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E. Metabolic/Endocrine Systems
E.1
Obesity
Content
Areas
- Diagnosis:
BMI and waist circumference
- NHLBI
Obesity Guidelines
- Metabolic
and pathophysiology consequences
- Epidemiology
- Etiology
- Treatment
: behavioral, pharmacological, surgical, dietary
- Fad
diets
- Prevention
and lifestyle modification
- Physical
activity
- Medical
nutrition therapy
| After
training, the learner will be able to: |
| Knowledge
Objectives: Medical Students |
- State
the National Heart Lung and Blood Institute (NHLBI) guidelines
used to classify a person as overweight and/or obese.
- Describe
the metabolic and pathologic consequences of being overweight
or obese as associated with the following chronic disorders:
hypertension, insulin resistance, and dyslipidemia. Explain
the mechanism by which each disorder results in these effects.
- Identify
at least four effective changes to daily activity regimens
that can be used to prevent excessive weight gain and at
least two behavioral strategies for sustaining appropriate
weight following weight reduction.
- Describe
the risks and benefits of the following non-traditional
weight loss interventions: pharmaceutical treatments, very
low calorie diets, the protein sparing modified fast, and
surgical treatment.
- Give
at least four examples of specific changes in diet, exercise,
and other behaviors (e.g., consuming smaller food portions)
that promote optimal health, and explain how each change
results in its specific effect.
- Identify
those stages of life when becoming overweight or obese is
most likely to occur, and identify effective strategies
that medical professionals can use to help patients prevent
excess body weight.
- Compare
and contrast the clinical usefulness of each of the following
measures in predicting morbidity and mortality: body weight
and height, waist circumference, percent body fat, Body
Mass Index (BMI), and body fat distribution.
- Cite
the prevalence of persons who are overweight or obese in
the U.S. by age, gender, and ethnicity.
- Identify
at least three characteristics or behaviors of people who
are most successful at maintaining appropriate weight after
a weight loss regimen.
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| Knowledge
Objectives: Residents |
- Outline
and evaluate the evidence evaluating the short-term and
long-term efficacy of various commonly adopted diets, such
as the Zone, Atkins, Weight Watchers, LA Weight Loss, Sugar
Busters, and Jenny Craig diets.
- Given
the weight, height, age, and sex of a child or adolescent,
assess the patient’s risk of becoming overweight or
obese as an adult in the U.S. using the US Centers for Disease
Control and Prevention (CDC) pediatric BMI growth charts.
- Identify
common metabolic and pathophysiologic consequences of specific
nutritional regimens used to treat common obesity-related
morbidity in ambulatory and inpatient (ICU and non-ICU)
care, and explain the mechanism of each effect.
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| Knowledge
Objectives: Specialists |
- Explain
how an individual’s genetic makeup, metabolism, diet,
physical activity, and weight history affect body weight
and responsiveness to dietary interventions.
- Compare
and contrast the CDC recommendations for the treatment of
childhood obesity vs. the NHLBI recommendations for the
treatment adults who are overweight or obese.
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| Practice
Behavior Skills: Medical Students |
- Take
an appropriate dietary and social history including family
history of being overweight or obese, develop an appropriate
differential diagnosis, and design an effective nutritional
management plan.
- Perform
an appropriate physical examination for an overweight and/or
obese child, adolescent, or adult; measure the patient’s
body weight and waist circumference, determine the percent
body fat, calculate the BMI, estimate the patient’s
body fat distribution, and evaluate the patient for other
signs and symptoms of weight related morbidity.
- Effectively
educate patients about the goals they can realistically
expect to achieve, as well as the potential complications
of common therapies for overweight or obese individuals.
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| Practice
Behavior Skills: Residents |
- Appropriately
refer overweight or obese patients for individualized nutrition
therapy based on the NHLBI guidelines.
- Identify
the five dietary supplements most commonly used in weight
reduction plans, and compare and contrast their efficacy.
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| Attitude
Objectives: All Learners |
- Recognize
that being overweight or obese has become a national epidemic
of increasing prevalence in the United States, and appreciate
the value of as little as a 10% decrease in weight on co-morbidities
or even maintaining body weight for those likely to become
more obese.
- Demonstrate
a commitment to utilizing a multi-disciplinary team approach
to the medical care of overweight and/or obese patients.
- Demonstrate
sensitivity to the social, emotional, and psychological
factors that may affect an individual’s behavior and
body image.
- Demonstrate
a commitment to interact with overweight and/or obese patients
in a non-judgmental manner.
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