Case Study 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...
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Case Study

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 31. 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. 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. Sally's 37 inches waist size indicates central obesity, which increases the risk of heart attack and stroke.

b. Her BMI of 31 indicates that she is of normal weight.

c. She is at increased risk of developing diabetes because she now has mildly elevated blood glucose levels  and her father had type 2 diabetes.

d. Her mildly elevated blood pressure increases the risk of hypertension in the near future, and hypertension  is a major risk factor for heart disease.


2. Sally has learned that when "energy in" exceeds "energy out", much of the excess energy will be stored in fat cells of adipose tissue. Sally wants to know which energy yielding nutrients can increase this fat storage if eaten in excess. Which of the following would you tell her?

a. Only excess dietary fat will be stored as body fat

b. Only excess dietary carbohydrate will be stored as body fat

c. Only excess dietary protein will be stored as body fat

d. Excess consumption of all three energy yielding nutrients will be stored as body fat


3. Sally is interested in how fat cells develop, or more specifically the "Fat Cell Theory". You inform her that during certain periods of growth, fat cells increase in number. The period in which this increase in number occurs most rapidly is:

a. infancy

b. elderly years

c. middle age

d. late childhood and early puberty


4. Sally has recently read an article describing an obesity gene, or "ob" gene. This gene codes for a protein which helps to regulate food intake and energy expenditure. What is this protein known as?

a. lipoprotein lipase

b. leptin

c. ghrelin

d. uncoupling proteins


5. 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?

a. The satiety hormone leptin increases with lack of sleep.

b. Lack of sleep decreases ghrelin levels.

c. Levels of Neuropeptide Y, a brain chemical that causes carbohydrate cravings, are most likely high and  are causing her sleep problems.

d. Lack of sleep increases levels of ghrelin which stimulates appetite, and decreases levels of leptin that  decreases appetite.


6. Sally has been told that she most likely has gained weight from having a higher percentage of white adipose tissue, due to inefficient uncoupling proteins.  What would you tell her?

a. White adipose tissue releases heat and burns fat, so that is not a reason to gain weight

b. It is her lack of sleep that is increasing her white adipose tissue; better sleep would decrease white  adipose tissue

c. Exercise would be beneficial to help produce a "browning" effect on white adipose tissue by producing fat cells known as "brite adipocytes", therefore decreasing white adipose tissue percentage.

d. Drinking large amounts of coffee would decrease white adipose tissue percentage.


7. Sally believes that it is predominately genetics that has caused her to gain weight.  You inform her obesity reflects the interactions between genes and environment. All of the factors surrounding a person that promote weight gain, such as increased food intake, especially of unhealthy choices, and decreased physical activity is known as:

a. appetite syndrome

b. obesogenic environment

c. surplus environment

d. excessiveness syndrome


8. Sally's friend, Monique, was morbidly obese and had gastric bypass to help her lose weight. Sally is considering surgery as an option. Which of the following is a correct fact that you would share with Sally?

a. Bariatric surgery only reduces the size of the stomach; it has no effect on hunger hormones.

b. Bariatric surgery is appropriate for any amount of weight loss that is desired.

c. Bariatric surgery is only an option for those whose BMI ≥40 or BMI ≥ 35 with obesity-related health problems.

d. After surgery, eating patterns do not have to be changed.


9. Sally's estimated energy requirement, based upon her age, height, and weight is approximately 2000 kcalories per day. To reduce her weight by 1 lb per week, how many kcals should she actually consume?

  1. 2000 kcals
  2. 1800 kcals
  3. 1500 kcals
  4. 400 kcals

10. Sally is very interested in changing her daily patterns to achieve a healthy weight. You inform her that to be truly successful she needs to include all of the following EXCEPT

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