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Weight Management Cheat Sheet (DRAFT) by

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Pediatric BMI

Perc­entile cut-off value
Classification of BMI
<5th percentile
Underw­eight
≥5th & <85th percentile
Healthy weight
≥ 85th and <95th percentile
Overweight
≥ 95th percentile OR ≥ 30 kg/m2
Obese
Adole­scents can have a BMI ≥ 30, but have a BMI-fo­r-age <95th percen­tile. They will still be consider obese

Pediatric

Chil­dhood
Geneti­c/h­ormonal weight
- Prade­r-W­illie syndrome
- Cushing's syndrome
- Thyroid issues
Dietary factors
- Low intakes of F&V
- High intakes of fast foods and sweets
- Increased consum­ption of sugar-­swe­etened beverages
- Increased breakfast skipping
- Increased parenteral work hours
MNT
Weigh­t-loss goals
- Realistic
- Still growing in height
- Should not necess­arily attempt to fully normalize weight
Children at risk for overwe­ight
- Mainte­nance of current weight recommended
- Gradual decline will occur in BMI as the child grows in height due to prolonged mainte­nance
Overw­eight
- Gradual weight loss is recomm­ended
Weight loss should not exceed more then 2 lbs per week in children. High rate of weight loss is reserved for 6-11 year olds in the 99th percent title and 12-18 tear olds with ≥ 95 percent tile

Prader­-Wili syndrome

Children never feel satisfied after eating a meal causing continuous food intake
Developed in childhood causing a excessive appetite
Begins around age 2
Complex genetic condition
Leads to life-t­hre­atening obesity and overeating
Obe­sit­y: Can cause life-t­hre­atening compli­cations
Ove­rea­tin­g: Can cause them to eat themselves to death
Standard care of PWS is restri­cting foods.
Beha­vioral problems
Temper outburst
Stubbornness
Compulsive behavior
Signs & Symptoms
Infants
- Poor muscle tone
- Feel floppy
- Elbows­/knees when resting are loosely extended iinstead of fixed
- Distinct facial feature
- Almond shaped eyes
Thin upper lip
- Narrow bridge of nose
narrow forehead
- Dolich­oce­phaly
- Poor respon­siv­eness
- Tired/hard time getting up
- Poorly responding to stimul­ation
- Weak cry
- Poor sucking ability
- Failure to thrive
Underd­eve­loped genitals
Males:
-Small penis and scrotum
- Crypto­rch­idism
Females:
-Small clitoris and labia
Childhood to Adulthood
- Food cravin­g/w­eight gain
- Constant craving for food
- Underd­eve­loped sex organs
- Hypogo­nadism
- Poor growth­/ph­ysical develo­pment
Under­pro­duction of growth hormone
- Short height (adult)
- Low muscle mass
- High body fat
- Cognitive impairment
Moder­ate­/Mild intell­ectual disabi­lity
- Thinking
- Problem solving
- Delayed motor develo­pment
Toddlers
- Milestones in physical movement
- Speech problems
- Delayed speech
-Can cause poor articu­lation in adulthood
- Sleep disorders
- Sleep apnea
- Other
- Small hands and feet, scoliosis, hip problems, saliva flow reduced, visual problems, regulating body temper­ature problems, high pain tolerance, and hypopi­gme­ntation
Causes
Loss of active genes in a specific region of chromosome 15
- Paternal genes on chromosome 15 are missing
- Two copies of the chromosome 15 were inherited from the mother
- Error/­defect on chromosome 15 in paternal genes

Cushing's Syndrome

Also known as hyperc­ort­iso­lism
A condition when there is an overab­undant of hormone cortisol produced by the body
- Rare syndrome
Signs & Symptoms
- Weight gain
- Mid-torso specif­ically
- Vertical growth slows or stops
- Arms and legs are thin
- Compared to rest of the body
- Stretch marks
- Abdomen, arms, thighs, and buttocks
- Face shape
- Round
- Hirsutism in girls
- Menstrual changes
- Acne
- Fatigue
- Early/late puberty
- Diabetes
- Hypert­ension
- High choles­terol
- Other symptoms
Easy bruising, emotional changes, weakened bones, muscle weakness, sleep distur­bance, hyperc­alc­emia, and kidney stones
Causes
- Adrenal and pituitary gland abnorm­ality
- Adrenal tumor
- Glucoc­ort­icoid treatment

Thyroid disease

Hyperthyroidism
Over production of thyroid hormone
Hypoth­yro­idism
Under production of thyroid hormone
Congenital hypoth­yro­idism
-Effects infants
- Develo­pment issues of thyroid gland result in loss of thyroid function
Hypert­hyr­oidism in newborns
- Occurs occasi­onally
- Condition referred as neonatal hypert­hyr­oidism
Hasimoto's thyroi­ditis
- Most common cause of hypoth­yro­idism in childr­en/­ado­les­cents
- Symptoms developed slowly

