Pathophysoplogy Chp 5 Obesity
The nurse is caring for a woman who has struggled with her weight for many years. She has recently begun to lose weight by taking the medication orlistat. This medication assists weight loss by inhibiting pancreatic and gastric lipase. Which system does this medication affect? Nervous and gastrointestinal system Hypothalamus Nervous system Gastrointestinal
Gastrointestinal orlistat: reduce fat absorption CNS Lorcaserin: hypothalmic neurons: saiety phentemine: appetite suppressant bupropion: dopamine and norepinephrine reuptake inhibator CNS and gastrointestional liraglutide: glucagon-peptide receptors: saiety Orlistat is a medication that acts on the gastrointestinal system. Orlistat decreases the hydrolyses of ingested triglycerides leading to reduced fat absorption. While other drugs may act on the nervous system or both nervous and gastrointestinal systems, none act on the hypothalamus.
At a 36-week prenatal visit with a pregnant woman who began pregnancy with a body mass index (BMI) of 32.0 kg/m2, the healthcare provider indicates that they believe the fetus is very large. The nurse anticipates that the provider will initially assess the patient further for which complication? Preterm delivery Pregnancy-induced hypertension Dyslipidemia Gestational diabetes
Gestational diabetes Obesity during pregnancy can lead to development of gestational diabetes. Hyperglycemia during pregnancy can cause increased fetal insulin secretion leading to macrosomia. Dyslipidemia, pregnancy-induced hypertension, and preterm delivery can also be related to obesity, but macrosomia is often due to hyperglycemia.
Which is true regarding physical activity and all-cause mortality rates? Lower levels of physical activity are associated with greater all-cause mortality rates. Lower levels of physical activity are associated with lower all-cause mortality rates. Greater levels of physical activity are associated with lower all-cause mortality rates. Greater levels of physical activity are associated with greater all-cause mortality rates.
Greater levels of physical activity are associated with lower all-cause mortality rates. Those who are moderately active on a regular basis have lower mortality rates than those who are less active.
Metabolic Syndrome
Hallmarks of Metabolic Syndrome: obesity Insulin resistance, increased visceral fat, Increased release of free fatty acids --Impairs hepatic insulin clearance Alterations in peripheral metabolism National Cholesterol Education Program Adult Treatment Panel III) -Five defining criteria for metabolic syndrome -Presence of three of five criteria indicates metabolic syndrome
The community health nurse is working with a nearby middle school to address obesity. The nurse refers to Healthy People 2020 Nutrition and Weight Status objectives. Which activities promote health and reduce the risk of chronic disease? Education about healthful diets and physical activity Healthful diets, and achievement and maintenance of healthy body weights Institution of policies that support healthy food options Access to resources for healthy foods and physical activity
Healthful diets, and achievement and maintenance of healthy body weights The Healthy People 2020 Nutrition and Weight Status objectives promote health and reduce the risk of chronic disease through healthful diets and the achievement and maintenance of healthy body weights. Education, resources, and policies can all be helpful strategies to support these activities.
Which lab result would indicate to the nurse that a patient has an increased risk for coronary artery disease? Low levels of triglycerides High levels of high-density lipoproteins (HDL) High proportion of small, low-density lipoproteins (LDL) Low levels of high-sensitivity C-reactive protein
High proportion of small, low-density lipoproteins (LDL) A high proportion of small LDL particles indicates a risk for coronary artery disease. Higher levels of HDL particles and lower levels of triglycerides and C-reactive protein are associated with a lower risk for coronary artery disease.
Which factors are associated with oxidative stress caused by a patient being overweight and obese? Hyperglycemia, increased production of reactive oxygen species (ROS), decreased levels of antioxidant defenses, chronic inflammation, hyperleptinemia and increased lipid levels Decreased production of reactive oxygen species (ROS), increased levels of antioxidant defenses, decreased lipid levels, and the production of inflammatory cytokines Activation of gastrointestinal epithelium, polymorphonuclear neutrophils, macrophages, production of inflammatory cytokines and other mediators Production of pro-inflammatory cytokines, endothelial adhesion molecules, and pro-atherogenic and chemotactic mediators
Hyperglycemia, increased production of reactive oxygen species (ROS), decreased levels of antioxidant defenses, chronic inflammation, hyperleptinemia and increased lipid levels ctors related to a patient being overweight and obese, such as hyperglycemia, increased production of ROS, decreased levels of antioxidant defenses, chronic inflammation, hyperleptinemia and increased lipid levels, are associated with oxidative stress. GI issues including malignancies and inflammatory bowel disease cause inflammation leading to oxidative stress. Increased, not decreased ROS; decreased, not increased antioxidant defense levels; and increased, not decreased lipid levels are associated with oxidative stress due to being overweight or obese. The production of pro-inflammatory cytokines, endothelial adhesion molecules, and pro-atherogenic and chemotactic mediators is a response to cellular stress secondary to obesity.
