NURS 220: CHP 7 Weight Management

gastric banding reduces the size of the stomach to ____ _____ while a sleeve gastrectomy is the _____ of a part of the stomach up to ____%

1 cup, removal, 15

up to ____/____ of people on restrictive diets binge eat; most patients are _____ or ______

1/2, obese, overweight

weight loss diets SHOULD: 1. provide at least _____ kcals, 0.8 protein, 20-30% fat, and enough _____ to spare protein 2. offer a ______ of ordinary foods from all _____ _____ at reasonable cost 3. promote ____ weight loss and encourage a permanent _____ change 4. not use ______ aids or misrepresent ______ of the author 5. inform the client about _____

1200, carb, variety, food groups, gradual, lifestyle, unproven, qualifications, risks

for weight gain prevention, one should exercise for at least ______ minutes minimum per week; for weight loss one should exercise for more than _____ minutes per week

150, 250

hospitalization for eating disorders occurs when the person reaches below ____% of weight and there is a significant decrease in _____ and ______

70, BP, electrolytes

patients with bulimia nervosa use _____ or _____ to purge and have ______ and ______ eating patterns with large weight _____

cathartics, emetics, secretive, irregular, fluctuations

______ food and thinking about food, weight, and dieting _____ are two huge red flags for _____ _____

compartmentalizing, daily, eating disorders

binge eating disorder involves feeling a lack of _____ (can't stop eating), feelings of ______ afterwards (shame, guilt, depressed, angry), and they will continue to _____

control, distress, diet

the treatment for bulimia nervosa is to help the person gain _____, establish _____ eating patterns, and restore ______

control, regular, health

the set-point theory is evident in people who go on _____ diets

deprivation

which strategy would not help an underweight person to gain weight?

drink plenty of water

weight can be influenced by familial habits such as _____ and ______, but _____ plays a large role seen in instances with ______ separated at birth who still have similar weights

eating, activity, genetics, twins

we must rule out _____ disorders and ______ diseases for the underweight

eating, wasting

symptoms of bulimia nervosa include ______ imbalances, decreased _____, ______ rupture, tooth ______, and a calloused _____ finger

electrolyte, BP, esophageal, erosion, index

two causes of obesity in humans are:

genetics and physical inactivity

the opposite of leptin

ghrelin

hormone coded for by the ob gene

leptin

what is the secret to permanent weight loss?

maintainable, not extreme, lifestyle changes

the newest category of eating disorders that involves binge eating WITHOUT purging

binge eating disorder

example goals for an obese person: reduce body weight by ____% in ____ months _____ lower body weight _____ weight gain

10, 6, maintain, prevent

a weight loss of just ____% can really improve _____ for an obese person, they do not necessarily need to reach their _____ weight

10, health, goal

_____% of overweight achieve _____-_____ weight loss defined by _____% of body weight for at least _____ year

20, long-term, 10, 1

List Body Mass Indexes that indicate the following conditions: Overweight: ____-____ Obese: > ____ Morbidly or Clinically Severe Obesity: >____ (with health problems) or >____

25-29.9, 30, 35, 40

a low-kcal diet with _____ or more servings/ day of milk/ milk products can enhance fat loss; Ca deficiency can affect the ability to destroy _____

3, fat

a healthy eating plan involves balancing CHO, fat, and protein AND lowering energy density: ____-____% CHO kcal ____-____% fat kcal ____-____% protein kcal high-_____ and high- _____ foods avoid _____ and _____ fats limit _____ kcals from ____ and _____ (increase nutrient density!)

45-65, 20-35, 10-35, fiber, bulk, saturated, trans, empty, sugar, fat

_____% of adults are underweight, which has fewer health _____ than being overweight

5, risks

a nutritionally sound weight-loss diet might restrict daily energy intake to create a:

500 kcal per day deficit

realistic energy intakes: _____-_____ fewer kcal/day = ____-_____ lbs lost a week _____ kcal/ day minimum for women ____ kcal/ day minimum for men *below those = nutritional inadequacy because you cannot fit in all the food groups

