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Obesity 2


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Define obesity
means grown fat by eating

excess accumulation of adipose tissue
Ways to measure body composition
Bod Pod =air displacement
Hydostatic Weighing= water displacement method
DEXA= bone mineral density & %body fag
SKIN FOLD= calipers
BIOELECTRICAL EMPIDENCE ANALYSIS= muscle that contains H2O and conduts
BMI categories
under <18.5
normal 18.5-24.9
over 25-29.9
obese 1 30-34.9
obese 2 35-39.9
obese 3 >40
Hip to waist ratio and risk factors for males and females
waist= smallest below ribs
hip= largest around butt

Very low >70 >80
Low 70-89 80-99
High 90-109 100-120
Very High >110 >120
Global trends
men are overweight women are obese

adult obesity double
children overweight double
adolecent overwieght tripled
Three states leading obesity
West Virginia
Modernization and Urbanization
Modernization (growth of industry and technology)
Modernization an abundance of food A decrease in overall physical activity.
Urbanization (population growth in large cities).
Associated with changes in diet More sedentary lifestyle.
Twin Studies
Identical twins lost almost identical amounts of weight

Tremendous variability in the amount of weight lost between pairs of fraternal twins
Adoption Study
Strong association
Adoptee ï‚® BMI of Biological Parents
Adoptee ï‚® BMI of Adoptive Parents
Family Patterns and Critical periods
Both parents 80% chance
one parent 40%
neither 7-14%

Pregnancy, Menopause, Adolesecent
Energy Expenditure
3500kcal = 1 lb fat

Resting Met rate = 60-75%
maintain body function

Thermal Effects of Feeding= 10%

TH Effect of PA = 15-30%
most variable and sed v phys
Spontaneous Daily Activity
SDA usually decreases with decrease in body weight

Adding excersice can help
Fat Free Mass
These yoyo dieters lose approximately 25% of their weight as fat-free mass (metabolically active tissue) that does not resynnthesize when weight is regained
fat cells
hypertrophy (increased size of existing cell)
___________ (increased # of cells)
Combination of both.

Fat content within a cell = 35% greater in obese
Total # of fat cells = 3x greater in obese

Obese: may have 75 billion fat cells compared to 27 billion in non-obese
Know Polymorphism,Founder Effect, Genetic Drift
Genetic variant, mutation

Founder Effect
In a population, if a few are carriers for an altered gene, many of their descendants may carry the gene

Genetic Drift
Populations with little genetic diversity
Energy Expenditure,
Adrenergic receptor genes
Polymorphism of this gene = resistance to weight loss

Uncoupling proteins
UCP3 expression was lower in those who were diet-resistant
Appitite & leptin
Leptin (protein hormone, considered the ‘appetite gene’)
Leptin = tells our bodies ‘we’ve had enough’. Without leptin, eat continuously.

Obesity = related to very rare mutation in leptin gene

Congenital leptin deficiency = treated with administration of leptin

Obese with normal leptin levels who are given leptin = do not lose weight (unless in extreme dosages)
Melanocortin system genes
All mutations of this gene result in obesity.

POMC gene: adrenal insufficiency, early onset obesity, red hair.

Researchers have shown that treating such individuals with adrenocorticotropic hormone (known to have an anorexic effect) did not have much impact.
Insulin Resistance Drugs
Related to visceral adipose accumulation, and coronary artery disease.

Researchers have shown that weight loss after gastric bypass surgery was greater for those with lower pre-surgery adiponectin levels.

Hipatic lipase
Related to increased LDLs, reduced HDLs, visceral adiposity, and insulin resistance.

Visceral obesity and insulin resistance = related to high HL activity.

Weight loss = associated with decreased HL activity.
Lessons From a Mouse
Normal adult mouse = 30-35 grams
Genetically obese mouse = 80-90 grams
Translation: a person weighing 450-500 lbs (p.10)
Obese mice have a defective allele of the leptin gene. No leptin = no signal to stop eating. (p.11)
Pharmaceutical company - Amgen, bought the drug rights to leptin.