Which step in the development of adiposity-related obesity immediately proceeds adipocytes becoming lipid-laden and hypertrophied, ultimately contributing to systemic and local inflammation? Binding of chemokine and integrin receptors on monocytes and recruitment into adipose tissue Differentiation of monocytes into macrophages in adipose tissue Cellular stress causing adipose tissue cells to produce pro-inflammatory cytokines Increased nutrient intake and decreased physical activity
Increased nutrient intake and decreased physical activity due to increased caloric load and decreased energy, adipocytes becoming lipid-laden and hypertrophied, ultimately contributing to systemic and local inflammation. Increased nutrient intake and decreased physical activity lead to the adipocyte becoming lipid-laden and hypertrophied due to the increased caloric load and decreased energy expenditure. Cellular stress, differentiation of monocytes, and binding of chemokine and integrin receptors are all steps that occur later in the process. this then causes Cellular stress causing adipose tissue, immune cells, enothelial cells to produce pro-inflammatory cytokines, then Binding of chemokine and integrin receptors on monocytes and recruitment into adipose tissue, then Differentiation of monocytes into macrophages in adipose tissue
A 22-year-old female has gained over 30 pounds in the past 5 years, pushing her body mass index (BMI) to 32. She had previously been an athlete, but a knee injury sidelined her several years ago and although she has healed, she no longer has the motivation to run. She works long hours and often finds herself eating fast food for meals. After a physical assessment, she discusses treatment options for her obesity. Which treatment intervention for obesity is most appropriate for this patient? Medications Lifestyle change Medication followed by surgery Surgical intervention
Lifestyle change Because this patient is young and has modifiable lifestyle factors that can be addressed to treat her weight gain, lifestyle changes are the most likely treatment to be recommended. Medication and surgery tend to be utilized at later stages of treatment and each are associated with risks.
Increased waist circumference (central obesity)
Men > 40 inches Women > 35 inches
Hyperglycemia, chronic inflammation, and hyperleptinemia, along with increased production of reactive oxygen species (ROS), decreased levels of antioxidant defense, and increased lipid levels are most commonly associated with which condition? Production of inflammatory cytokines related to cancer Oxidative stress caused by being overweight and/or obese Gastrointestinal issues such as inflammatory bowel disease Production of pro-inflammatory cytokines
Oxidative stress caused by being overweight and/or obese Factors related to overweight and obesity, such as hyperglycemia, increased production of ROS, decreased levels of antioxidant defenses, chronic inflammation, hyperleptinemia and increased lipid levels are associated with oxidative stress. Production of inflammatory cytokines may be linked to cancer but are not associated with hyperglycemia, increased ROS, decreased antioxidant defense levels, hyperleptinemia, or increased lipid levels. The production of pro-inflammatory cytokines, along with endothelial adhesion molecules and pro-atherogenic and chemotactic mediators is a response to cellular stress secondary to obesity. GI issues, such as inflammatory bowel disease is due to inflammation, which can then lead to oxidative stress.
In a presentation to the school board about the need to institute policies to help prevent obesity, which information should the school nurse present? "Most states in the United States have adult obesity rates below 25%." "Almost half of the adults in the United States meet the current recommended guidelines for moderate or vigorous-intensity exercise per week." "Lack of physical activity plays a fairly minor role in obesity as compared to genetic and environmental factors." "Adult obesity rates have begun to decrease after years of increasing."
"Almost half of the adults in the United States meet the current recommended guidelines for moderate or vigorous-intensity exercise per week." Currently, only 48% of U.S. adults meet current recommended guidelines for moderate (150 minutes) or vigorous (75 minutes) intensity exercise per week. Physical inactivity contributes to chronic disease development both independently and in combination with obesity. Obesity rates for U.S. adults have been increasing, with most states exceeding 25%.
A community nurse is leading an aerobic dance class for teenage girls. The nurse encourages the girls to exercise outside of their school and the class, so as to improve their physical fitness. One of the girls asks what the difference between physical fitness and exercise is. Which response by the nurse is most accurate? "Exercise is a physical activity that you plan to do, so as to help increase your ability to get through the day with ample energy and no undue fatigue—which is what physical fitness is." "Physical fitness refers to organized sports, like softball, volleyball, or soccer, whereas exercise is less structured and is usually more fun." "Exercise is defined as a physical activity that you do on your own, whereas physical fitness is working out with a group of people, just like this class." "The goal of exercise is to look good; the goal of physical fitness is to feel good!"
"Exercise is a physical activity that you plan to do, so as to help increase your ability to get through the day with ample energy and no undue fatigue—which is what physical fitness is." Exercise is thought of as a subcategory of physical fitness. It is planned, structured, and tends to be repetitive in nature with the goal of improving or maintaining physical fitness. Physical fitness is a term that generally describes the overall ability to get through the day alert, energetic, and without undue fatigue, so as to enjoy leisure time and meet unforeseen emergencies.
A 27-year-old male patient tells the nurse that he runs 3 miles every morning and plays on two competitive soccer teams. He describes himself as feeling great and always having energy, rarely being fatigued until the end of the day when he lays down to sleep. Which phrase will the nurse most likely use to describe this patient? "High level of physical fitness; low levels of exercise" "Low levels of planned, structured, repetitive movements" "High level of physical fitness" "Exercises every morning; participates in physical fitness on competitive team"
"High level of physical fitness; low levels of exercise" The patient is describing himself as someone who regularly exercises such that he has high levels of physical fitness. The patient does not have low levels of exercise in his life; nor does he have low levels of planned, structured, and repetitive movements—a way to describe exercise. Exercise and physical fitness are not differentiated by the number of people participating in an activity.