Pharma­cologic treatment

Not a first line treatment
Lipase inhibi­tors
Orlistat or Alli
- Only FDA approved long-term weight loss drug
- Reduce digestion of trigly­cerides by blocking pancreatic and gastric lipases
- Taken 3 times daily
- With reduce­d-kcal and lowfat meals
- 25-30% fat digestion reduction
- 150-180 kcals per day lost
- Side effects
- fecal staining of underwear, flatus with fecal discharge, fecal urgency, fatty/oily stools, increased urgency and frequency of defeca­tion, and fecal incont­inence
Appetite suppre­ssa­nts
- Promote weight loss
- Decreases appetite and increase satiety
- Prescribed shorter amounts of time
 

Bariatric Surgery

Must have a BMI of 40 or higher
Comorbid conditions BMI 35 or higher
Must had failure of nonsur­gical weight loss
Classi­fic­ation
- Restrictive procedures
Restrict the amount of food that enters the SI
- Malabs­orptive procedures
Various sections of SI are bypassed leading to malabs­orption of nutrients
- Combin­ation of restri­ctive and malabs­orptive procedures
Types
- Laparo­scopic Adjustable Gastric Banding (LAGB)
- Roux-en Y Gastric Bypass (RYGB)
- Sleeve Gastre­ctomy (SG)

Laparo­scopic Adjustable Gastric Banding

Often called the band and is a restri­ctive procedure
It works by allowing the stoma to become narrow causing the emptying of the pouch to be delayed. Allowing the individual to feel full and restrict food intake. Band can be deflated when needing higher food intake.
- A small stomach pouch is made in the upper portion of the stomach by a hallow band.
- The hollow band is connected to a port (by tubing its tied to)
- injection of saline solution through the port allows inflation of the band
- Adjusting stomach size
- Increasing stomach size add solution by inject sterile saline through the port filling the band
- Reducing stomach size remove solution gradually over time by repeated adjust­ments
-Preformed laparo­sco­pically
- Less tissue damage, fewer postop­erative compli­cat­ions, shorter hospit­ali­zat­ions, reduced health­-care costs, and shorte­r-p­eriod of post-o­per­ative time.
Adva­nta­ges
- Restricts food intake
- 40-50% of weight loss induced
- No cutting of the stomach or intestinal rerouting
-Short hospital stay usually less then 24-hours
- Reversible & Adjustable
- Lowest rate among approved bariatric procedures for early postop­erative compli­cations and mortality
- Lowest rate for micron­utrient defici­encies
Disa­dva­nta­ges
- Slower weight loss compared to other surgical procedures
- Higher failing of patients losing 50% of excess body weight compared to other surgical procedures
- Foreign device in body
- Band slippa­ge/band erosion can occue
- Dilation of esophagus can occur if patient overeats
- Strict commitment to postop­erative diet
- Re-ope­ration is the highest

Roux-en Y Gastric Bypass

Known as Gastric bypass. A restri­cti­ve-­mal­abs­orptive procedure
This surgical procedure is known as the gold standard because of its high effect­iveness and durability
The procedure makes a small pouch that bypasses the remainder of the stomach, duodenum, and first section of jejunum. Food digestion is reduced and nutrient absorption is reduced. Allowing restri­ctive food intake
Consum­ption of 6-8 small meals daily. To reduce dumping syndrome risk do 2-4 Tbsp of food at a time.
- Small gastric pouch is made in the upper portion of the stomach
- Distal jejunum is cut and attached to the new small stomach pouch
Adva­nta­ges
- Signif­icant long-term weight loss
- Restricts food consum­ption amount
- May increase energy expend­iture (by leading to condit­ions)
- Changes in gut hormones
Reduce appetite
Enhance satiety
- >50% excess weight loss mainte­nanced
Disadvantages
- More complex operation compare to AGB and LSG. Can lead to great compli­cation rates
- Long-term micron­utrient defici­encies
- Vitamin B12, Iron, Calcium, Folate
- Must commited to dietary recomm­end­ations and life-long micron­utrient supple­men­tation

Sleeve Gastre­ctomy

Known as the sleeve
This procedure removes the left side of the stomach allowing 85% of the stomach to be removed. This leaves the remaining stomach as a narrow banana­-shaped thublar pouch
Advantages
- Restricts food
- Signif­icant weight loss
- No foreign objects
- No bypass­/re­-ro­uting of food stream
- Short hospital stay (usually 2 days)
- Changes in gut hormone
Reduce appetite
Enhance satiety
Disa­dva­nta­ges
- Non-re­ver­sible
- May cause long-term vitamin defici­encies
- High early compli­cation rate

RD & Bariatric surgery

Uniquely trained to provide nutrition care preope­rat­ively and postop­era­tively
Provide compre­hensive nutrition assessment
Provide risks/­ben­efits of bariatric surgery
Provide nutrition education on lifelong changes post-s­urgery
Early postop­era­tive
- Evaluate intake of adequate protein and fluids
- Intake based on nutrition needs
-1.0-1.5 g/kg protein needs as IBW
- 1.5-2.0 g/kg protein needs as IBW for additional needs/­com­pli­cations
- Micron­utrient supplement montioring
- Monitor adverse effects
- Nausea­/vo­miting, consti­pation, diarrhea, and dumping syndrome.
Late postop­erative period
More then 12 months
- Assess nutrition related lab values
- Supplement recomm­end­ations adjust­ments
- Recomm­end­ations based on defici­encies prevention
Assess & educate on long-term lifestyle behavior changes
- Diet
- Activity levels