Problem: most obese have abnormally HIGH levels of leptin.
Hormone released from the stomach, and stimulates hunger

Humans injected with ghrelin = intense hunger

Communicates the state of energy balance to the brain

Ghrelin = increases during fasting, among dieters, and after weight loss (weight regain?)
Adipose Tissue(brown v White)
White = large abdominal area, large buttocks.
Visceral and Peripheral

Brown = not as fatty as white. Primary function to ‘burn fatty acids for non-shivering heat generation’
Human babies = brown adipose tissue. Gone by adulthood
Adipose Tissue
Visceral = in men, seen with MRI,found around organs, dangerous

Perefieral= subqutanous, in women, long term, around butt
The body produces little or no insulin (T1) or
The cells don’t respond appropriately to the insulin that is produced (T2)

1 out of 15 people
1.3 mil new each year
6th leading cause of death
Type 1
5-10% of diabetics
1 million people in the U.S
Insulin Dependent or Independent Diabetes Mellitus?
Auto_________ disease - body’s immune systems turns against itself. Destroys the beta cells
Total destruction of the beta cells leaves the body without insulin

CAUSES; genetic, viral, food
Type 2
Insulin Resistance = body is less responsive to insulin

Body often pumps out great amounts of insulin to deal with the surplus of blood sugar
Insulin = eventually demand exceeds production

90% are overweight
over the age of 40
Test of Diabetes
Oral Gluclose Tolerance Test

Bloodsugar Monitor/acucheck (50-80$)
Prickless Test(1000$)
Comorbid of Diabetes
Reinopathy (eye damage,After 20 years, nearly 100% of Type 1 and 60% of Type 2 diabetics develop Retina receives inadequate blood supply)

Neuropathy (Nerve damage to arms and legs Numbness, tingling, reduced sensitivity to touch
Reduction in sensitivity in the feet

Kidney Disease (type 1)
Gynoid lipodystrophy (GLD)-
1= doesn't appear
2- pinch test
3=eveident at rest,orange peel
4= possibly painful
Mattress phenomenon & hard v flacid
For larger areas, skin of thigh pressed between two hands
Hard = observed in young women who perform regular PA. Evident orange peel effect when pinched.

Flaccid = Found in inactive women, have lost weight suddenly.
Is cellulite Modifyable or no?
No=cannot change predisobosing factors,diet and excercise cannot alter bands
Yes=gels, ointments, foams, creams, and lotions
Active ingredients: antioxidants and vasodilators to increase vascular flow and lymphatic drainage.
Vitamin C:Stabilizing or stimulating collagen deposition
Milieu Interieur
milieu interieur’ or the internal environment.
Ronsard key Factors
Circulation: capillaries weaken, buildup of fluids
Muscles:are underused and underdeveloped.
Nutrition: quality of food
Stress: proper digestion, circulation
Age: early 20s and up
Cellulite Forming PAtterns
Diet is firmly established during the teen years

Heavy salt, fat, and sugar

Cycles of starving and binging

Cellulite starts during these years but b/c the skin is taut, doesn’t necessarily show up

Cellulite is often most present with excess adipose tissue - advantageous to keep to a minimum.
Eat Right
No deprivation

No diet - need to be able to stay on it for life

Limit: processed foods, sugar, fat, caffeine, alcohol, salt

Increase: potassium, fiber, and water to detoxify system

Loss of muscle tissue with dieting = leaves more room for cellulite to spread
Portion Sizes
Large portion trend’ began in the 1970s, rose sharply in the 1980s
Competition among franchises Consumer demand

Newer editions of cookbooks state fewer serving sizes for identical recipes from older editions

plates from 10 in to 12.5
Define Nutrition and kilocalorie
science of food and how the body uses food in health and disease

Kilocalorie = Calorie = kcal
Measure of energy content of food
1 Kcal = amount of heat it takes to raise the temp of 1 liter of fluid 1° C
1000 calories = 1 kcal
What to choose
Breads, cereals, grains <2 fat/serving
Crackers <4 grams fat/serving
Soups <2 grams fat/serving
Meats Lean cuts, ground beef/turkey 91+% fat free
Lunch Meats <4 grams fat/ounce
Frozen entrees <4 grams fat/ounce
Info on Protien,Carb,Fiber
RDA = _______ grams per kilogram of body weight.
Ex: 100 lbs = 45.4 kg

Carb= 4cal/gr
simple=milk or fruit but usually candy
complex=bread, starch

Fiber(25-25 gr perday)=soluble= decrese blood cholesterol and blood glucose (citrus fruits, oats, legumes, barley)

insoluble= proper bowel function (wheat)