A patient who is interested in losing weight asks the nurse about the leptin products that are advertised. He asks how leptin is involved in weight loss. Which response by the nurse provides the best explanation? "Leptin is produced by the body in response to food ingestion, reducing appetite and food intake." "Leptin transports across the blood-brain barrier where it binds to leptin receptors and inhibits appetite." "Leptin has multiple effects that address obesity, including decreased fatty acids and visceral adipose tissue." "Leptin has a direct impact on helping you feel full by binding with receptors on the vagus nerve."
"Leptin transports across the blood-brain barrier where it binds to leptin receptors and inhibits appetite." Leptin provides signals to the brain about the amount of adipose tissue reserves. It is synthesized in white adipocytes and released into the systemic circulation. It is then transported across the blood-brain barrier where it binds to specific leptin receptors on the hypothalamus and inhibits appetite. Leptin acts on leptin receptors in the hypothalamus to regulate peptides involved in food intake. Leptin also interacts with the mesolimbic dopamine system, which is involved in motivation and reward of feeding.
A patient recently diagnosed with type 2 diabetes has been referred to the diabetes nurse for education. The patient tells the nurse that the healthcare provider indicated that the diabetes was a result of obesity. The patient states, "I have heard this before but do not understand how they are related." Which statement by the nurse explains the relationship between obesity and development of type 2 diabetes? "While being obese certainly plays a role in the development of type 2 diabetes, it is just one of many factors." "Obesity results in many hormonal changes, many of which cause high glucose levels. Over time, these changes will lead to development of type 2 diabetes." "Obesity can cause cells to be resistant to insulin, requiring higher levels of insulin to keep glucose levels normal; this leads to the development of type 2 diabetes." "When a person is obese, the body just cannot keep up with the intake of foods requiring metabolism and type 2 diabetes is the result."
"Obesity can cause cells to be resistant to insulin, requiring higher levels of insulin to keep glucose levels normal; this leads to the development of type 2 diabetes." Obesity leads to insulin resistance due to altered functions of insulin target cells and the accumulation of macrophages that secrete pro-inflammatory mediators. This results in a less-than-expected insulin effect on tissue insulin receptors, thus requiring increased levels of insulin to keep glucose levels in the normal range.
A nurse is conducting diabetes risk assessments at a local church. Two parishioners are discussing their results with the nurse. The parishioners ask why, even though they have similar body mass indexes (BMI), one of them has a higher risk for type 2 diabetes than the other. Which explanation by the nurse provides the correct response to this question? "BMIs don't tell the whole story; it is best not to focus upon why there is a difference." "I'm not really sure why there is such a difference since BMI is generally the best indicator of type 2 diabetes risk." "While your BMIs are similar, your body fat is carried differently by each of you; risk is higher if most of your body fat is in the abdominal area." "It is important that you know and address your risk; let's discuss what you can do to decrease your risk of type 2 diabetes."
"While your BMIs are similar, your body fat is carried differently by each of you; risk is higher if most of your body fat is in the abdominal area." In this situation, the statement that type 2 diabetes risk is associated with both increased weight (and consequently BMI) and a central distribution of body fat most accurately explains the difference between the risk for the two parishioners. Indicating that the parishioners should not focus on the BMI or that the nurse does not know why they are different do not provide therapeutic or helpful responses to the parishioners.
Health Risks of Obesity
-Increased risk for numerous diseases (E.g., T2D, orthopedic problems, systemic disorders) -Reduced quality of life and functional capacity -Shortened lifespan -Functional limitations -Psychosocial impac ---Including social stigma and discrimination -Conceptual definition of obesity (Excess body fat) Clinical definition of obesity --Based on BMI
Defining Criteria for Metabolic Syndrome (National Cholesterol Education Program Adult Treatment Panel III) (must have 3 of the three things to have a metabolic syndrome, loose weight, releases glucose
1. Increased waist circumference (central obesity) Men > 40 inches Women > 35 inches 2. Elevated triglyceride levels > 150 mg per dL 3. Elevated blood pressure > 130/85 mmHg 4. Elevated fasting glucose > 100 mg per dL 5. Reduced high-density lipoprotein (HDL) cholesterol Men < 40 mg per dL Women < 50 mg per dL 6. c-reactive protein: <0.8mg/L
Approximately how many miles does 800 MET-minutes equate to? 20 8 1 12
12 miles per week of walking The recommended 800 MET-minutes per week is equivalent to approximately 12 miles of walking or jogging per week. MET-minutes do not need to be consecutive miles walked or run each week, but rather can be combinations of exercises with different intensities, durations, frequencies, and bursts of energy.
Obesity in children (age 2 to 19) is related to the BMI-for-age percentile that the Centers for Disease Control and Prevention (CDC) plots on growth charts. Which percentile is a child in to be considered obese? 75th percentile 85th percentile 95th percentile 80th percentile
95th percentile A child is considered obese in the 95th percentile of comparative growth charts. In the 85th percentile, but lower than 95th, a child is considered overweight.
Elevated fasting glucose
> 100 mg per dL
Elevated blood pressure
> 130/85 mmHg
Elevated triglyceride levels
> 150 mg per dL
leptin
A hormone produced by adipose (fat) cells that acts as a satiety factor in regulating appetite. adipocyte derived secretory product that provides signals to the brain about the amount of adipose tissue energy reserves.
