety  | +-----------------------------------+-----------------------------------+ | Levels usually decrease after | With leptin resistance, brain | | eating, and create hunger as they | does not respond to increased | | rise (typically before a meal or | levels of leptin → continued | | after a period of fasting)  | hunger and overeating | +-----------------------------------+-----------------------------------+ ***Obesity: Other Factors*** - Environmental factors: availability and accessibility of healthy foods and opportunities for physical activity. - Socioeconomic status: influence dietary choices and access to healthcare - Psychosocial factors: stress, emotional eating, and social influences can also contribute to weight gain. ***Metabolic syndrome*** - Refers to a set of risk factors that increase the risk of developing CVD and diabetes  - Main underlying risk factor is insulin resistance  - Body has decreased ability to respond to insulin  - Will see hyperinsulinemia as pancreas tries to compensate  +-----------------------------------+-----------------------------------+ | **Metabolic syndrome = 3 of the | | | following: ** | | +===================================+===================================+ | **Waist circumference | AMAB: \>/ 102 cm  | | (increased)** | | | | AFAB: \>/ 88 cm  | +-----------------------------------+-----------------------------------+ | **Triglyceride levels | \>/ 1.7 mmol/L | | (elevated)** | | | | Or medical treatment for elevated | | | triglyceride levels  | +-----------------------------------+-----------------------------------+ | **HDL cholesterol level | AMAB: \< 1.0 mmol/L  | | (reduced)** | | | | AFAB: \/ 130 mm Hg systolic or 85 mm | | | Hg diastolic or medication | | | treatment for HTN  | +-----------------------------------+-----------------------------------+ | **Fasting glucose level | \>/ 5.6 mmol/L  or medication tx | | (elevated)** | for elevated glucose lvls  | +-----------------------------------+-----------------------------------+ ***Metabolic syndrome: management *** - Management of risk factors  - Lifestyle changes  - Increasing physical activity - Regular exercise helps improve insulin sensitivity, reduce blood pressure, and manage weight - Healthy diet - diet rich in fruits, vegetables, whole grains, and lean proteins can help control blood sugar levels, lower cholesterol, and reduce inflammation ***Health risks associated with obesity *** - Respiratory - increased risk for sleep apnea  - Type 2 diabetes  - Osteoarthritis  - GERD  - Cholelithiasis (gallstones) - Cancer - increased risk for certain types  ***Obesity: management *** - Should prioritize enhancing health factors - such as metabolic, mechanical, mental health, and QoL - rather than just focusing on weight loss  - Should also encompass outcomes that are significant to the patient  - Management options include:  - Health-behaviour changes (e.g. healthy eating, physical activity, behavioural strategies such as goal setting, stress management, etc.)  - Medications (used in combination with health-behaviour changes)  - Surgery  ***Pharmacological management of obesity *** - Pharmacotherapy for obesity management is indicated for individuals with a BMI \>/ 30 kg/m\^2 or \>/ 27 kg/m\^2 with weight-related complications, alongside lifestyle changes  - Medications can help with weight loss maintenance, delay type 2 diabetes, improve glycemic control and improve outcomes with certain health conditions (e.g. NAFLD - non alcoholic fatty liver disease)  - Four medications indicated for long-term obesity management in Canada  - Liraglutide (Saxenda)  - Semaglutide (Wegovy) - Naltrexone/bupropion (Contrave)  - Orlistate (Xenical) - **Liraglutide & Semaglutide** - Glucagon-like peptide-1 (GLP-1) receptor agonists (also used in the management of type 2 diabetes)  - GLP-1 is a hormone secreted by the small intestine - Liraglutide (Saxenda): subcutaneous, daily injections  - Semaglutide (Wegovy): subcutaneous, weekly injections  - ***Contraindications:*** personal/family hx of medullary thyroid carcinoma, pregnancy  - ***Common side effects:*** nausea, vomiting, diarrhea, abdo pain, constipation  - ***Rare AE:*** pancreatitis, renal insufficiency and retinopathy, thyroid tumours  - A diagram of a patient\'s flowchart Description automatically generated - **GLP 1** is a hormone that plays a role in glucose metabolism and appetite regulation  - It enhances insulin secretion from the pancreatic beta cells by causing insulin to be released when blood glucose levels are high → lower blood sugar levels  - GLP-1 inhibits the secretion of glucagon from the pancreatic alpha cells, preventing excessive glucose release into the bloodstream  - It also slows gastric emptying -aids in weight management by moderating rise in blood sugar levels after meals and prolongs feeling of fullness. It acts on the brain to promote satiety, reducing overall food intake.  - GLP-1 receptor agonists mimic the action of GLP-1. They can be helpful in management of obesity and Type 2 diabetes.  - **Naltrexone/Bupropion (Contrave)** - *Naltrexone* is an opioid antagonist - *Bupropion* is an atypical antidepressant (helps with smoking cessation) - MOA in weight loss is unclear  - Thought to play a role in the regulation of appetite by the hypothalamus  - PO usually BID  - ***Contraindications***: Seizure disorders, uncontrolled HTN, opioid use, pregnancy  - ***Common side effects:*** nausea, constipation, headache, dizziness, insomnia, dry mouth, increased sweating  - ***Rare AE:*** suicidal thoughts or feelings, seizures, increased heart rate, hypertension, liver damage  - **Orlistat** - Reduces the metabolism and absorption of fat in the GI tract by inhibiting the action of digestive enzymes  - Undigested fat is then excreted in the feces  - Helps with modest weight loss  - Associated with reduced total & LDL cholesterol, increased HDL, reduced fasting blood glucose  - Can lead to reduced absorption of fat-soluble vitamins  - PO, up to TID, with each main meal that contains fat  - ***Contraindications:*** chronic malabsorption syndrome, cholestasis, pregnancy  - ***Common side effects:*** stool leakage, diarrhea, flatulence, abdominal bloating  - ***Rare AE:*** liver damage, acute pancreatitis, kidney stones  ***Surgical Approaches *** - Bariatric surgery: involves reducing the size of the stomach  - Gastric banding: stomach size is limited by placement of an inflatable band around the stomach  - Vertical sleeve gastrectomy: removal of approximately 75% of the stomach, leaving a stomach shaped like a sleeve  - Come with risks and require commitment to long term lifestyle changes