36.32 grams of protein
Criteria for cholesterol
High Risk Optimal

Total >200 240
LDL >100 160
HDL <60 >40
Triglycerides >150 200
typical cal intake
women & older adults= 1600
teen boys, active men= 2800
children,activeteen grls=2200
Target weight x10 (for light activity)
Target weight x15 (for moderate activity)
Target weight x 20 (for heavy activity)
the basic nutritional needs 30% of calories in the diet should come from fat
10-15% monounsaturated(peanuts,olive)(‘good fats’)
10% polyunsaturated(corn,sunflower)(‘good fats’)
<10% saturated(coconut;solid at room temp)(‘bad fats’)

People who are trying to lose weight should not eat less than 20% of total calories from fat
Healthy enviornment
Schedule regular mealtimes
Eat meals together
Plan for snacks

Grocery shop AFTER eating
Shop from a list

Store less healthy foods out of sight
Eat all food in the same place
high/low fat food choices
Alfredo,Parmigiana,Au gratin,Tempura,Hollandaise Puffed
eating on the go
Choose ketchup, salsa or mustard over mayo on sandwiches and burgers.
Add veggies to sandwiches and pizza.
Include green salads with fat-free dressing.
For Salty Craving: pretzels, light popcorn, whole grain crackers, baked chips.

At Vending Machines: 100% fruit juices, pretzels, peanuts.
Define Health and Quality of Life
Health not just the absence of disease but rather a complete well being (social, physical, mental).

Quality of Life well-being as influenced by a person’s experiences, perceptions,and expectations.
Conditions and BMI
obesity is associated with more than 30 med conditions and a strong realtionship with atleast 15 of those

(Dyslipidemia,Type 2 diabetes
Coronary Artery,Disease,Stroke)
Mortality and BMI
Linear - as obesity increases, mortality increases

Mortality slightly increase as BMI rises above 31 kg/m2 and then rapidly with body mass indexes above 35 kg/m2
recommendations during pregnancy
30-40 years ago women were instructed by their physicians to gain no more than 15 to 20 lbs.

Weight gain standards have been changed since then because of the number of low birth weight babies.
Costs for morbidity and mortality
‘Include preventive, diagnostic, and treatment costs’

Morbidity and mortality costs
Morbidity: ‘value of income lost from decreased productivity, restricted activity, absenteeism, and bed days’.
Mortality: ‘value of future income lost by premature death’.
92.6 billion
Fuding inequities
Public research funding for obesity is appallingly low given that it is a major public health crisis”.

“The National Institutes of Health (NIH) has a budget of more than $29 billion and is the largest public funder of medical research. In setting the priorities of its budget, the NIH has virtually neglected obesity research”.
3 budget priorites for NIH
Number of people who have a particular disease.
Number of deaths caused by a disease.
Degree of disability produced by a disease.
consumers spend on weight loss
Consumers spend about $30 billion per year trying to lose weight or prevent weight gain
partnership for healthy weight managment
This partnership was made up of a group of representatives from government, academia, etc. in order to help the public make informed decisions on weight loss products and programs.
IVF and fertlity decline
The extra tissue between the probe and ovary make ultrasound images appear very "fuzzy“

This makes it very difficult to clearly see ovaries and eggs
For IVF, a needle is pushed in vaginally to reach the eggs in the ovaries

If the ovaries are too high, the needle cannot safely get the eggs out 
appropriate weight gain
Appropriate weight
(0-13 wks) After 1st trimester
Underweight 30-40 lbs
Normal weight 25-35 lbs
Overweight 15-25 lbs
Obese 15 lbs
Twins 40-50 lbs
Foods to avoid and PICA
Cheeses Soft, ‘fresh’ such as feta, goat, Brie, Camembert, blue cheese

Milk, juices, apple cider, cheese

Raw foodsEgg(mousse/ tiramisu), raw/uncooked meats, fish, or shellfish

Processed meats Hotdogs/deli meats
Complications with pregnancy
Pregnancy hypertension Inability/ difficulty placing epidural Wound infection

Gestational diabetes Overdue births Endometrial infection

Menstrual disturbances are 3x greater for those who have severe obesity Longer labors Urinary Tract Infection
Risks for obese mothers
Neural Tube Defects
Higher rates of childhood obesity
large birth weight baby
exercise and pregnancy
Previous experience
Pregnancy complications
Physician approval

4-6wks resume exercise after delivery

after 3rd mo avoid excersie

use Lamaze and Kegal exercises

Valsalva Maneuver= holding breath
Prevelance=Approximately 1 in 10,000-15,000 births
Effects both genders,all race