Ghrelin
A hunger-arousing hormone secreted by an empty stomach is the peptide produced in the stomach that stimulates appetite. ghrelin levels increase before meals and decreases after a meal. ghrelin production is stimulated by fasting and suppressed by intake of food, acting in part by modulating the orexigenic hypothalmus neurons PPy and AGRP neurons in the hypothalmus
Which definition reflects the World Health Organization's definition of obesity? Weight that is higher than what is considered as a healthy weight for a given height The health condition of anyone significantly above their ideal healthy weight A condition in which a person has an unhealthy amount and/or distribution of body fat Abnormal or excessive fat accumulation that may impair health
Abnormal or excessive fat accumulation that may impair health The World Health Organization defines obesity as abnormal or excessive fat accumulation that can impair health. The Centers for Disease Control and Prevention (CDC) defines obesity as weight that is higher than what is considered as a healthy weight for a given height, while the American Heart Association defines it as the health condition of anyone significantly above their ideal healthy weight. Finally, the National Cancer Institute defines obesity as a condition in which a person has an unhealthy amount and/or distribution of body fat.
The nursing instructor is teaching a group of nursing students about appetite stimulation and depression. Which statement made by the one of the nursing students accurately describes the process of appetite stimulation? "When anorexigenic neurons are activated, appetite is stimulated." "Appetite-stimulating hormones are derived from pro-opiomelanocortin and an amphetamine-regulated transcript peptide." "An individual's appetite is stimulated by activation of orexigenic neurons." "Expression of alpha-melanocyte stimulating hormone stimulates peoples appetites."
An individual's appetite is stimulated by activation of orexigenic neurons." Activation of orexigenic neurons expressing neuropeptide Y and agouti-related protein stimulates appetite. Appetite is depressed by activation of anorexigenic neurons that express alpha-melanocyte stimulating hormone. This hormone is derived from pro-opiomelanocortin, and cocaine and amphetamine-regulated transcript peptide.
Lifespan Considerations: Childhood, Adolescence,
Cardiovascular disease Insulin resistance and diabetes Dyslipidemia Musculoskeletal problems Sleep apnea/obesity: not getting enough air because the the fat compresses the airway, fat squeezes the airway) Social and psychologic problems fix: lifetyle changes, dietary, physical activity, behavioral therapy
Visceral Adiposity
Central fat distribution (BMI) Contributes to increased level of low-density lipoprotein (LDL) --Increased risk for heart disease, CAD -contains one single molecule of apolipoprotein B protein Increased body weight --Increased cardiac workload ---Risk for cardiomyopathy and heart failure, stroke
Which gastrointestinal hormone results in the transfer of satiety signals to the hypothalamus? Adiponectin Ghrelin Glucagon-like-peptide-1 Cholecystokinin
Cholecystokinin Cholecystokinin (CCK) binds to CCK receptors on the vagus nerve, which transfers satiety signals to the hypothalamus. Ghrelin, adiponectin, and glucagon-like-peptide-1 (GLP-1) all play other roles in normal food intake.
A patient who has struggled with obesity for the majority of adulthood has been told that he has lower than average cholecystokinin levels. He asks the nurse how low levels of cholecystokinin might contribute to obesity. Which response by the nurse explains the function of this hormone? "Cholecystokinin is produced in the stomach and stimulates appetite, increasing before meals and decreasing after meals." "Cholecystokinin is produced in the duodenum and small intestine; it stimulates gut motility, gallbladder contraction, gastric emptying, and acid secretion." "Cholecystokinin is a hormone that binds with other receptors on the vagus nerve and indicates when you are full." "This hormone is secreted in the small bowel and colon in response to food ingestion and the presence of fat, resulting in reduced appetite and food intake."
Cholecystokinin is produced in the duodenum and small intestine; it stimulates gut motility, gallbladder contraction, gastric emptying, and acid secretion." Produced by I-type cells in the duodenum and small intestine in response to fat and protein, cholecystokinin is a peptide that stimulates gastric motility, contraction of the gallbladder, pancreatic enzyme secretion, gastric emptying, and acid secretion. It also transfers satiety signals to the hypothalamus.
Lifespan Considerations: Pregnancy: Fetal and Neonatal
Congenital abnormalities Hypoglycemia (BP can be high) Increased fetal insulin secretion and macrosomia (overweight baby) Premature delivery Miscarriage Stillbirth
A community nurse is working with a group of young adults who are overweight or obese and want to lose weight. Which group member is classified as class III obese? Roger, who has a BMI of 31.9 kg/m2 Darlene, who has a BMI of 41.8 kg/m2 Ricki, who has a BMI of 33.8 kg/m2 Ana, who has a BMI of 36.1 kg/m2
Darlene, who has a BMI of 41.8 kg/m2
An occupational health nurse is conducting a health fair for employees. Based on the nurse's calculation of body mass index (BMI), which employee would the nurse classify as obese class II? Employee A with a BMI of 22.6 kg/m2 Employee B with a BMI of 35.2 kg/m2 Employee C with a BMI of 33.6 kg/m2 Employee D with a BMI of 41 kg/m2
Employee B with a BMI of 35.2 kg/m2 A BMI between 35 and 39.9 kg/m2 classifies individuals into obesity class II. Employee A, with a BMI of 22.6 kg/m2 is not obese, but considered normal weight. Employee C, with a BMI of 33.6 kg/m2 is classified with class I obesity. Employee D, with a BMI of 41 kg/m2 is classified with class III obesity. class I 30-34 kg/m2 classII 35-39.9 kg/m2 class III >40 kg/m2
Costs related to adolescent overweight and obesity
Estimated $254 billion Premature morbidity and mortality Direct medical costs
Which is true regarding physical activity and musculoskeletal disease? Physical activity prevents osteoarthritis. Physical activity is inversely associated with risk of hip and spine fracture. Bone mineral density of the spine and hip is unresponsive to physical activity. Low-intensity, high-impact physical activities have disease-specific benefits.
