The Complete Skinny on Obesity Worksheet

What nonsurgical interventions should be attempted prior to bariatric surgery?

- Lifestyle interventions - Antiobesity medications

Which hormone is the "satiety" hormone that tells your brain that you are full and which is the "hunger hormone" that tells your brain that you are hungry? (Ghrelin or Leptin)

- Satiety hormone = Leptin - Hunger hormone = Ghrelin

BMI

- Underweight <18.5 - Normal 18.5 - 24.9 - Overweight / Pre-obese 25.0 - 29.9 - Obese > 30 - Obesity (Class I) 30.0 - 34.9 - Obesity (Class II) 35 - 39.9 - Extreme obesity (Class III) > 40.0

What are 3 other assessment methods or classifications of body weight & obesity besides the BMI

- Waist Circumference - Waist-to-Hip Ratio - Body Shape (apple or pear - apple is greater risk)

3 components contribute to the "perfect storm" related to obesity

1. Chain (fast) food environment 2. Decreased activity 3. Chemicals

Metabolic Syndrome is considered a result of the damage from the "Perfect Storm". Name the 7 disorders that are included in this syndrome:

1. Hypertension 2. Type 2 Diabetes 3. Heart Disease 4. Lipid Problems 5. Cancer 6. Dementia 7. Fatty Liver 8. Also, Polycystic Ovarian Syndrome

Roux-en-Y gastric bypass

A horizontal row of staples across the fundus of the stomach creates a pouch with a capacity of 20 to 30 mL. The jejunum is divided distal to the ligament of Treitz, and the distal end is anastomosed to the new pouch. The proximal segment is anastomosed to the jejunum

Gastric banding

A prosthetic device is used to restrict oral intake by creating a small pouch of 10 to 15 mL that empties through the narrow outlet into the remainder of the stomach

Which monosaccharide or simple sugar is metabolized in the liver?

Fructose

Biliopancreatic diversion with duodenal switch (also called sleeve gastrectomy with duodenal switch)

Half of the stomach is removed, leaving a small area that holds about 60 mL. The entire jejunum is excluded from the rest of the gastrointestinal tract. The duodenum is disconnected and sealed off. The ileum is divided above the ileocecal junction, and the distal end of the jejunum is anastomosed to the first portion of the duodenum. The distal end of the biliopancreatic limb is anastomosed to the ileum.

basic pathophysiology / etiology of obesity?

Obesity is a chronic, relapsing disease characterized by an excessive accumulation of body fat and weight gain. These increases in body fat cause adiposopathy (i.e., dysfunction of adipose tissue), which promotes the development of metabolic, biomechanical, and psychosocial diseases and disorders. Dysfunctional adipose tissue cells release biochemical mediators that cause chronic inflammatory changes, which can lead to a multitude of diseases, including heart disease, hypertension, and type 2 diabetes. At the most fundamental level, obesity results from a metabolic imbalance, characterized by an excess of caloric consumption relative to caloric expenditures. That is, too many foods are consumed and too little physical activity is conducted over the long term, resulting in weight gain.

Gastrointestinal Lipase Inhibitor

Orlistat - Diminishes intestinal absorption and metabolism of fats, particularly triglycerides

Obesity is a Public Health issue

TRUE

Sleeve gastrectomy

The stomach is incised vertically and up to 85% of the stomach is surgically removed, leaving a "sleeve"-shaped tube that retains intact nervous innervation and does not obstruct or decrease the size of the gastric outlet

Is obesity considered a disease?

Yes, this resolution was based upon the scientific observation that obesity followed criteria commonly used for defining a disease; namely, it can be said that obesity impairs normal bodily function, possesses characteristic signs and symptoms, and causes morbidity

List 6 complications related to bariatric surgery

a. Hemorrhage b. Venous Thromboembolism (VTE) c. Bile Reflux d. Dumping Syndrome e. Dysphagia f. Bowel and Gastric Outlet Obstruction

What complications are older adults with obesity at risk for that may negatively affect their quality of life?

a. Research suggests that older adults with obesity are at risk for complications that may negatively affect their quality of life. In particular, older adults with obesity may be at greater risk of falls and mobility impairments. More older adults with obesity are admitted to nursing homes than normal weight older adults al. One study found that older adults with obesity had lower resting hemoglobin-oxygen saturation levels (i.e., SpO2 levels), which presumably could lead to hypoxemia, dyspnea, and ischemic complications (e.g., myocardial infarction). Another study found that in one long-term care facility, more older adult residents who were overweight had indwelling urinary catheters than their counterparts who were leaner, which presumably could lead to urosepsis.

obesity

an "abnormal or excessive fat accumulation that may impair health" - response to endorsements by multiple health care organizations and societies, including the American College of Cardiology, the Endocrine Society, and the American College of Surgeons, to name a few, the American Medical Association (AMA) House of Delegates in 2013 officially resolved that obesity should be diagnosed as a disease

Dual Agents

bupropion/ naltrexone - Each of these medications combines two medications with known anti-obesity effects; when taken together, the effects are synergistic

GLP-1 Receptor Agonists

liraglutide - Mimics the effects of incretions, resulting in delayed gastric emptying, thus curbing appetite

Selective Serotonergic 5-HT2C Receptor Agonist

lorcaserin - Stimulates central 5-HT2C receptors, causing appetite suppression.

Sympathomimetic Amine

phenteramine/ topiramate - Stimulates central noradrenergic receptors, causing appetite suppression