Cause=Flaw in hypothalamus
Abnormality on chromosome 15 at the time of conception(dad)

Character=Hypotonia, Hypogonadism, Obesity,almond shaped eyes,narrow forhead,downteraned eyes
pathologically excessive appittie and eating
PWS do's and dont's
DO=Lock cabinets and refrigerator
Clear the table of food immediately after meals
Keep food off the counters
Keep candy dishes off of coffee tables, etc.
Keep lives structured

DON'T=Use food as reward/ punishment
Tease/ use sarcasm
BMI % with childhood overweight
Overweight =85th %
Obese = 95th %
orthopedic complications and pshycho effects on childhood obesity
Orthopedic Complications
Bone and cartilage not strong enough
Young children= bowing/ overgrowth of leg bones
Pain and limited ROM due to excess weight on growth plate of the hip

Psychosocial Effects and Stigma
Teasing, jokes, derogatory name calling, hurtful comments by family, peers, strangers Reported negative assumptions such as laziness, being unclean
preventions for parents
parents dont' think Pe should be removed but believe illegal drugs to be the highest risk and obesity to be the lowest

In terms of being somewhat or very concerned about their child’s weight, 30% said yes.
reccoment for curb child obesity
Enroll child in structured activities (gymnastics, soccer, dance, martial arts)
Limit TV time

Prepare foods together
Avoid rushing meals
What type of ED effects people and who are they?
Bulimia, Caucasians,

Slower reaction time
Lesser ability to concentrate
anxiety that take up working memory capacity
Greater likelihood for depression and low self-esteem
Risk factors and emotional health
Genetics – evident through twin studies
Abnormal serotonin levels
Higher BMI
History of dieting
Substance use
Maternal eating difficulties
Childhood eating difficulties
Sexual abuse

negative comments from parents especially mothers have a negative efffect on emoional health, 82% of women report neg comments as a child
how fo foster a healthy body image in children
Avoid teasing in the family
Encourage healthy eating and exercise, not dieting
Model good behavior
Don’t complain about your own body
Don’t be critical of other’s weight or shape
Avoid categorizing food as good or bad
Don’t avoid activities such as swimming, dancing, etc. that bring attention to weight or shape
refeeding syndrome
Most likely in those who are severely malnourished
Congestive heart failure
Sudden cardiac death
How can you minimize this syndrome? slow it down
cost for residential treatment
83 days , around $950 a day
Binge Eating Disorder (BED) is an officially recognized eating disorder according to the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV-TR).

Of those who seek professional treatment for obesity, 1/5 meet the criteria for BED.

EDNOS = Eating Disorder Not Otherwise Specified
Conditions with all AN,BED,BN
ANOREXIA:Downy hair
Abnormally slow HR and BP
Dehydration/ kidney failure
Dry skin
Hair loss

High cholesterol
High triglycerides
Type II diabetes
Gallbladder disease

BN:Gastric rupture
Inflammation of the esophagus
Tooth decay
males and eating disorders
Underweight liking their appearance
77% of men

Dissatisfied with their weight
41% of men

Ideal of muscularity
Plastic surgery options (pectoral/calf implants)
pregancy prone to ED
ANOREXIA:Placental infarction
Neonatal cardiac problems
Maternal anemia

BULIMIA:Low birth weight
Early eating difficulties of mother

The greater number of obstetric complications for the mother, the greater risk of the child developing an eating disorder.

Placental infarction (tissue death)
womb implications on adult health
Low birth weight
Increased risk for bulimia nervosa
Increased risk of heart disease
Increased risk for hypertension
Increased risk for obesity
Increased risk for diabetes
Increased risk for schizophrenia

High birth weight
For females, to increased risk of breast cancer.
Increased risk for later obesity.
osteopenia vs osteoporosis
OSTEOPENIA:Low bone mass and can lead to osteoporosis
Most severe bone loss is associated with
Earlier onset of anorexia nervosa
Longer duration anorexia nervosa

OSTEOPOROSIS:“porous bones”
In anorexics, osteoporosis develops in about 38-50% of cases Predisposes an individual to fracture
osteoporosis facts
Effects predominantly spongy bone called tribecular
90% of sufferers are females