Physical activity is inversely associated with risk of hip and spine fracture. Bone mineral density of the spine and hip is responsive to physical activity. high-intensity, Low-impact physical activities have disease-specific benefits. Physical activity is beneficial for musculoskeletal health and is inversely associated with the risk of hip and spine fracture. Bone mineral density in the spine and hip is responsive to physical exercise. It cannot prevent osteoarthritis, although patients who participate in moderate-intensity, low-impact physical activity may note disease-specific benefits.
Lifespan Considerations: Pregnancy: Maternal
Pregnancy-induced hypertension Gestational diabetes: hyperglycemia increased fetal insulin secreation (large body size) (can trigger cesarean or premature labor. Thromboembolism Respiratory complications Preterm delivery Cesarean deliveries
oxidative stress
Reactive oxygen species (ROS) are highly reactive, unstable molecules that interact with and damage other molecules (PLCDNA)
Which mutations are associated with severe obesity syndromes resulting from alterations in central or peripheral appetite control mechanisms? Adiposity-related Single-gene Multiple-gene Epigenetic
Single-gene Single-gene mutations are associated with severe obesity syndromes resulting from alterations in central or peripheral appetite control mechanisms. Multiple-genes, referred to as polygenic, are thought to be responsible for the more common form of obesity, not the severe obesity that results from alterations of appetite control mechanisms. Epigenetic modifications are also associated with the more common form of obesity. Adiposity—specifically, visceral-adiposity—is not a mutation; it refers to central fat distribution that contributes to higher levels of small LDL particles rather than large, buoyant LDL particles.
Weight loss promotion:
Surgical interventions: -Laparoscopic adjustable -Gastric banding -Roux-en-Y gastric bypass -Laparoscopic (open sleeve) gastrectomy Pharmacologic interventions
Health Risks Due to Excess Fat
T2D Dyslipidemias Metabolic syndrome Nonalcoholic fatty liver disease Endocrine changes Hypertension and heart disease Obstructive sleep apnea Musculoskeletal and skin disorders Gallbladder disease Cancer
Which is true regarding a man and a woman who both have a BMI of 32? Neither are at risk of developing type 2 diabetes. The woman is at increased risk of developing type 2 diabetes. The man is at increased risk of developing type 2 diabetes. Both have the same risk of developing type 2 diabetes.
The woman is at increased risk of developing type 2 diabetes. women develop diabetes after BMI of 31 Men develop diabetes after BMI 35
A male patient is being evaluated for potential metabolic syndrome. Which set of criteria, if noted in the patient history, would support this diagnosis? Blood pressure of 130/78 mmHg, high-density lipoprotein level of 32 mg/dL, triglyceride level of 130 mg/dL Triglyceride level of 140 mg/dL, high-density lipoprotein level of 46 mg/dL, blood pressure 130/85 mmHg Waist circumference of 42 inches, fasting glucose level of 100 mg/dL, high-density lipoprotein level of 36 mg/dL Triglyceride level of 164 mg/dL, waist circumference of 38 inches, fasting glucose level of 100 mg/dL
Waist circumference of 42 inches, fasting glucose level of 100 mg/dL, high-density lipoprotein level of 36 mg/dL The diagnosis of metabolic syndrome is based on five criteria from the National Cholesterol Education Program Adult Treatment Panel III. The individual must have at least three of the five criteria to be diagnosed with metabolic syndrome. A waist circumference greater than 40 inches (for men), a fasting glucose level greater than or equal to 100 mg/dL, and a high-density lipoprotein level less than 40 mg/dL for men would support a diagnosis of metabolic syndrome.
A 67-year-old woman with diagnosed heart disease is being assessed for possible metabolic syndrome. Which set of data indicates that the patient does have metabolic syndrome? Waist circumference: 38 inches; BP: 128/78 mmHg; HDL: 50 mg/dL; triglycerides: 139 mg/dL Waist circumference: 35 inches; BP: 127/80 mmHg; fasting glucose: 89 mg/dL Waist circumference: 39 inches; BP: 132/90 mmHg; fasting glucose: 86 mg/dL; HDL: 57 mg/dL Waist circumference: 42 inches; BP: 135/96 mmHg; HDL: 42 mg/dL; fasting glucose: 100 mg/dL
Waist circumference: 42 inches; BP: 135/96 mmHg; HDL: 42 mg/dL; fasting glucose: 100 mg/dL The diagnosis of metabolic syndrome is based on five criteria from the National Cholesterol Education Program Adult Treatment Panel III. The patient must have at least three of the five criteria to be diagnosed with metabolic syndrome. A waist circumference greater than 35 inches (for women), blood pressure ≥130/85 mmHg, a fasting glucose level ≥100 mg/dL, and a high-density lipoprotein level <50 mg/dL (for women) would indicate metabolic syndrome.
