Obesity & Physical Inactivity

Interventions - obesity

Physical activity, Reduced caloric & fat intake Medications to treat co-morbid conditions Surgery

A client asks the nurse about antioxidants. She indicates that her sister swears by​ antioxidants, saying that they help to improve health and prevent obesity. The client asks how she can increase the amount of antioxidants in her diet. Which should the nurse tell the client to include to increase antioxidants in the​ diet? a. Bright colored fruits and vegetables b. Foods rich in omega 3 c. Dairy products d. Whole wheat grains

a. Bright colored fruits and vegetables​ Rationale: Antioxidants inactivate reactive oxygen species​ (ROS) that play a role in oxidative​ stress, which can occur secondary to obesity. Antioxidants also convert very toxic to less toxic reactive oxygen​ molecules, and repair the damage done by ROS.​ Bright-colored fruits and vegetables such as blueberries and tomatoes have high antioxidant properties.

A client asks the nurse during a​ community-based education class on nutrition what regulates appetite. Which response correctly identifies the main regulatory organ for​ appetite? a. Hypothalamus b. Thyroid c. Pituitary d. Brainstem

a. Hypothalamus​ Rationale: The main regulating center for appetite and energy homeostasis is the hypothalamus. The​ brainstem, pituitary​ gland, and thyroid also play roles in appetite regulation through neural pathways and regulation of hormones but are not the main regulators of appetite.

A recent nursing graduate is trying to understand the relationship between chronic inflammation and obesity. Which would the graduate correctly identify to the preceptor as the first step in the development of​ adiposity-related obesity ultimately contributing to systemic and local​ inflammation? a. Increased nutrient intake and decreased physical activity b. Monocytes differentiated into macrophages within the adipose tissue c. Adipocytes becoming lipid-laden and hypertrophied d. Macrophages in the adipose tissue secreting and producing proinflammatory mediators

a. Increased nutrient intake and decreased physical activity Rationale: Increased nutrient intake and decreased physical activity is the initial step in the development of​ adiposity-related obesity. This causes adipocytes to become​ lipid-laden and​ hypertrophied, resulting in cellular stress leading to the production of proinflammatory​ cytokines,

You are teaching a class about the goals of Healthy People 2020. You know that the class members understand these goals when they mention - a. Reducing risk and maintaining a healthy weight b. Increasing risk and maintaining a healthy weight c. Reducing risk and monitoring labs d. Increasing risk and maintaining the status quo

a. Reducing risk and maintaining a healthy weight

An obese client asks the nurse why he is at higher risk of cardiac disease than his spouse even though both are overweight. They each have a history of cardiac disease in their families. The​ client's excess weight is mostly noted in the abdominal​ region, while his spouse carries her extra weight mostly in the thighs and hips. Which response by the nurse provides the correct explanation for the difference in​ risk? a. Your increased risk is mostly related to the fact that extra weight is predominantly due to poor eating habits. b. The difference is risk is more than likely related to differences in genetics and heredity. c. As compared to your spouse, your extra weight tends to be centrally located, which increases the amount of bad cholesterol in your body. d. While I can't be sure, I think that you might also have insulin resistance or another disorder that would increase your cardiac risk relative to your spouse.

c. As compared to your spouse, your extra weight tends to be centrally located, which increases the amount of bad cholesterol in your body. Rationale: Cardiac disease risk is increased if fat is centrally distributed versus being located in the lower body regions such as the hips and thighs.

A teacher is asked to educate parents about healthy weights of children and adults. She is able to do both, using a BMI chart. How is childhood obesity categorized differently from adult obesity? a. Childhood obesity is plotted by age. b. Childhood obesity is plotted by age and race. c. Childhood obesity is plotted by age, height and weight. d. Childhood obesity is plotted by age, height and race.

c. Childhood obesity is plotted by age, height and weight.

Which gastrointestinal hormone plays a role in controlling appetite by sending satiety signals to the​ hypothalamus? a. Ghrelin b. Peptide YY (PYY) c. Cholecystokinin (CCK) d. Leptin

c. Cholecystokinin (CCK) Rationale: Cholecystokinin​ (CCK) is a peptide produced in response to the presence of fat and protein. It binds to CCK receptors on the vagus​ nerve, transferring satiety signals to the hypothalamus.

The nurse is developing a program to address childhood obesity in the community. Which is of important to achieve successful​ outcomes? a. Adapt interventions to the unique needs of each child. b. Provide educational materials in a variety of formats. c. Involve the entire family. d. Listen to the concerns of the child.

c. Involve the entire family​ Rationale: Involvement of the family has been cited as the most important success factor in addressing childhood obesity.

