Question

Ch 9 Case Study: Lifestyle Changes for Weight Loss 0 x Sally is a 43-year-old mother of two who has gained 50 pounds over the past 5 years. She is 64 inches tall and weighs 180 pounds with a BMI of 30.8. Her waist circumference is 37 inches. She acknowledges that she is not as physically active as she would like to be. She also notes how recent stresses in her life have affected her sleep and seem to have triggered her appetite for sweets and comfort foods. Sally's father recently died from complications of type 2 diabetes, and her mother and sisters are overweight. Sally says she is very motivated to "not get diabetes and is disturbed that her recent physical exam revealed mildly elevated blood pressure, glucose, and cholesterol levels. 1. Sally stated that recent stresses in her life are affecting her sleep and seemed to have triggered her appetite for sweets and comfort foods. Which of the following statements would be best to explain why her lack of sleep has increased her appetite? O a. The satiety hormone leptin increases with lack of sleep. b. Lack of sleep increases uncoupling protein. O c. Lack of sleep increases levels of ghrelin which stimulates appetite and decreases levels of leptin which decreases appetite. O d. Levels of Neuropeptide Y, a brain chemical that causes carbohydrate cravings, are high and may contribute to her sleep problems O e. Lack of sleep decreases ghrelin levels. 2. Looking at Sally's health information, you need to tell her about all of the following health risks to encourage her to lose weight. Which health risk is incorrect? a. Her BMI of 30.5 indicates that she is overweight. b. Sally's 37 inch waist sire indicates central obesity which increases the risk of heart attack and stroke. c. Her mildly elevated blood pressure increases the risk of hypertension in the near future, and hypertension is a major risk factor for heart disease. d. She has also gained more than 10 pounds since the age of 18, which doubles the risk of developing diabetes. e. She is at increased risk of developing diabetes because she now has mildly elevated blood glucose levels and her father had type 2 diabetes 3. Sally's friend, Monique, was morbidly obese and had surgery to help her lose weight. What should Sally know about weight loss surgery? a. Gastric banding suppresses hunger by changing production of gastrointestinal hormones. b. About 25% of the excess weight will remain lost after 15 years. c. Advantages of gastric bypass include being more flexible, less Invasive, and safer. O d. Advantages of gastric banding include being more durable, reliable, and effective. e. Bariatric surgery is only an option for those whose BMI 240 or BMI 235 with obesity-related health problems.

Answer 1

1.Sleep deprivation or loss of sleep has effects on the appetite control hormones, ghrelin and leptin. Ghrelin is an appetite stimulating hormone and  leptin is responsible for appetite suppression. In normal conditions ghrelin is secreted by the stomach which signals the brain to crave for food and fill the stomach. Once the stomach is full, the body releases the satiety hormone leptin which suppress appetite. During sleeplessness the stomach secrete more ghrelin which leads to increase in appetite and eat more food and leptin gets released in smaller amounts which makes the body not to recognize when the stomach is full. This leads to increase appetite and over eating.

Thus the answer is, C. Lack of sleep increase the levels of ghrelin which stimulate the appetite and decreases levels of leptin which decrease appetite.

2. In the given scenario, It is mentioned as Sally's BMI is 30.8, her waist size is 37 both indicate obesity. It is also given that her father had type 2 diabetes and she had mild increase in blood pressure, glucose. These all are risk factors for future diabetes and cardiac disease. Sally is motivated to decrease weight to reduce these risk. It is not mentioned that she gained 10 pounds of weight since the age of 18 instead it is given as she gained 50 pounds over the past five years.

Thus the answer is, D. she has also gained more than 10 pounds since the age of 18 which doubles the risk of diabetes.

3. Bariatric surgery is an invasive procedure which the make surgical changes to stomach and digestive system that reduce the amount food intake and absorption of nutrients which helps in loosing weight. It is a major surgical procedure with lots of complications and side effects.Bariatric surgery are recommended for those who had unsuccessful efforts in loosing weight with dietary management and exercises, BMI more 40 or more or BMI 35 or more with obesity-related health problems.

Thus the answer is, E. Bariatric surgery is only an option for those whose BMI $\small \geq$ 40 or BMI $\small \geq$ 35 with obesity related health problems.