BMI
Weight in kilograms divided by square of height in meters BMI classification Normal: 18.5-24.9 kg/m2 Overweight: 25.0-29.9 kg/m2 Obese: > 30.0 kg/m2 obese I 30-34.99 obese II 35-39.9 Obese III >40 Morbid obesity: > 40 kg/m2 (surgery cannot be done if your BMI is over 25.0)
Obesity
World Health Organization (WHO) : Abnormal or excessive fat accumulation that may impair health
hypothalmus is the regulating center of
appetite and energy homeostasis, stimulated and depressed by the ARC of the hypothalmus neural afferentas and hormonal signals from the periphery signal to higher brain center signals to regulate the hedonic or pleasurable aspects of food ingestion Sight, smell and memory of food
orexigenic
appetite stimulating neurons expression neuropeptide Y (NPY) and agouti-related protein (AGRP)
genetic disorders of obesity
are associated with disruption of leptin-melanocortin pathway affecing only 1-5% of obese people
polymorphisms and epigenetic
are associated with more common forms of obesity
hepatomegaly
enlargement of the liver enzymes leads to fibrosis or cirrhosis and then lead to steatosis (fatty changes) and steatohepatitis (inflammation and fatty changes)
epigenetic factors
environmental influences that change the expression of genetic material can be passed down through mitosis and meiosis
Adiponectin
increases insulin sensitivity and fatty acid oxidation decreased fatty acids and muscle triglycerids, increased hepatic insulin action, increased glucose stimulated insulin secretion, decreased visceral adipose tissue and decreased inflammation
congenital leptin deficiency
single gene defect: leptin can't be produced excessive weight gain, various appetites -recombinant leptin reverse the condition with injection with leptin
Glucagon-like peptide 1 (GLP-1)
substance released by the intestines and travels to the brain- terminates eating is a peptide produced in the L-cells of ileum and colon, exerting anorexigenic effects through the GLP-1 receptors which are distributed in the brain, gastrointestinal tract, and pancrease GLP-1 amplifies glucose- dependent insulin secretion form the pancreatic B- Cells
obesity, metabolic syndrome, insulin resistance T2D and CAD have in common
the pathophysiological mechanisms of inflammation and oxidative stress are involved. adipose tissue has endocrine functions, that are related to excess fat cells and problems related to increased fat mass.
Hyperinsulinemia
the presence of excess insulin in the blood -Related to obesity -Classic characteristics of impaired glucose tolerance Weight gain -Increases insulin resistance -Impairs glucose transport into insulin-sensitive cells --Increased body mass index (BMI) ---Causes increased endogenous insulin secretion
hypothalamus is signaled by adipose tissue hormones, gastrointestinal hormones and endocrine hormones
to influence food intake and energy expenditure. dyregulation of these signals increase adiposity and obesity: affects ceullar regulation, inflammation, mood, oxygenation, perfusion, sleep and tissue integrity
Reduced high-density lipoprotein (HDL) cholesterol
Men < 40 mg per dL Women < 50 mg per dL
physical activity
any form of movement that causes your body to use energy
Physical Activity and Health-Related Physical Fitness
Cardiorespiratory disease Metabolic disease Cancer Musculoskeletal disease Mental health
Healthy People 2020 - Nutrition and Weight Status
Goals: - Promote health - Reduce risk of chronic disease Strategies: - Encourage healthful diet - Support achievement and maintenance of healthy body weight - Address behavioral, environmental, and political factors that support desired changes Objective Categories: - Healthcare and Worksite Settings - Weight Status BMI - Food Insecurity (Calorie intake) - Food and Nutrient Consumption - Iron Deficiency
anorexigenic
appetite inhibiting/suppressing/depressing neurons, which express a-melanocyte stimulating hormone (a-MSH) derived from pro-opiomelanocortin (POMC), cocaine and amphetamine-regulated transcript peptide (CART)
single gene mutations
are associated with severe obesity syndromes resulting from alterations in central or peripheral appetite control mechanisims.
antioxidant defense system
are enzymes such as superoxide dismutase and gluathione peroxidase that inacticate ROS that convert very toxic to less toxic reactive oxygen molecules or repair the damage done by ROS
Homozygous mutation in gene encoding for leptin
associated with severe obesity, hyperphagia (increase of appetite), and impaired satiety also associated with delayed puberty and hypogonadic hypogonadisim
C-reactive protein (CRP)
blood test used to measure the level of inflammation in the body; may indicate conditions that lead to cardiovascular disease
post surgical effects
caloric restrictions, rapid emptying of nutrients, enhanced nutrient/bile delivery to mid/distal jejunum and ileum. reduced hepatic glucose production, increase tissue glucose uptake, improved insulin sensitivity and enhanced pancreatic B-cell function
oxidative stress in maternal
causes vascular endothelial injury, placental inflammation and altered gene expression.
inflammatory cytokines
cytokines that promote inflammation due to cellular stress that causes adipocytes, endothelial cells and immune cells to produce inflammatory cytokines chemoattactant and endothelial adhesion molecules bind chemokine and integrin receptors on monocytes and turn them into adipose tisues monocytes differentiate into macrophages inside adipose tissue where they secrete and produce proinflammatory mediators
All-cause mortality
death for any reason; reduction in premature all-cause mortality has been associated with physical fitness the most active individuals experience a greater reduction in the risk of mortality compared with the least active
nonalcoholic fatty liver disease (NAFLD) and obesity
describes the accumulation of fat in the liver of people who drink little or no alcohol
leptin enhances
enhances the expression of POMC. the source of a-MSH and CART, peptodes that decrease food intake.