You are asked why obesity occurs with respect to hormones. You know that obesity occurs as a result of defects in - a. GLP 3 b. PZZ c. Peptide cholecystokinin d. Amylase

c. Peptide cholecystokinin

A new nurse is teaching a class at the local YMCA. The students are older adults from the community. The nurse's topic is the importance of weight management as the individuals age. Understanding of this material is noted by a student who says - a. Weight gain will not affect my ability to care for myself. b. Weight loss will not help if I have joint pain. c. Weight gain will affect my ability to do simple tasks, such as turning in bed, by myself. d. Weight loss can increase my change of diabetes and its complications.

c. Weight gain will affect my ability to do simple tasks, such as turning in bed, by myself.

A client is considering bariatric surgery to achieve weight loss. The client asks the nurse which procedure involves creating a small pouch from the stomach and bypassing the rest of the stomach and some of the small intestine. Which procedure would the nurse identify as correctly fitting this​ description? A. Laparoscopic adjustable gastric banding B. ​Roux-en-Y gastric bypass C. Laparoscopic gastrectomy D. Open sleeve gastrectomy

B. ​Roux-en-Y gastric bypass ​Rationale: Roux-en-Y gastric bypass describes the procedure that involves creating a small pouch from the stomach that remains attached to the esophagus at one end and a section of the small intestine at the other. This bypasses the rest of the stomach and some of the small intestine.

The nurse is educating the client who is being started on orlistat to assist with weight loss. Which statement by the nurse accurately describes how orlistat helps people lose​ weight? A. ​"Orlistat produces​ hypophagia, which is a reduction in food intake and eating​ behaviors." Your answer is not correct. B. ​"Orlistat is a combination drug that includes an appetite suppressant and an anticonvulsant. Together they make you not feel​ hungry." C. ​"Orlistat inhibits pancreatic and gastric enzymes that would normally break down ingested​ triglycerides, leading to reduced fat​ absorption." D. ​"Orlistat slows gastric emptying and increases the feeling of being​ full, resulting in weight​ loss."

C. ​"Orlistat inhibits pancreatic and gastric enzymes that would normally break down ingested​ triglycerides, leading to reduced fat​ absorption." ​Rationale: Orlistat inhibits pancreatic and gastric​ lipase, which decreases the hydrolysis of ingested triglycerides and leads to reduced fat absorption.​

Which statement correctly differentiates physical activity from​ exercise? A. ​"Physical activity is only characterized by​ purpose, while exercise is characterized by​ purpose, intensity, and​ mode." B. ​"Exercise always involves increased energy expenditure as measured in​ kilocalories, while physical activity may​ not." C. ​"Physical activity refers to any activity including​ occupational, leisure-time, and​ household, while exercise does​ not." D. ​"Exercise is​ planned, structured, and repetitive with a goal of improvement or maintenance of physical​ fitness."

D. ​"Exercise is​ planned, structured, and repetitive with a goal of improvement or maintenance of physical​ fitness." Rationale: Exercise is a subcategory of physical activity and is​ planned, structured, and repetitive with a goal of improvement or maintenance of physical fitness. This differentiates it from physical activity. Physical activity and exercise are both characterized by​ mode, intensity, and purpose​ (occupational, leisure-time, and​ household) and involve increased energy expenditure.

Criteria for Metabolic Syndrome

Increased waist circumference (M > 40 inches & F > 35 inches) Increased BP >/= 130/85 Increased triglyceride levels >/= 150 Increased fasting glucose >/= 100 Decreased HDL levels (M < 40 & F < 50)

Insulin resistance _____ with weight gain

Increases with weight gain

Define BMI categories - Normal Overweight Obese Morbid Obesity

Normal = 18.5 - 24.9 Overweight = 25.0 - 29.9 Obese = >30 Morbid Obesity = > 40

Based on assessment​ data, which client being cared for by the nurse meets the criteria for a diagnosis with metabolic​ syndrome? a. African American woman, female, waist circumference 33 inches, BP 130/80 mmHg, triglycerides 138 mg/dL, fasting glucose 86 mg/dL, HDL cholesterol 60 mg/dL b. Caucasian man, male, waist circumference 42 inches, BP 140/80 mmHg, triglycerides 160 mg/dL, fasting glucose 90 mg/dL, HDL cholesterol 50 mg/dL c. Asian American woman, female, waist circumference 36 inches, BP 120/76 mmHg, triglycerides 170 mg/dL, fasting glucose 76 mg/dL, HDL cholesterol 58 mg/dL d. Hispanic man, male, waist circumference 38 inches, BP 128/86 mmHg, triglycerides 140 mg/dL, fasting glucose 110 mg/dL, HDL cholesterol 48 mg/dL

b. Caucasian man, male, waist circumference 42 inches, BP 140/80 mmHg, triglycerides 160 mg/dL, fasting glucose 90 mg/dL, HDL cholesterol 50 mg/dL Rationale: An individual who meets three out of five criteria meets the definition of metabolic syndrome. These criteria​ include: Increased waist​ circumference: >40 inches for men or​ >35 inches for women; Elevated​ BP: greater than or equals≥​130/85 mmHg; Elevated​ triglycerides: greater than or equals≥150 ​mg/dL; Elevated fasting​ glucose: greater than or equals≥100 ​mg/dL; Reduced HDL​ cholesterol: <40​ mg/dL for men and​ <50 mg/dL for women

