Definition 1 of 258
-can occur after long, complicated bariatric surgery
-sx: dark urine, low urine output
-dx: CPK and urine myoglobin
-trx: supportive care, push fluids
Behavior Therapy
arcuate nucleus
Rhabdomyolysis
Pharm in peds
Definition 2 of 258
-change behavior and feelings will follow
-components: self monitoring, stimulus control (avoidance), problem solving, goal setting,
contingency mgmt, enlist social support, relapse prevention training, stress mgmt, rewards,
ongoing contact
Obesity and HTN
Rhabdomyolysis
Behavior Therapy
Dumping Syndrome
,Definition 3 of 258
-found in the arcuate nucleus
-receive peripheral signals
-2 neuron systems in AN: NPY/AgRP (weight gain) or POMC/CART (weight loss)
Sleep and mortality
First order neurons
second order neurons
Forbes Rule
Definition 4 of 258
-DRI=dietary reference intake
-RDA=recommended dietary allowance (varies for gender, pregnancy, age, but RDA is for nearly
all healthy people)
-AI=adequate intake (used when RDA can't be determined--nutrient has either RDA or AI--based
on observed intakes of nutrient by group of healthy ppl)
-UL=tolerable upper intake level (max amnt of nutrient that won't cause toxicity for nearly all ppl)
-EAR=estimated average requirement (amt of nutrient needed to meet requirement of half of all
healthy ppl in the population)
-DV=daily value (based on 2000 cal/d)
Surgical complications: RNYGB and SADIS/SIPS
Nutrition definitions: DRI, RDA, AI, UL, EAR, DV
Pre-op bariatric surgery psych eval
GI sites of nutrient absorption
,Definition 5 of 258
-strongest risk fx for obesity before age of 6, after age of 6 the child's weight is the strongest
predictor
-1 parent obese=3x risk of obesity in adulthod
-2 parents obese = 10x risk
Parental obesity impact on childhood obesity
Therapeutic % weight loss for obesity related dz's
Definition 6 of 258
-Van Cauter, European Journal of Endocrinology, 2008
-sleep deprived x 1 week (10 hr down to 4 hr)
-leptin decreased x 20%
-ghrelin increased x 30%
-this happened even when reduced 8 hr to 5 hr
-some young healthy participants developed pre-DM during this 1 week study
decreased sleep =
-reduced leptin and energy expenditure
-increased ghrelin, orexin, NPP-Y, appetite
post op anastomotic/marginal ulcers
Sleep and hunger hormones
causes of B12 deficiency
Shift Work Sleep Disorder
, Definition 7 of 258
-pro-opio-melanocortin (POMC)
-downstream from leptin
-POMC is cleaved into other peptides (ACTH, alpha MSH-skin pigmentation and body weight
regulation) by enzymes PC1 and CPE
CAUSE: monogenic-auto recessive, chromosome 2
-heterozygous carriers have normal pigmentation and cortisol, but higher predisposition of
obesity
-methylation of normal POMC gene can contribute to different body weights
PRESENTATION: normal birth weight, early onset obesity and hyperphagia, adrenal insufficiency
(no ACTH), pale complexion, red hair, normal intellectual fx
DX: testing for POMC mutation
TRX: trx adrenal sx's; downstream melanocortin replacement (setmelanotide), no specific trx
PA guidelines
Obesity and HTN
POMC deficiency
B1 deficiency (bariatric surgery)
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