500-1000, 1-2, 1200, 1600

treatment for eating disorders are ______ including counselors, psychiatrists, doctors, and RDs; they address _____ and ______ related to food, weight, and relationships; recovery can take _____ and _____ counseling, _____ therapy, _____ modification, _____ guidance, and sometimes _____ may be necessary

multidisciplinary, thoughts, behaviors, years, family, cognitive, behavioral, nutrition, psychotherapy

causes of obesity are _____ and based on _____ and _____; many diets only affect the _____ of obesity, not the _____

multifactorial, genetics, lifestyle, symptoms, why

continues to suppress hunger and allows a person to not eat again for a while- do not start eating again

satiety

fad diets will often guarantee _____ and _____ outcomes, claim to reset _____ or change _____, and neglect plans for _____

unrealistic, quick, metabolism, genes, maintenance

the dietary guidelines recommends _____ min/day of moderately intense activity

60

if a child has obese parents, there is an _____% chance the child will be obese

80

to determine a realistic energy intake for someone trying to lose weight, calculate the _____ and then do a _____ - _____ kcal/ day deficit either through kcal ______ and/or an increase in _____ _____; a quick calculation is _____ x _____

EER, 500, 1000, reduction, physical activity, weight, 10

weight loss pills, powders, and other dietary supplements

OTC weight loss products

name two inappropriate obesity treatments

OTC weight loss products and other gimmicks

steam, sauna baths, brushes, sponges, wraps, creams, and massages

TEMPORARY gimmicks of weight loss

behavior and attitude modifications: 1. becoming aware of behaviors: food and activity _____ 2. making _____ changes 3. _____ weight 4. personal _____: identify stressors (cues!) that trigger overeating 5. ____ setting 6. ______ skills including new ways of thinking such as self-esteem/efficacy and positive talk

diary, small, maintaining, attitude, goal, cognitive

intuitive eating: reject the _____ mentality honor your ______ feel your _____ challenge the food ______ (neutral thoughts) make ______ with food get some ______ cope with your ______ respect your _____ _____ practice _____ nutrition (variety, frequency, adequacy water)

diet, hunger, emotions, police, peace, satisfaction, emotions, body, exercise, gentle

applying behavior modification with cues: _____ inappropriate cues _____ cues you cannot eliminate _____ cues to appropriate behaviors _____ desired behaviors arrange ______ for negative behavior ____ yourself for positive behaviors

eliminate, suppress, strengthen, repeat, consequences, reward

physical activity is benefical as a part of weight control programs: 1. _____ expenditure: increases energy output by muscles and _____ system 2. BMR is increased _____ (_____) and ____-____ (builds _____ tissue which is metabolically more active) 3. _____ control (fatty acids + glucose released in body) 4. _____ benefits (curbs inappropriate appetite to eat when _____, anxious, or depressed and reduces stress and increases _____ self-esteem)

energy, cardiovascular, immediately, metabolism, long-term, lean, appetite, physiological, bored, high

reasonable strategies for weight loss: realistic _____ intake ______ adequacy _____ portions

energy, nutritional, small

physical activity can be sustained by choosing activities that one _____ and will be able to do _____

enjoys, regularly

can you pass the fridge without opening it? does studying in the kitchen make you want to eat? does seeing people with ice cream make you want some?

environmental cues

LPL is an ______ that promotes fat _____; ______ in obese people ghrelin is a ______ that stimulates ______; ______ in lean people leptin is a _____ that depresses _____ in relation to amount of fat; obese people could have _____, but resist it or it is defective

enzyme, storage, higher, hormone, appetite, lower, hormone, appetite, alot

symptoms of anorexia nervosa involve extreme _____, _____, _____ intolerance, brittle ____/_____, _____, and fine _____ _____

fatigue, malnutrition, cold, hair/nails, amenorrhea, body hair

leptin is secreted by fat cells in proportion to the _____ of fat _____

amount, stored

gastric banding/ sleeve gastrectomy causes the patient to have to eat more _____ and _____ amounts of food

frequently, smaller

name the three types of eating disorders

anorexia nervosa, bulimia, and binge eating

ghrelin stimulates ______ and promotes energy ______; it should naturally _____ after eating

appetite, storage, decrease

weight loss is not _____ for everyone who is overweight, only those where it is affecting _____: in fact, "_____ _____" is more dangerous (increases chronic disease, cholesterol, and HTN) so if someone is not _______ and will gain the weight back, it is better to stay overweight

appropriate, health, weight-cycling, motivated

gastric bypass/ banding has similar effects and complications of a _______ and nutrients will be ______ for the rest of their lives