A client who has been diabetic for many years and well controlled on insulin visits the healthcare provider to discuss recent needs of increased insulin to maintain glucose levels in normal range. The nurse notes that the client has also gained almost 40 pounds in the past year. Which pathophysiological process correctly describes what may be occurring with this​ client? a. Inflammation b. Insulin resistance c. Oxidative stress d. Metabolic syndrome

b. Insulin resistance Rationale: The history of weight gain and increasing resistance to insulin support possible insulin resistance. When BMI​ increases, secretion of endogenous insulin also increases to maintain normal blood glucose levels.​

The nurse is counseling a newly pregnant client about healthy pregnancy outcomes. The client began the pregnancy with a body mass index placing her in obese class I. Which should the nurse include in the session concerning impacts of​ obesity-associated maternal hyperglycemia on fetal​ outcomes? a. Delayed labor b. Large fetal size c. Congenital abnormalities d. Neonatal hypoglycemia

b. Large fetal size Rationale: Obesity-related hyperglycemia in the mother can lead to large fetal​ size, often triggering premature delivery or necessitating a cesarean delivery.

Which strategy would be considered an environmental approach to work toward achievement of the Healthy People 2020 objectives for nutrition and weight​ status? a. Requiring school cafeterias to provide more healthful food options b. Removal of unhealthy foods from high school vending machines c. Changing legislation to increase the amount of free and reduced fee lunches for school children d. Offering individual counseling to students to support healthy lifestyle behaviors related to nutrition and physical activity

b. Removal of unhealthy foods from high school vending machines Rationale: Removing unhealthy foods from vending machines would change the environment by removing access to unhealthy options during school hours. Requiring school cafeterias to provide more healthful food options and changing legislation to offer more free and​ reduced-fee lunches would be policy approaches. Offering individual counseling would be an individual approach.

You are placed in charge of an intervention for the students of a local elementary school. You know that a key factor for change in children's association with food is to address - a. The parents because they are all making incorrect food choices. b. The food insecurity that these children experience because it affects their food choices. c. The city parks and rec department because are not enough state of the art activities at the local YMCA. d. None of the above, since you are just one person.

b. The food insecurity that these children experience because it affects their food choices.

Mr. Xi is scheduled to undergo a Roux-en-Y gastric bypass He wants to know what he should expect from the procedure. you explain that - a. He will not be restricted in his diet post procedure. b. He will be monitored for increased hepatic glucose production. c. He will have improved insulin sensitivity and thus improved beta cell function. d. He will need to use more diabetic medication because of the surgery.

c. He will have improved insulin sensitivity and thus improved beta cell function.

The nurse is teaching lifestyle behavior modifications related to diet and physical activity to a morbidly obese client. The client has been resistant to the teaching and​ states, "It really​ doesn't matter what I​ do, it's caused by​ genetics." Which would be the correct response by the​ nurse? a. Genetics only results in obesity if an individual is exposed to certain things in the environment. b. There is a strong link between genetics and what is referred to as common obesity; however, in cases such as yours with severe obesity, no link has been found. c. While gene mutations have been found to lead to severe obesity, lifestyle changes may still be helpful. d. The evidence linking genetics to obesity is very weak; the majority of obesity is caused by lifestyle choices.

c. While gene mutations have been found to lead to severe obesity, lifestyle changes may still be helpful. Rationale: Genes have been found that are associated with both common obesity and severe​ obesity; thus the best answer to the question acknowledges the link between genetics and obesity but also acknowledges the role lifestyle behavior plays.

The nurse is conducting wellness screenings at a local manufacturer. Based on body mass index​ (BMI), which would the nurse classify as obese class​ I? a. 36.8 ​kg/m2 b. 41.2 ​kg/m2 c. 27.9 ​kg/m2 d. 34.5 ​kg/m2

d. 34.5 ​kg/m2 ​Rationale: BMI can be used to classify individuals as​ normal, overweight, or obese. The obese classifications are further divided into three​ classes: obese class​ I, 30-34.99 ​kg/m2​; obese class​ II, 35-39.99 ​kg/m2​; and obese class​ III, = 40 ​kg/m2. The participant with a BMI reading of 36.8 ​kg/m2 would be classified as obese class II. A BMI of 27.9 would classify an individual as overweight.