AGRP binds to MC4R
food intake increases
Functional Outcomes Due to Obesity
Psychosocial impairment: -Stigmatization -Depression -Stereotyping -women are more affected than men,. depression in both men and women Functional limitations: Worsen as BMI increases Lifespan considerations: -Increased BMI associated with increased mortality deaths occur with BMI over 30. -Affects obese and overweight individuals up to age 75 years
Physical inactivity and sedentary lifestyle
only 45% of adults meet the minium of 150 min moderate or 75 min of vigorous intensity exercise per week) decrease physical activity, metabolic rate and thermogensis reduce energy expenditure and increase energy storage in the form of adipose tissue.
children: BMI:
overweight 85-95 percentile obesity: >95th percentile
Inflammation and Oxidative Stress
proinflmmatory cytokines (TNDa and IL-6) are produced in fat-laden adipose tissue, stimulate inflammatory cells (macrophages and nutriphils) to produce ROS.
exercise
purposeful physical activity that is planned, structured, and repetitive, and that improves or maintains physical fitness
physical fitness
the ability to carry out daily tasks easily and have enough reserve energy to respond to unexpected demands health related and performance related fitness
epigenetics
the study of environmental influences on gene expression that occur without a DNA change
oxidative stress is present
when there is an increased production of ROS relative to the body's antioxidant denfenses.
leptin is synthesized in
white adipocytes and released into the systemic circulation and then it is transported across the blood-brain barrier and binds to specific leptin receptors on the hypothalmus, inhibiting appetite
leptin interacts
with the mesolimbic dopamine system which is involved in motivation and reward of feeding.
Obesity contributes to development of:
-Diabetes #1 disease -Cardiovascular disease -Metabolic syndrome -Cancer -Arthritis and disability -Gallbladder disease -Acute pancreatitis -Nonalcoholic fatty liver disease -Pulmonary complications -Depression
Insulin Resistance
1.Cellular insulin resistance E.g., adipose tissue (body stores glucose in fat, body is unable to use it), liver, and muscle cells Impaired glucose transport into insulin-sensitive cells accumilation of Macrophage that secrete of proinflammatory mediators More insulin needed to maintain normal blood glucose Hyperglycemia and type 2 diabetes (T2D) may develop
The nurse is working with a group of women over 50 years of age. The nurse discusses the metabolic equivalent of task (MET) minutes per week that need to be achieved to enjoy favorable cardiorespiratory outcomes. How many MET-minutes per week should the nurse recommend? 1200 600 800 500
800 (MET) minutes per week / 12 miles
Health Risks of Physical Inactivity
All-cause mortality: Inversely related to physical activity Energy expenditure may be more important than activity type
Obesity: Contributing Factors
Genetic Behavioral: stress eater, grazer. (walk instead of eating) Metabolic (thyroid, adrenal gland, too much estrogen) Environmental (meals at the table) (counter eating, cars, fast food) Socioeconomic (affordability) Physical inactivity and sedentary lifestyle Linked to contributing factors for obesity Increase risk for chronic disorders (with or without obesity)
Factors in the Etiology and Pathophysiology of Obesity
Genetics Inflammation Insulin resistance (bigger you get the more you store in the fat, body doesn't know waht to do) Visceral adiposity: central fat people, pear or apple, Oxidative stress Metabolic syndrome
Lifespan Considerations: Older Adulthood
Greater functional limitations Potential protective effect on frail older adults and those with chronic diseases
Regulation of Food Uptake
Hypothalamus: -Regulating center: appetite and energy homeostasis -Receives input from peripheral organs -Receives signals from brainstem along neural pathways Arcuate nucleus (ARC) of hypothalamus: -Appetite stimulation and depression Integration of various additional signals: -E.g., smell, sight, memory of food, and social context of eating Hormonal modulation
Linking Pathophysiology to Treatment
Increased physical activity: Diabetes Prevention Program (DPP): lifestyle change reduced risk by 58% and medication reduced risk by 31%
Obesity in the United States
Increased prevalence over past 20 years Adults: More than 33% are obese Children: 17% are obese (less active)
Prader-Willi Syndrome (PWS)
Inherited from the father; characterized by reduced motor function, obesity, muscular hypotonia, short stature, small hands and feet, mental deficiencies; resulted form lack of expression of a singel gene SNRNP which encodes a small nuclear ribonuceloprotein which is a complex that controls gene splicing. Offspring does not carry active copy of PW gene.
A morbidly obese male in his early 30s is asking the nurse about different options he has for bariatric surgery. He informs the nurse that he has researched a technique that involves an adjustable silicone band being placed around the stomach, creating a small pouch above the band and a narrower stomach below. Which type of bariatric surgery does the nurse tell the patient this is? Laparoscopic gastrectomy Roux-en-Y gastric bypass Laparoscopic gastric banding Open-sleeve gastrectomy
Laparoscopic gastric banding: adjustable silicone band Roux-en-Y gastric bypass: small pouch is created from the stomach and remains attached to the esophagus and small intestine Open-sleeve gastrectomy/Laparoscopic gastrectomy: stomach is divided vertically and size is reduced by 75%
Linking Pathophysiology to Treatment: Interventions to Achieve Weight Loss
Lifestyle changes -Caloric restriction -Limited fat intake -Increased consumption of antioxidant-rich foods Medications -Statins -New medications under investigation Surgery -E.g., gastric banding weight loss helps with diabetes T2D,
Which is true regarding women who are obese? Obese women are at decreased risk of depression than men. Obese women appear to be stigmatized less frequently than men. Anxiety disorders show a reciprocal relationship with obesity in women. Obese women are at greater risk of psychological dysfunction than obese men.