gastrectomy, malabsorbed

surgery that causes the SI to be bypassed and limits the size of the stomach- suppresses hunger by changing production of intestinal hormones

gastric bypass

name three obesity surgery treatments

gastric bypass, gastric banding, and sleeve gastrectomy

hormone secreted by the stomach cells when we are HUNGRY or fasting

ghrelin

eating disorders are most prevalent in _____, young _____, and ______; there is a rising prevalence in _____, girls under ______, and women _____-_____ years

girls, women, athletes, men, 12, 45-65

fat cell number increases rapidly during _____; cells can grow _____ and then divide to increase _____

growth, larger, number

the FDA only looks into OTC weight loss products when _____ has been reported (e.g. ephedra was taken off market); many of these drugs are _____ which can cause more problems for the _____

harm, stimulants, obese

goals for weight loss should be based on _____ or _____ rather than simply weight

health, fitness

to qualify for aggressive obesity treatments, one must have _____ problems, already tried to _____ weight, and has a certain _____

health, lose, BMI

binge eating followed by self-induced vomiting, fasting, use of laxatives/diuretics, or over-exercising

bulimia nervosa

eating behaviors: appropriate: response to _____ inappropriate: response to _____ in the _____ of hunger

hunger, appetite, absence

leptin triggers the ______ to decrease _____, increase _____ expenditure, and stimulate _____ loss

hypothalamus, appetite, energy, fat

all of the following describe the behavior of fat cells except: a) the number decreases when fat is lost from the body b) the storage capacity for fat depends on both cell number and size c) the size is larger in obese people than in normal-weight people d) the number increases most rapidly during the growth years and tapers off when adult status is reached

a

both ____ and ____-strengthening physical activities are beneficial but must be accompanied by _____ restriction

aerobic, muscle, kcal

genetics and weight lipoprotein lipase leptin ghrelin fat cell development set-point theory environmental stimuli learned behavior physical inactivity

causes of obesity

the set-point theory suggests that the body _____ a desired weight and will adjust its _____ and _____ activity to achieve that weight, despite a person's efforts to change

chooses, metabolism, hormonal

aggressive treatments of obesity need to be done in _____ with an exercise plan and diet change; can also be done _____ with those (long time)

conjunction, solely

orlistat (OTC = alli) ______ production of ______ digesting ______ in ______ and reduces fat ______ by 30% which limits energy intake (fat is malabsorbed IF they are following a proper diet)

inhibits, fat, enzymes, pancreas, absorption

causes of eating disorders can be ______/______ such as pressures to be _____, teasing, troubled ______, or trouble expressing feelings OR they can be ______ such as _____, _____, PTSD, low self-esteem, and lack of ______

interpersonal/ social, thin, relationships, feelings, psychological, depression, anxiety, control

strategies for weight gain: 1. physical activity to build ____ _____ (weight training) 2. eat ______-_____ foods (+500 kcals in cheese, nuts, etc...) 3. _____ meals daily 4. _____ portions 5. extra _____ 6. beverages without empty kcals like _____ and ______

lean muscle, energy-dense, three, large, snacks, juice, milk

ghrelin levels are higher in _____ people or people on ____-_____ diets; it can increase due to a lack of ____

lean, low-kcal, sleep

which of these behaviors will best support successful weight management?

learn appropriate portion sizes

______ behavior (intuitive eating) involves getting in touch with your ______ and rejecting _____; some people never truly feel ______

learned, hunger, diets, hungry

the protein produced by the fat cells under the direction of the ob gene is called:

leptin

enzyme which PROMOTES fat storage in fat cells

lipoprotein lipase

obese people may expend too _____ energy (conserve it!); the bigger you are, the harder it is to _____

little, move

aggressive drug treatments for obesity cause problems ____-_____ and have many _____-_____

long-term, side-effects

obese people should have a _____ of leptin (gain in body fatness stimulates its production to suppress appetite, increase energy expenditure, and produces fat loss), BUT it might be ______ or they may _____ it

lot, defective, resist

eating disorders involve being _____ and ______; ____% of females and _____% of males have eating disorders