The nurse identifies the criteria that classify a female client with metabolic syndrome. Which of the following criteria does the nurse list? a. Waist circumference of 32 inches b. Triglycerides of 150 c. HDL of 68 d. Fasting glucose level of 109 mg/dL

d. Fasting glucose level of 109 mg/dL

A 45 year old female has been referred to you for treatment of obesity. What is the first treatment you initiate? a. You recommend OTC diet pills to be taken daily. b. You recommend a diet change from 2,500 calories to 1,000 calories. c. You recommend joining an elite gym of competitive weight lifters. d. You recommend 30 minutes of brisk walking 5 times a week.

d. You recommend 30 minutes of brisk walking 5 times a week.

Which statement correctly describes the relationship between weight and development of type 2​ diabetes? A. ​"Weight gain across the lifespan contributes to an increased risk for type 2​ diabetes." B. ​"The risk of type 2 diabetes does not increase significantly until body mass index exceeds 24.99 ​kg/m2​." C. ​"The risk of type II diabetes for individuals classified as obese class I by body mass index​ (BMI) does not significantly differ from those classified in higher​ classes." D. ​"Development of type 2 diabetes due to weight gain generally also involves the influence of other​ weight-related conditions."

​A. ​"Weight gain across the lifespan contributes to an increased risk for type 2​ diabetes." Rationale: Weight gain across the lifespan as well as after the age of 18 contributes to an increased risk for type 2 diabetes.

Which volume of physical activity as measured in metabolic equivalent of task​ (MET) minutes per week is required to achieve the most favorable cardiorespiratory​ outcomes? A. ​>200 MET-minutes B. ​>800 MET-minutes C. ​>500 MET-minutes D. ​>300 MET-minutes

​B. ​>800 MET-minutes Rationale: To achieve the most favorable cardiorespiratory​ outcomes, the volume of physical must exceed 800​ MET-minutes per week.

A nurse is providing education to a family who is attempting to help their​ middle-school-aged child lose weight. The inclusion of which information would be important to include to ensure the safety and​ well-being of a child dealing with​ obesity? A. Education concerning therapeutic and nontherapeutic ways for parents to communicate with the child about obesity B. Tips on how to eat healthily in school cafeterias C. Teaching parents signs and symptoms that their child may exhibit if they are being bullied or victimized by their peers D. Discussions of ways to obtain support for weight loss from peers

​C. Teaching parents signs and symptoms that their child may exhibit if they are being bullied or victimized by their peers Rationale: Addressing childhood obesity can be difficult for families. Obese children are often victimized or bullied by their peers and have low​ self-confidence. For the safety of the​ child, it is important that parents are aware of and can identify signs of victimization or bullying in their child to address these problems quickly.

When teaching a class on physical​ activity, the nurse discusses the relationship between physical activity and​ all-cause mortality. Which correctly describes this​ relationship? A. Individuals must participate in regular​ high-intensity physical activity in order to reduce the risk for mortality. B. The overall volume of energy expended plays a minor role as compared to the type of activity in lowering​ all-cause mortality. C. The most active individuals have a greater reduction in mortality risk as compared to those who are least active. Your answer is correct. D. The type of physical activity is most important in lowering the risk of mortality.

​C. The most active individuals have a greater reduction in mortality risk as compared to those who are least active. Rationale: Physical activity and​ all-cause mortality have an inverse​ relationship; the most active individuals have a greater reduction in mortality risk as compared to those who are least active.

The nursing instructor asks the nursing student to explain the physiological process underlying​ leptin's ability to inhibit appetite. Which statement by the student reflects understanding of this​ process? a. The binding of leptin to leptin receptors on the hypothalamus activates gene transcription, resulting in reduced expression of peptides that increase food intake. b. Leptin interacts with the mesolimbic dopamine system, which regulates motivation and reward of feeding. c. Leptin modulates the orexigenic hormones peptide YY (PYY) and agouti related protein (AGRP) neurons in the hypothalamus to stimulate appetite. d. Anorexigenic effects are exerted by leptin through the glucagon like peptide 1 (GLP 1) receptors.

​a. The binding of leptin to leptin receptors on the hypothalamus activates gene transcription, resulting in reduced expression of peptides that increase food intake. Rationale: Leptin's ability to inhibit appetite is based on the binding of leptin to leptin receptors on the​ hypothalamus, which activates gene transcription and results in reduced expression of the orexigenic hormones neuropeptide Y​ (NPY) and​ agouti-related protein​ (AGRP), which are peptides that increase food intake.