Disorder Eating

Signs & Symptoms
Constantly weighing oneself
Exercising with the primary goal to burn energy
Elimin­ating food groups
Avoiding social events to exercise or to skip meals
Excessive intake of caffeine
Irrita­bility
Tiredness
Being self-c­ritical
Marked increase or decrease in weight not related to a medical condition
Sudden change in eating habits such as elimin­ating meats or dairy products from food choices
Develo­pment of abnormal habits such as ritualized behavior at meals
Severe dieting and restri­cting even when not overweight
Severe dieting and restri­cting even when not overweight
Intense preocc­upation with weight and body image
Compulsive or excessive exercising
Isolation, depres­sion, irrita­bility
Isolation, depres­sion, irrita­bility
Trips to the bathroom after meals
Complaints of lighth­ead­edness or weakness
Appearance of preocc­upation with eating habits of others; may even prepare elaborate meals for others
Thinning or very dry hair
Frequent complaints of bloating or stomach pain after eating
Constant complaints of being cold

Anorexia nervosa

Self-­imposed starva­tion
Nutrit­ional & physio­logical compli­cations
Amenorrhea, estrogen imbalance, electr­olyte
imbalance, abnormal thermo­reg­ula­tion, anemia, RBC dysfun­ction
Physical findings
Lab Results
Low body weight (<85% recomm­ended)
Low fasting blood sugar
Lanugo
Impaired glucose tolerance
Brittle, listless hair
Elevated choles­terol
Dry skin
Fluid and electr­olyte abnorm­alities
Bradyc­ardia (<60 bpm)
Low iron/zinc levels
Hypotension (systolic <90 mm Hg)
Low B12 levels
EKG abnormalities
Metabolic acidos­is/­alk­alosis
Decreased GI motility
Hypoka­lemia, hypoma­gne­smia, hypoph­osp­hatemia
Decreased gastric emptying
Low resting metabolic rate
Death factors
Duration of illness
>10 years
Chronic hypoka­lemia
Plasma albumin chroni­cally less than 3.6 g/dL
Absolute QT = 600 ms.
Diag­nosis
Restri­cting type
- Does not binge eat
- No purging behaviors
Binge-­eat­ing­/pu­rging type
- Regularly binge eats
- Regularly purging behavior

Anorexia nervosa nutrition prescr­iption

- Establish energy intake
- REE prediction
- Miffli­n-St. Jeor using current body weight
- Nutrition prescr­iptions usually start with 1,200-­1,400 kcal and gradually go up 100-200 kcal increments
Goal
- 1-2lb weight gain per week
Macr­onu­trient compos­ition
Carbs
50-55% of total energy
Fat
25-30% of total energy
Protein
15-20% of total energy or 0.8 g/kg- 1.2 g/kg of recomm­ended body weight

Bulimia nervosa

Recurrent episodes of binge eating
Bulimia nervosa is an eating disorder charac­terized by episodes of excessive eating (bingeing) followed by compen­satory behavior for weight control (purging).
Binge/­purge cycle occurs twice a week for 3 months
On avergae
Methods
Self-i­nduced vomiting
Laxative, diuretic, and/or diet pill abuse
Excessive exercise
Fasting
Types
Purging type
Engages
-Self-induce vomiting
- Laxative abuse
- Enema abuse
- Diuretic use
Nonpurging type
Compe­nsatory behaviors
- Fasting
- Excessive exercise without induces vomiting, enema, or diuretic use
Clinical characteristics
Fatal electr­olyte imbalances
primarily from vomiting
Dehydr­ation
Scarring or calluses on knuckles
Elevated blood urea nitrogen
GI symptoms
Swelling of salivary glands, esophageal varices, hernias, reflux, amylase elevation, pancre­atitis, delayed gastric emptying
Laxative abuse
Hyperu­remia, elevated vasopr­essin, rectal bleeding, abdominal cramps, fluid retention, hypoca­lcemia, hypoma­gne­semia
Dental
Dental caries, enamel erosion

References

Dr. Amaya power point slides 3, 4, 7, 8, 13, 16,17, 18, 24, 25, 29, 30, 35, 38, 43, 47, 48, 50
Koumourou, R. (2019, September 5). Thyroid disease in children. Retrieved from https:­//w­ww.m­yd­r.c­om.a­u/­kid­s-t­een­s-h­eal­th/­thy­roi­d-d­ise­ase­-in­-ch­ildren.
Children's Hospital. (2016, March 28). Cushing's Syndrome. Retrieved from https:­//w­ww.c­ho­p.e­du/­con­dit­ion­s-d­ise­ase­s/c­ush­ing­-s-­syn­drome.
Bariatric Surgery Proced­ures: ASMBS. (n.d.). Retrieved from https:­//a­smb­s.o­rg/­pat­ien­ts/­bar­iat­ric­-su­rge­ry-­pro­ced­ures.

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