General Medicine - Energetic conversion of nutrients, ATP

10 important questions on General Medicine - Energetic conversion of nutrients, ATP

How is obesity assessed?

By calculating the BMI of a person. = body mass index
overweight: >= 25
obesity: >= 30
Not always correct because a very muscular person could be heavy, but  low body fatness, which isn't unhealthy.

Distribution of body fat is a measure for health. Abdominal body fat is unhealthier than fat on the thighs and buttocks. So, a waist-to-hip ratio can be used to assess body fatness.
obesity in men: >1, obesity in women: >0.9

Definition of overweight and obesity in children below 5yrs =

  • Weight-for-height grwoth standards > 2 SD above the WHO growth reference median = overweight
  • weight-for-height growth standards > 3 SD above the WHO grwoth reference median = obese

Definition overweight and obesity for children aged 5-19yrs =

  • BMI-for-age > 1 SD above the WHO growth reference median = overweight
  • BMI-for-age > 2 SD above the WHO growth reference median = obese
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Obesity is a major risk factor for non-communicable diseases such as...

  • Cardiovascular diseases (mainlu heart disease and stroke), which were the leading cause of death in 2012
  • diabetes
  • musculoskeletal disorders (especially osteoarthritis, a highly disabling degenerative disease of the joints)
  • some cancers (including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney and colon)

The risk for these diseases increase with increased BMI. Other health consequences are depression, anxiety, gallstones, varicose veins, menstrual abnormalities, hyperlipidaemia, increased morbidity and mortality.

What is bariatric surgery?

A surgery designed to lead to weight loss. It will either shrink the stomach so the patient can only eat small amounts of food, or will change the way that the digestive system can absorb the food.
If the stomach is removed from the duodenum and reattached to the jejunum/ileum, it decreases the amount of absorption that can occur from the foods we eat.

What are the criteria which should be met to be eligible for bariatric surgery?

  • Severely obese or have medical condition related to being obese + BMI > 40 without comorbidities or BMI > 35 with comorbidities
  • Patient needs to have tried to lose weight in other ways (e.g., healthy eating, dieting, exercising, attempt to other lifestyle change)
  • Patient will need to attent classes to understant how the body will react to the surgery, and how they need to make lifestyle changes so the surgery will be effective

What are different deficiencies that can occur before and after the surgery? And how to solve them:

Before surgery, deficiency in folic acid (because of poor diet/fast food).

After surgery, lifestyle changes are needed to avoid certain foods, eat limited quantities and regular exercise. And patients need to take: folic acid, vit B12, vit D and iron.

3 different types of bariatric surgical procedures:

  1. Adjustable Gastric Band
  2. Gastric Bypass
  3. Vertical Sleeve Gastrectomy

Adjustable Gastric Band =

The surgeon places a band around the top portion of the stomach, to create a pouch. This pouch serves as a new, smaller stomach. Patients feel fuller faster, causing them to eat less and lose weight. Band can removed at any time.

Vertical Sleeve Gastrectomy =

The surgeon removes up to 80% of the patient's stomach. Majority of the stomach is removed, so this is permanent.

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