Obese women are at greater risk of psychological dysfunction than obese men. depression is shown to be common in both men and women Obese women tend to be at greater risk of psychological dysfunction than obese men. They are frequently stigmatized more so than men. Depression shows a reciprocal relationship in obese people; however, women are at increased risk of depression than men.
health-related physical fitness
Parts of physical fitness that help a person stay healthy; includes cardiovascular fitness, flexibility, muscular endurance, strength, and body fatness (neurological disorder for balance)
Which statement about the regulation of food uptake is inaccurate? Activation of orexigenic neurons results in appetite stimulation. Many different hormones modulate hypothalamic gene expression and energy intake. The thyroid is the regulating center of appetite and energy homeostasis. Appetite is stimulated and depressed in the arcuate nucleus of the hypothalamus.
The thyroid is the regulating center of appetite and energy homeostasis. The hypothalamus is the regulating center of appetite and energy, not the thyroid. However, many factors affect the process of appetite stimulation and depression.
Peptide YY (PYY)
a protein, produced in the gastrointestinal tract, that is released after a meal in amounts proportional to the energy content of the meal; it decreases appetite and inhibits food intake is a peptide secreted by the L cells of the distal small bowel and colon in response to food and ingestion and presence of fat in the intestinal lumen, reducing appetite and food intake. the major form of circulating PYY9PYY3-36) binds to hypothalmic receptors and reduces food intake
Dyslipidemia
abnormal blood lipid levels, including high levels of low-density lipoprotein, and triglyceride levels as well as low high-density lipoprotein levels can lead to CAD
decreased levels of antioxidants in obesity
add to the oxidative stress in order for the body to attempt to inactivate teh increase amount of ROS present
inflammation and obestiy
adiposity related obesity begins with increased nutrient intake and decreased physical activity adipocyte becomes lipid laden and hypertrophied in response to caloric load and decreased energy expenditure.
cardiovascular disease and physical activity
aerobic exercise volume of physical activity exceeds 800 MET-min per week (ration of metabolic rate consumption during physical activity) = 12 miles per week.
performance related fitness
agility, balance, coordination, power, reaction time, speed
the most common heatobiliary pathology with obesity
gallbladder diesease increased cholesterol turnover related to total body fat cholesterol production is linaerly related to body fat and increase cholesterol is excreated in bile. higherlevels of cholesterol concentrations in relation to bile acids and phospholipids in the bile increase the chance of precipitation of cholesterol gall stones in the gallbladder.
GLP-1
glucagon-like peptide 1 is released into the blood by the intestine in response to food intake, slows food absorption, increases satiety and improves insulin responsiveness.
hyperglycemia
high blood sugar insulin resistant associated with obesity produces ROS AGEs are formed from proteins, lipids and nucleic acids: activate intracellular signal pathways, including those in adipose cells, which produce ROS.
oxidative stress associated with obesity is
hyperglycemia, increased production of ROS, decreased levels of antioxidant defenses, chronic inflmmation, increased lipid levels and hyperleptineamia
insulin resistance
inability of insulin to achieve its expected biological response
OSA (obstructive sleep apnea) and obesity
increased neck circumference, fat deposits in pharyngeal area leads to smaller lumen, increases BP, and decreases O2 during sleep, increased abdominal pressure on diaphram leads to reduced lung compliance and decreased Residual lung volume
Obesity is associated with
increased plasma and tissue levels of triglycerides and free fatty acids due to increased dietary fat intake.
NIDDM T2D obesity
increased weight with visceral adiposity risk is lowest in women with BMI less than 22, but if BMI is 31 or more T2D have a greater risk men: lowest risk is BMI less than 23 and highest risk of BMI greater than 35
endocrine changes and obesity
irregular menese, anovular cycles, decreased fertility in men and womean, toxemia, HTN, cesarean, hirsutism (altered reproductive and endocrine status) PCOS,> gonadotropin secreation>blood glucose
leptin acts on
leptin receptors in the ARC of the hypothalmus to regulate the production and release of peptides involved in food intake.
HTN and obesity
men: 1.28-1.84 women 1.65-2.42
Genetics and obesity
monogenic (single gene) and plygenic (multiple genes) are causes of besity
heart disease and obesity
most common cause of death, major factors: increase BMI and dyslipidemia, low level of HDL cholesterol places a person for CAD than elevated triglyceride levels.
CCK (cholecystokinin)
released by small intestine- stimulates gallbladder, pancreatic juices is a peptide produced by I-type cells in the duodenum and small intestines in response to fat and proteins, stimulating gut motility, contraction of the gallbladder, pancreatic enzyme secretion, gastric emptying and acid secretion. CCK binds to CCK receptors located on the vagus nerve transferring satiety signals to the hypothalamus.
increased visceral adiposity
resulsts in increased levels of IL-6, TNFa and C-reactive protein, and reduced levels of adiopectin and interleukin 10 that leads to insulin resistance and endothelial dysfunction that leads to metabolic syndrome, diabetes and athrosclerosis.
MC4R binds in the paraventricular necleaus by a-MSH
results in reduced food intake POMC neurons inhibits AGRP to increase activation of MCR4 by a-MSH and decrease activation of MCR4 by AGRP
genetic heritability in common obesity
rolse of genetics in obesity heritability. combination of genetics and environmental contribute to obesity
