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Terms in this set (24)
What are some different approaches to obesity and which are most effective?
Can be treated with lifestyle modifications alone, medications, endoscopic bariatric therapies, and bariatric surgery (all include lifestyle changes)
Most effective is bariatric surgery plus lifestyle changes
What is intragastric balloon therapy for obesity?
There is a balloon endoscopically inserted into the stomach and it is inflated to a certain degree. This works by slowing gastric emptying and it occupies gastric space (feel full)
What are the common adverse symptoms of intragastric balloon therapy?
Nausea, vomiting, abdominal pain, reflux
What is aspiration therapy for obesity?
A tube connects the inside of the stomach to a device on the outside that siphons off calories (25-30%, 2-3 times a day)
What is laparoscoptic bariatric surgery?
Small incisions are used with a camera to helps with diagnosis or therapeutic interventions
What are advantages to laparoscopic bariatric surgery?
Reduced pain with a smaller incision site, reduced hemorrhaging, shorter recovery time
How does the sleeve gastrectomy differ from the Roux-en-Y in its ability to promote long term weight loss?
Sleeve results in overall lower long-term weight loss that RNY
How does the sleeve gastrectomy differ from the Roux-en-Y in its potential complications?
The sleeve is safer, cheaper, and easier to perform than gastric bypass
How does the surgical procedure of a Roux-en-Y bypass work?
There is a small pouch in the fundus of the stomach created by stapling off the rest of the stomach. The proximal jejunum is then cut and attached to the pouch and the distal jejunum is connected to the distal duodenum
Why does weight loss occur with a Roux-en-Y bypass?
Restricted eating due to smaller stomach area and malabsorption due to bypass of the duodenum and stomach
What are the medical complications of a Roux-en-Y bypass?
Abdominal pain, vomiting, dumping, gallstones, and greater risk of kidney stones (more FA which bind Ca, leaving oxalate to create stones)
What is the important connection between pregnancy and bariatric surgery?
Due to risk of malnutrition, women should wait to get pregnant until at least a year after surgery
What are the nutritional complications of a Roux-en-Y bypass?
Need lifelong vitamin/mineral supplementation, *Ca, Fe, B12, folate, B6
Why is food intake reduced leading to weight loss after Roux-en-Y gastric bypass?
Reduced intake due to discomfort with large quantities AND reduced appetite due to hormones
What are the actions of StuGLP-2?
It stimulates intestinal growth , making them better able to digest and absorb nutrients
What is an incretin hormone?
Hormones from the GI tract that mediate a decrease in blood glucose levels. They are released after eating and increase secretions of insulin
What is the action of GLP-1 after Roux-en-Y gastric bypass?
This hormone typically lowers blood glucose. After RNY, it slows gastric emptying, increases satiety, and inhibits glucagon secretion
What is the use of GLP-1 receptor agonists to treat Type 2 Diabetes?
It lowers blood glucose and is only stimulated by eating (so it doesn't cause the danger of low-blood sugar)
Why does a shorter Roux limb length produce a greater increase in GLP-1 levels and greater weight loss?
Possibly more malabsorption due to less absorptive area. Ileum remaining sees poorly digested contents which results in a stronger stimulus sent to the L cells to secrete GLP-1
What does the August 2020 NEJM study conclude about the cause of improved insulin sensitivity after Roux-en-Y bypass in patients with Type 2 diabetes?
Weight loss is the reason insulin sensitivity returns after surgery
What are the pre-surgery nutritional recommendations for a Roux-en-Y bypass patient?
Some weight loss is encouraged pre-op to reduce the size of the liver and make the surgery easier to perform. Also, need ot address any deficiencies (B12, thiamin, iron, folic acid, vitamin D)
What are the post-surgery nutritional recommendations for a Roux-en-Y bypass patient?
Small meals with little "grazing" and caloric-dense liquids, increased protein (1-1.5 g/kg IBW)
What are the lifelong nutritional recommendations for a Roux-en-Y bypass patient?
Mineral/vitamin supplementation, nutritional follow-up
Describe the post-op gastric bypass diet one month after surgery
-No accompanying beverage
-Lots of protein
-Stop meal at first sign of fullness
-Avoid concentrated sweets
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