Osteoporosis is nearly an epidemic now in females over the age of 60 years

As bones become more fragile, they will break more easily and with less force than they would if they were strong and healthy.
MES = minimal essential strain
The first clue that someone has osteoporosis is usually a broken bone; however, this is an indication that the disease has caused the bones to become very weak and brittle

No cure exists for osteoporosis

The best treatment is to achieve peak bone mass as a child
T = 0 No different from standard
T > 0 More dense than standard
T < 0 Below the standard

T = -1.0 10% below standard
T = -1.0 to -2.4 Low bone density, osteopenia
T = > -2.5 Osteoporosis

*Most older women have a T-score below the standard
unalteralbe risk factors vs modifiable
YES:eating distordes, Medications,smoking, high alchol intake, exercise, inadequate diet

NO:age, female, ethniticity, family history, small body frame, irregualar periods
primary and seconday amenorrhea
A lack of menstruation during the reproductive years. Amenorrhea decreases bone density at an age when bone formation should still be occurring

Primary: When a female has not experienced menarche by either 16.5 years of age or within 2 years after the development of secondary sexual characteristics

Seconardy:The absence of menstruation for greater than 6 months in a woman with previously normal cycles
Female Training
women cannot excersie at the same rate as men because it causes damage to their reproductie cycles
Female athlete Traid
Eating Disorders, Amenorrhea, Osteoporosis
Reversing bone damage
Not effective: Hormone replacement, calcium supplements

Effective: weight gain, better nutrition, menstration
Why we screen clients
To choose the appropriate program1:
self help v non clinical v clinical
Overeaters Anonymous
Popular diet books
Problems:Not individualized –more geared toward universal views

Nonclinical:Commercial based franchises
Consultants who guide the program Graduates of the program or certified professionals
Intensify self-help efforts
Provide support/ education

Problems: Differing education/ expertise of consultants. Sometimes they are just graduates of the program

CLINICAL:Monitor/ supervise treatment, alone or part of multidisciplinary team. May be affiliated with a hospital or university.

Licensed professionals
Registered dietitians

Nutrition Medicine clinic
Recommendations for stress testing a diabetic
70% of diabetes do not engage in physical activity.

The American Diabetes Association recommends that the diabetic receives stress testing if they have the following:
Older than 35
T2 diabetes >10 years
T1 diabetes >15 years
Risk factors for coronary artery disease
7 positive and 1 negative risk factors
FAMILY HISTORY:coronary revascularization,sudden death
before 55 years of age in father or male first-degree relative
before 65 years of age in mother female first-degree relative
SED LIEFSTYLE:less than 30 min per day 3x a week
OBESE:BMI > 30 kg/m2
waist girth
>102 cm for men
>88 cm for women
waist/hip ratio
> 0.95 for men
> 0.86 for women
Systolic BP > 140 mmHg
Diastolic BP > 90 mmHg
HDLs <40 mg/dL

IMPARED FASTING GLU:Fasting blood glucose of > 100 mg/dL

on at least 2 separate occasions

(-) HIGH HDL>60
signs and symptoms with diseases
Dypsnea=abnormally uncomfortable awareness of breathing)
Ischema= cloted blood flow
syncope=loss of consciousness
Orthopnea=recumbent position at rest that is relieved after sitting up or standing
anginal=Pain, discomfort in chest, neck, jaw, arms
Intermittent claudication= Pain in limbs due to insufficient blood supply (usually due to atherosclerosis)
Criteria for low moderate and high risk testing
Low Risk=Men <45 years of age and women <55 years of age who are asymptomatic and meet no more than one risk factor threshold

Moderate Risk=Men > 45 years and women > 55 years or those who meet the threshold for two or more risk factors

High Risk=Individuals with one or more signs and symptoms or known cardiovascular, pulmonary, or metabolic disease
define PA v excercise v physical fitness
PA='bodily movement that is produced by the contraction of skeletal muscle and that substantially increases energy expenditure'

EXCERCISE='planned structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness'

FITNESS=multidimensional concept comprised of skill-related and health-related fitness’
5 health related components of fitness
best for measuring body composition of an obese person
DEXA:width, lenght, max capac
BODPOD:tight fit,tight cloth
SKINFOLD:calipers too small
HYDRO WEIGH: bathing suit

Tests = to estimate Physical working capacity, obese almost always suffer from low PWC...always use proper warm up and cool down techniques
Highest rate of change
Ability to move a joint through complete range of motion

Issues for those overweight/ obese:
General health (activities of daily living)
Overweight more flexible?
Rate of change effects= 1 week
Risks for excersie
Vigorous physical exertion increases the risk of sudden cardiac death and acute myocardial infarction.