malnourished, underweight, 6, 3

factors that contribute to the slowing of weight loss over time: 1. _______ may slow in response to ______ kcalorie intake and loss of metabolically active _____ tissue 2. less _____ may be expended in physical activity as body _____ diminishes 3. body weight lost early in dieting may be composed of a greater percentage of _____ and _____ tissue, which contains fewer kcalories per pound as compared with later losses that appear to be composed mostly of fat (changes in body _____)

metabolism, lower, lean, energy, weight, water, lean, composition

most patients with bulimia nervosa are _____ or ______; it is _____ prevalent than anorexia nervosa

normal, overweight, more

an inappropriate response to hunger involves eating, but not for ______; eating can be connected to deep _____ needs related to soothing when _____ or in _____

nourishment, emotional, stressed, pain

the amount of fat depends on the fat cell _____ and _____

number, size

weight maintenance: 1. weighing yourself only _____ a week 2. one _____ of exercise daily 3. ______ modification (believe in yourself and get support groups) 4. dealing with ______

once, hour, behavioral, lapses

name two health risks of being underweight

osteoporosis and undernutrition

appetite suppressant and increased feelings of fullness by enhancing the release of norepinephrine

phentermine

name two obesity drugs

phentermine and orlistat

rare inherited disorder in which ghrelin levels do not drop after a meal, leading to severe obesity

prader-willi syndrome

why dieting is a losing proposition: _____ (expensive doesn't mean more benefits) and "____" are temporary motivators treats _____ (weight) not the ______ problems temporary ______, not lifestyle changes ______ imbalanced seems _____ and denies hard work involved in ______ weight loss reduces _____ requirements by reducing ____ ____ _____ response makes long term weight loss harder

price, magic, symptoms, underlying, deprivation, nutritionally, easy, permanent, kcal, lean tissue, starvation

anorexia nervosa is most commonly found in post _____ females and has two types: _____ (decrease food intake) and _____-_____ (eating normal amounts then purging)

pubescent, restrictive, binge-purging

what is the best approach to weight loss?

reduce daily energy intake and increase energy expenditure

a syndrome for athletes in which intake is impaired and there is decreased physiological function such as bone health, anemia, hormone imbalance, stress fractures, and loss of period

relative energy deficiency in sport (REDS)

factors that may indicate a person has anorexia nervosa: 1. severe energy _____ 2. a _____ to gain/ maintain weight at _____% of IBW 3. _____ body image 4. intense _____ of gaining weight

restriction, refusal, 85, distorted, fear

occurs as receptors in the stomach stretch and hormones become active, causing the person to feel full- stop eating

satiation

proposes that body weight is physiologically regulated

set-point theory

the obesity theory that suggests the body chooses to be at a specific weight is the:

set-point theory

during weight loss, fat cells can _____ but never disappear, which is why it is hard to ______ weight loss- the only way for fat cells to be removed is _____

shrink, maintain, liposuction

physical activity does not help a person to:

spot reduce (MYTH-lose fat in trouble areas)

genetics influences how energy is _____ and _____ through the _____

stored, expended, BMR

the biggest problem associated with the use of prescription drugs in the treatment of obesity is:

the necessity for long-term use

lipoprotein lipase hydrolyzes ______ in the blood into _____ for storage

triglycerides, fat

feasible amount of weight loss ______; ask someone what the lowest _____ weight they have had- do not set a goal below that!

varies, adult

obese people usually have more ______ in their fat cells than lean people which makes them more effective at ______ fat

LPL, storing

television watching requires little energy beyond _____, replaces time spent on more ______ activity, and encourages _____ of high-kcal foods

RMR, vigorous, snacking

the environmental stimuli for obesity comes from food ______, large _____, and ______ and _____ foods are typically high in ______

availability, portions, convenience, fast, fat

changes in the makeup of the intestinal _____ are known to accompany changes in body weight by influencing energy balance through regulation of _____ availability and storage, interaction with signaling _____ involved in metabolism, modification of intestinal _____, release of intestinal _____, and low-grade chronic _____

microbiota, energy, molecules, permeability, hormones, inflammation

weight loss recommendations: _____/ _____ products limit _____ and _____ meal ______: regular, in response to hunger eat _____ adequate ____ (many people interpret thirst as hunger)

milk, milk, sugar, alcohol, spacing, breakfast, water

name two aggressive obesity treatments

obesity drugs and surgeries

includes all of the circumstances that people encounter daily that push them toward fatness

obesogenic environment