NAANutrition Academic Award Program
 
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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.
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.
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.
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.
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.
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.

*Red bold items were ranked in the top 1/3 of all objectives.
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