Exercise however only provokes preexisting conditions.
Heel cracks
Joint discomfort
Increased risk for fracture
Factors effecting adherence
Clinicians:Advise too much, too soon = poor adherence from client
Clinician:may have a difficult time relating to those leading more sedentary lifestyles
‘Putting’ themselves in an overweight body
Knowledge of clients physical limitations

Clothing:Moderate-intensity can be done in almost all clothing types

Note that overweight/ obese individuals may feel uncomfortable in typical exercise clothes

Footwear:ADA recommends silica gel or air insoles and polyester or blend socks = keep feet dry
Sneakers lose their joint-protecting properties after 400 miles of walking or jogging
lifestyle activities v traditional excercise
30 min per day lifestyle activity and eating low-calorie self-selected diet VERSUS traditional structured vigorous aerobic activity
Conclusion=Individual may be less intimidated doing lifestyle activity program

just excersie alone without any diet changes can have posite long term effects
How much PA
PA estimates
Ancestral humans
1000 kcals expended
3000 kcals consumed

Today’s humans
300 kcals expended
2100 kcals consumed

To ward off obesity epidemic
We need a 3:1 ratio, thus today’s humans need to expend 700 kcals per day, thus an additional 400 kcals burned per day

Maintain weight loss that one has sustained = 60-90 min moderate-intensity per day.

To prevent crossing over from overweight to obese = 45-60 min moderate-intensity per day.
Weight loss medication
BMI > 30without comorbidities
BMI > 27with comorbidities
Sleep apnea

Failure at previous attempts to lose weight

Family history of overweight or risk factors

Clinicians judgment of patients commitment to engaging in healthy diet and exercise
Agree v Disagree with weight loss medication
Agree: helps to aid w/lifestyle change but isn't a replacement

Disagree: easy way out,Reluctance from some health professionals b/c medication use may focus attention off healthy diet and physical activity
Aortic Valve Abnormalities
3 ways medication causes weight loss
decrease engery intake, decrease in nutrient absoroption, *incrase energy expenditure( no FDA drug)
DEA schedule
Schedule II drugs, increase availability of dopamine and norepinephrine, too much abuse potential

Schedule III drugs, less abuse potential, but are not often prescribed by physicians

Schedule IV drugs, little or no abuse potential, focus on norepinephrine release
works via lipase inhibitor and adverse conditioning
Ingesting large amounts of fat, side effects
Soft oily stool
Sibutramine (Meridia), reduces the reuptake of both norepi and serotonin, and is FDA approved

Those with the following should not be prescribed Sibutramine:
Poorly controlled blood pressure
Heart disease
Irregular heart beat
History of stroke
off label use
Not approved and taking for weight loss considered ____________ use
Not FDA approved for weight loss therapy
Longer than recommended
Combination therapies

Ex:Provigil (sleep disorders)
Zyban (smoking)
Average weight loss with medication & goal BMI
9-26 lbs max out after 6 months

BMI 24
what drug is approved by FDA for children?
what drug is approved the most for weight loss by FDA
Appitite suppressents
Criteria for weight loss surgery
BMI > 40 or more (about 100 lbs overweight for men and 80lbs overweight for women). BMI of 35 to 39.9 with serious medical conditions related to obesity that would improve with weight loss

Have attempted (and failed) previous weight loss efforts

Understand the risks, benefits, and side effects

Committed to lifestyle changes,needed for long-term successful weight loss

No medical, psychiatric, or emotional conditions

Realsitic expectations of the surgery
Three types of surgery
Restrictive: “limit food intake by creating a narrow passage from the stomach into the larger lower part, reducing the amount of food the stomach can hold and slowing passage of food


Malabsorbtive:“do not limit food intake, but instead exclude most of the small intestine so fewer calories are absorbed. no longer recommended because they result in severe nutritional deficiencies.”
Names for 2 Restrictive and 2 combination
Adjustable Gastric Banding (AGB)
Vertical Banded Gastroplasty (VBG)

Roux-en-Y Gastric Bypass (RGB)*most common
Biliopancreatic Diversion (BPD)* most complicated
dumping syndrome
after a meal high in simple CHO which contain sugars that are rapidly absorbed by the body and move too quickly through the body
criteria for surgery in children
Tried for at least 6 months to lose weight and not successful

Severely overweight: BMI >40

Reached their adult height
>13 for girls, >15 for boys

4. Serious weight-related health problems
Type II diabetes
Heart disease

5. Emotionally prepared

6. Referred to a team of experts
costs for surgery
foods after surgery
Healing of wounds
To maintain healthy organ function, 4 ounces of PRO/day

Sugary Foods:
High in cals and fat
Dumping syndrome
Impede room for necessary vitamins and minerals

Difficult to digest

Red meats
Tough steak
The connective tissue in the meat tends to not break down
Blockage – vomiting

Absorb water and swell, which can cause blockage of the stomach pouch outlet
Risks of sugery
flip through slides
3 benefits of gastric bypass
weightloss, no more sleep apnea, no more type 2 diabetes or if still there decrease in meds
bariatric surgery and depression
Surgery-suicide intervals
12 months
27 months
26 months

Pre-surgery and post-mortem BMIs
37.7 to 22.2 kg/m2
42.0 to 25.0 kg/m2
39.5 to 29.4 kg/m2

“Depressive disorder may persist in the bariatric surgery patient despite successful control of obesity”.
rates of anxiety and depression in the obese
Rates of anxiety and depression are 3-4 times higher among obese individuals compared to leaner peers.3
effects of childhood abuse on obesity
Obese patients seeking gastric bypass surgery reported higher rates of childhood maltreatment than normative community samples
32% reported childhood sexual abuse
37% reported some form of non-sexual childhood abuse or neglect

Patients who reported childhood sexual abuse (32%) had significantly higher levels of depression at 12 months after surgery.

A history of childhood sexual abuse is associated with
Eating disorders

“Childhood sexual abuse is remarkable common and is thought to affect up to 1/3 of women and 1/8 of men.”
effec of depression on metabolic syndome
Depression is associated with the metabolic syndrome and ischaemic heart disease11

Correlations between depressive symptoms and
Visceral obesity in men
Elevated glucose levels in women

Metabolic Syndrome: obesity, hypertension, hyperlipidemia, glucose intolerance
NES=classified as neither sleep nor ED
Little/ no appetite for breakfast
Eats more after dinner than during dinner
Consumes ½ of daily energy intake during and after dinner but before breakfast
Has difficulty falling/ staying asleep and wakes frequently and eats
Tense, upset, guilty while eating

NS-RED=closer to sleep
1-3% of the population (3-9 million people)

10-15% of those with eating disorders are affected

As with NES, NS-RED has found to have a genetic link

Tend to be dieters, thus vulnerable and hungry for night binges

May have a history of
Drug abuse
Sleep walking
Restless legs
Sleep apnea
genetic link in NES & NS-RED
yes both have a genetic linke
stress & food of NES , NS_RED
NS-RED= uncommon foods, foods high in fat and sugar


NED v BED=BED is typically done in short episodes whereas NES involves continual eating throughout the night.

BED often produces euphoria during, NES often produces guilt or shame.
treatment for NS-RED
Clinical interview

Sleep-disorder center

Avoid sleeping pills

Interventions for stress and anxiety reduction
Stress management classes
Assertiveness training
Reducing alcohol and caffeine intake

Soft/ rhythmic music at night

Family members lock cupboards and refrigerators at night and hide the keys

Baby alarms or burglar alarms triggered by motion
transtheoretical model
Law of inital values
incrase weight will initally lose more weight
action oriented
define self efficacy
people's beliefs about their capabilities to produce designated levels of performance that exercise influence over events that affect their lives. A strong sense of efficacy enhances human accomplishment and personal well-being in many ways.
internal v external locus of control
Internal locus of control
A person’s belief that the outcomes of their life are determined by their actions

External locus of control
A person’s belief that the outcomes of their life are determined by other people, external events, or chance.
5 problems with attrition
Procedures to decrease drop-out rates
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Motivating staff
$ down

barriers= time, money support, transportaion
foster autonomy or control?
intervention via team or clients family?
intervention via team for long term sucess
broad definition of sucess
Broader definitions of success in weight management
Physiological (body comp, cardio)
Behavioral (program completion, meeting exercise and diet goals)
Maybe it takes more than just one try
Psychosocial (quality of life, self worth, mental health)
individual therapy
Individual therapy for each
Low self-motivation
External locus of control
Low self-esteem
Low self-body image

Deck Info